Study: Radiation ineffective for rare bladder cancer cases

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In observing various treatment modalities for primary adenocarcinoma of the bladder, researchers from Henry Ford Hospital in Detroit determined that radiation therapy may not improve a patient's chances for survival.

The population-based study, which was presented at the 2010 American Urology Association's annual meeting in San Francisco on June 2, was the largest study describing the tumor characteristics, treatment patterns and survival for primary adenocarcinoma, a rare form of bladder cancer that has poor overall survival rates, according to lead author Naveen Pokala, MD, a urologist at Henry Ford.

"While this malignancy afflicts just one to two percent of people diagnosed with bladder cancer, chances of surviving it for five years are grim – only 18 percent – in part because it is usually detected at an advanced stage,” explained Pokala.

Pokala and colleagues identified 1,531 patients with primary adenocarcinoma via the Surveillance Epidemiology and End Results (SEER) 17 database. The patients were analyzed for location, SEER historic stage, treatment patterns and overall and cancer-specific survival.

The researchers included 853 patients (514 males, with an average age of 66.9 years). The patients that were diagnosed at autopsy, those without histological diagnosis with biopsy, and individuals diagnosed with secondary adenocarcinoma (678 patients) were excluded from the research.

Of the 853 patients, 96 underwent partial cystectomy; 164 total cystectomy; 375 endoscopy procedure; and 202 unspecified surgery. A total of 257 patients underwent radiation therapy, with 60 individuals receiving the treatment following biopsy or endoscopic resection, 181 after an unspecified surgical procedure, 18 after cystectomy and 12 after partial cystectomy. Radiation treatment details were incomplete in 15 patients, explained the researchers.

The cohort of patients that received radiation treatments did not experience an increase in survival rates when compared to those who did not receive radiation, said Pokala, who noted that race and year of diagnosis were factors that were determined not to have an effect on survival rates.

While the researchers noted that “the overall survival was poor,” for the study patients diagnosed with this form of cancer, the factors that did lead to improved prognoses were younger age (patients aged 60 and younger); a well-differentiated, localized tumor in the top of the bladder or the urachus; and whether or not the patient had undergone a total or partial cystectomy,” stated Pokala.