Organ-sparing treatments effective for bladder cancer

Traditionally, treatment for muscle-invasive bladder cancer is chemotherapy followed by the removal of the patient’s entire bladder, known as a radical cystectomy. However, Beaumont researchers have data suggesting that treatment consisting of limited surgery followed by combination chemotherapy and radiation is just as effective, while allowing patients to keep their bladder and maintain function.

“This is a big deal. No one wants their bladder removed,” said Craig Stevens, M.D., Ph.D., chairman, Radiation Oncology, Beaumont Health.

The surgical approach affects a patient’s quality of life and daily activities. Radical cystectomy is also associated with 67 percent of patients experiencing complications and up to a 2 percent death rate within 90 days of surgery.

“Our resident, Dr. David Lin, recently analyzed the National Cancer Database and, through his research, found equivalent outcomes using bladder-preserving approaches as opposed to radical surgery for muscle invasive bladder cancer,” said Daniel Krauss, M.D., Beaumont Hospital, Royal Oak radiation oncologist and one of the study authors. “This was true after controlling for factors such as patient age, baseline health/performance status, and presenting clinical disease stage.”

Bladder cancer is the sixth most common cancer in the United States – responsible for nearly 17,000 deaths in 2017. Nearly a quarter of those with bladder cancer have cancer in the muscle wall of their bladder, also referred to as muscle-invasive bladder cancer. This deadly form of cancer has a high risk of spreading.

Explained Dr. Lin, “Our analysis contributes further support to the use of organ preservation through a combination chemotherapy/radiotherapy as a viable option in the management of muscle-invasive bladder cancer.”

Dr. Krauss said, “This was not a clinical trial, but rather the research team analyzed a large database of patients. In the case of bladder cancer, we have good data to support organ-sparing therapy. There is no reason for doctors not to try this therapy first, and it’s been shown previously that if it doesn’t work, the bladder can be removed at that point without a significant increase in the surgical complication rate.”

Other members of the Beaumont bladder cancer research team included: Hong Ye, Ph.D., Kenneth Kernen, M.D., and Jason Hafron, M.D. The team’s research was recently published in Cancer Medicine.

Brachytherapy a cost-effective treatment for prostate cancer

Health care costs currently account for nearly 18 percent of the nation’s gross domestic product. It’s estimated that the national costs of prostate cancer care in the United States will rise to $15-20 billion in 2020. Providing cost-effective, quality care is a local, regional and national priority.

Another research team at Beaumont looked at the cost effectiveness of treating intermediate to high-risk prostate cancer with a combination of brachytherapy and external beam radiation therapy, versus just external beam radiation.

According to the American Cancer Society, nearly 161,000 American men were diagnosed with prostate cancer in 2017. After skin cancer, prostate cancer is the most common cancer diagnosed nationally among men.

The researchers calculated the estimated expected lifetime Medicare cost of brachytherapy was $68,696 compared to $114,944 for external beam radiation alone. The brachytherapy boost significantly lowered expected lifetime treatment costs because it decreased the incidence of metastatic prostate cancer, cutting the use of expensive targeted therapies. Brachytherapy patients were additionally shown to have an increase in quality adjusted life years, a measure taking into account both survival time as well as disease and treatment related impacts on quality of life, of 10.8 years vs. 9.3 years for patients receiving external beam radiation alone.

Brachytherapy is a form of radiation therapy that involves placing a radioactive source within the patient’s body at the site of the cancer. The radioactive source used to destroy the cancer is delivered by devices called implants. Brachytherapy may be performed in combination with external beam radiation therapy to help destroy the main mass of tumor cells for certain types of cancer.

“We found that brachytherapy is a medically- and cost-effective treatment compared to external beam radiation therapy alone,” said Daniel Krauss, M.D., Beaumont Hospital, Royal Oak radiation oncologist and one of the study authors. “Therefore our team concluded, brachytherapy boost should be offered as an option to all eligible patients with intermediate to high-risk prostate cancer.”

Other members of the Beaumont prostate cancer research team included: Charles Vu, M.D., Kevin Blas, M.D., Tom Lanni, and Gary Gustafson, M.D. The team’s research was recently published in Brachytherapy.