A groundbreaking study led by Dr. Richard T. Bryan from the University of Birmingham has revealed a promising new pathway for treating suspected bladder cancer. Published on January 14 in the Journal of Clinical Oncology, this research highlights the potential of multiparametric magnetic resonance imaging (mpMRI) to significantly reduce treatment delays for patients with muscle invasive bladder cancer. Supported by the National Institute for Health Research Health Technology Assessment Program, the study involved 143 participants and spanned across 17 hospitals in the United Kingdom from May 31, 2018, to December 31, 2021.
The study's participants were randomly assigned to either traditional transurethral resection of bladder tumor (TURBT) or an mpMRI-staged care pathway. Results demonstrated that mpMRI could expedite the treatment process, with imaging successfully identifying over 92% of participants with possible muscle invasive bladder cancer. The median time to correct treatment for these patients was notably shorter with initial mpMRI at 53 days, compared to 98 days with TURBT, thus reducing the waiting period by 45 days.
In the United Kingdom, patients with muscle invasive bladder cancer typically face long waits from diagnosis to treatment. On average, they wait 144 days from community referral to radical therapy, with nearly half waiting more than 180 days for cystectomy. This delay is particularly concerning due to the associated risk; every 28-day delay in treatment increases the risk of death by 6%-8%.
The study found that the mpMRI approach not only shortened treatment timelines but also allowed some patients to avoid TURBT altogether. According to a Cox model adjusting for stratification factors, there was a hazard ratio of 2.9 (95% CI, 1.0-8.1) favoring the mpMRI pathway over TURBT. However, the study also noted a learning curve in diagnosis accuracy, as 6 of 17 patients initially reported as having muscle invasive bladder cancer by mpMRI were later diagnosed with non–muscle invasive bladder cancer.
"Incorporating mpMRI ahead of TURBT into the standard pathway was beneficial for all patients with suspected [muscle invasive bladder cancer]," the authors of the new study wrote. "TURBT could be avoided in a proportion of these patients. This approach can improve decision-making and accelerate time to treatment," they added.
For those with non–muscle invasive bladder cancer, the study observed no significant difference in treatment times between mpMRI and TURBT, with median times of 17 and 14 days respectively. Despite this, the overall findings highlight the substantial impact of mpMRI in managing muscle invasive bladder cancer cases more efficiently.
The research included a median follow-up duration of 23.7 months, underscoring its robustness and long-term applicability. As healthcare providers strive to improve clinical outcomes, this study presents an innovative strategy to address chronic delays in bladder cancer treatment.
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