APPROPRIATE stratification of patients with suspected muscle-invasive bladder cancer (MIBC) using an MRI-based assessment could reduce the need for transurethral resection of bladder tumour (TURBT) and reduce time to correct treatment, according to new research.
Nicholas James, Institute of Cancer Research, London, UK, presented findings from a trial evaluating two different bladder cancer treatment pathways to determine the time it took for patients with MIBC to receive the correct treatment. A secondary aim was to evaluate to time to correct treatment for all patients.
Data from 143 patients with suspected bladder cancer were randomised to two different treatment pathways. Patients with possible MIBC or probable non-MIBC enrolled to pathway one (n=72) proceeded to TURBT. Following this, patients identified as having MIBC went on to receive chemotherapy, radiotherapy, surgery, or palliative care, and those with non-MIBC received adjuvant therapy.
The remaining patients (n=71) were allocated to pathway two, in which they had an initial evaluation by flexible cystoscopy to determine whether they had possible MIBC or probable non-MIBC, using the Likert scale. Following this, if the diagnosis was possible MIBC, patients proceeded to MRI, and if the diagnosis was non-MIBC, patients proceeded to TURBT.
The team found that the MRI-guided assessment for those with possible MIBC reduced the time to correct treatment to 53 days, compared to 98 with TURBT (hazard ratio: 3.4; 95% confidence interval: 1.4-8.3; p=0.0046). They also found “no adverse effect” on time to correct treatment for patients with non-MIBC.
These promising findings highlight how introducing MRI-based assessment to the care pathway for patients with suspected MIBC could lead to reduced time to correct treatment, which could potentially improve outcomes; however, this will need to be further evaluated on a larger scale.