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Accelerated radiotherapy with concurrent carbogen and nicotinamide showed therapeutic advantage

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51st ASTRO Annual Meeting

Among patients with bladder cancer, treatment with accelerated radiotherapy plus concurrent carbogen and nicotinamide demonstrated greater benefit than radiotherapy alone.

Peter J. Hoskin, MD, consultant clinical oncologist, Mount Vernon Hospital, in Northwood, United Kingdom, presented the findings from this trial at the 51st ASTRO Annual Meeting, held in Chicago.

Hoskin and colleagues assigned patients to radiotherapy plus carbogen and nicotinamide (n=168) or to radiotherapy alone (n=165) between 2000 and 2006. Treatment with radiotherapy was given at a dose of 55 Gy in 20 fractions during four weeks or 64 Gy in 32 fractions in six and a half weeks.

Compliance to radiotherapy was 98%; among patients in the radiotherapy with concurrent carbogen and nicotinamide group, almost 70% complied with nicotinamide intake and 85% complied with carbogen intake.

The median survival was 30 months in the control arm and 54 months in the experimental arm, according to data presented by Hoskin during the presentation.

The three-year estimates for OS were 59% in the experimental group and 46% in the radiotherapy alone group (P=.04). For disease-specific survival, the rates were 68% in the experimental group and 56% in the radiotherapy alone group (P=.1). Rates for local relapse-free survival were 74% for patients assigned to radiotherapy plus carbogen and nicotinamide and 63% for those assigned to radiotherapy alone (P=.1).

The HR for risk for death from any cause (0.86; 95% CI, 0.74–0.99) and for risk for death from local or metastatic disease (0.87; 95% CI, 0.73–1.03) were in favor of the experimental group. No differences were observed between treatment groups for grade-1 to grade-4 bowel and urinary outcomes. However, there was an increase in stool frequency in the experimental group.

“The findings of this trial demonstrated a 15% improvement in survival when carbogen and nicotinamide are given with radical radiotherapy for muscle invasive bladder transitional cell carcinoma,” Hoskin said.

For more information:

• Hoskin P. #7. Presented at: 51st ASTRO Annual Meeting; Nov. 1-5, 2009, Chicago.

More ASTRO meeting highlights>>