Chemoradiotherapy in Muscle-invasive Bladder Cancer: 10-yr Follow-up of the Phase 3 Randomised Controlled BC2001 Trial.
Abstract | BACKGROUND: OBJECTIVE: DESIGN, SETTING, AND PARTICIPANTS: A phase 3 randomised controlled 2 × 2 factorial trial was conducted. Between 2001 and 2008, 458 patients with T2-T4a N0M0 MIBC were enrolled; 360 were randomised to radiotherapy (178) or chemoradiotherapy (182), and 218 were randomised to standard whole-bladder radiotherapy (108) or reduced high-dose-volume radiotherapy (111). The median follow-up time was 9.9 yr. The trial is registered (ISRCTN68324339). INTERVENTION: OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Locoregional control (primary endpoint), invasive locoregional control, toxicity, rate of salvage cystectomy, disease-free survival (DFS), metastasis-free survival (MFS), bladder cancer-specific survival (BCSS), and overall survival. Cox regression was used. The analysis of efficacy outcomes was by intention to treat. RESULTS AND LIMITATIONS:
Chemoradiotherapy improved locoregional control (hazard ratio [HR] 0.61 [95% confidence interval {CI} 0.43-0.86], p = 0.004) and invasive locoregional control (HR 0.55 [95% CI 0.36-0.84], p = 0.006). This benefit translated, albeit nonsignificantly, for disease-related outcomes: DFS (HR 0.78 [95% CI 0.60-1.02], p = 0.069), MFS (HR 0.78, [95% CI 0.58-1.05], p = 0.089), overall survival (HR = 0.88 [95% CI 0.69-1.13], p = 0.3), and BCSS (HR 0.79 [95% CI 0.59-1.06], p = 0.11). The 5-yr cystectomy rate was 14% (95% CI 9-21%) with chemoradiotherapy versus 22% (95% CI 16-31%) with radiotherapy alone (HR 0.54, [95% CI 0.31-0.95], p = 0.034). No differences were seen between standard and reduced high-dose-volume radiotherapy. CONCLUSIONS: PATIENT SUMMARY:
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Authors | Emma Hall, Syed A Hussain, Nuria Porta, Rebecca Lewis, Malcolm Crundwell, Peter Jenkins, Christine Rawlings, Jean Tremlett, Thiagarajan Sreenivasan, Jan Wallace, Isabel Syndikus, Denise Sheehan, Anna Lydon, Robert Huddart, Nicholas James, BC2001 Investigators |
Journal | European urology
(Eur Urol)
Vol. 82
Issue 3
Pg. 273-279
(09 2022)
ISSN: 1873-7560 [Electronic] Switzerland |
PMID | 35577644
(Publication Type: Clinical Trial, Phase III, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved. |
Chemical References |
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Topics |
- Antineoplastic Combined Chemotherapy Protocols
(therapeutic use)
- Chemoradiotherapy
(adverse effects)
- Fluorouracil
(therapeutic use)
- Follow-Up Studies
- Humans
- Mitomycin
(therapeutic use)
- Muscles
- Urinary Bladder Neoplasms
(drug therapy)
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