In all, 154 patients were assigned to receive surgery as primary treatment, and 153 patients received combination therapy. At the end of the study, researchers found that median survival between the two groups was significantly different. Patients treated with surgery lived a median of 41 months, compared to 77 months in patients treated with chemotherapy followed by surgery.
When the investigators looked at death rates from bladder cancer, they concluded that more patients treated with surgery alone died of the disease, and they died at a faster rate 77 patients died of bladder cancer in the surgery arm, compared to 54 in the combination treatment group. Patients treated with surgery alone had a 66 percent greater risk of dying from bladder cancer than patients who received neoadjuvant chemotherapy, according to the research team.
When overall death rates were considered death from any cause, not just bladder cancer the results were not as significant, Grossman says. After follow-up of more than eight years in each group, 90 deaths occurred in the combination therapy compared with 100 deaths in the group treated with surgery, meaning that patients who received surgery had a 33 percent greater chance of dying than patients treated with combination therapy, says Grossman. "These patients are generally older and may die of other causes, but the chance of surviving was higher in the neoadjuvant group," he says.
Patients who did best of all were those who had no cancer left in the bladder at the time of surgery, the researchers concluded. At the time of surgery, sign
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Contact: Laura Sussman
lsussman@mdanderson.org
713-792-0655
University of Texas M. D. Anderson Cancer Center
27-Aug-2003