Multiparametric magnetic resonance imaging (MRI) and biopsy may speed up the time to correct treatment among patients with a muscle-invasive urothelial carcinoma, according to a recent study published by Bryan et al in the Journal of Clinical Oncology.
Background
Usual tests for muscle-invasive urothelial carcinoma involve transurethral resection.
“[Urothelial carcinoma] is a common cancer, and we know that with any cancer, and especially muscle-invasive [urothelial carcinoma], speed is of the essence when treating. Any ways to improve the time from initially suspecting cancer to getting the right treatment gives patients the best chance of responding well,” explained lead study author Rik Bryan, PhD, Professor in Urothelial Cancer Research and Director of the Bladder Cancer Research Centre at the University of Birmingham. “However, this aspect of the [urothelial carcinoma] care pathway has remained essentially unchanged worldwide for over 100 years, [while] the rest of medicine and health care has innovated around it. We wanted to evaluate whether the 21st century approaches that have benefited the diagnosis and treatment of all other [patients with] cancer would also benefit patients [with urothelial carcinoma],” he added.
Study Methods and Results
In the study, researchers analyzed whether adding multiparametric MRI as the first staging investigation may be as effective and quick as the usual surgical staging approach for urothelial carcinoma. They randomly assigned 143 patients with suspected urothelial carcinoma to either undergo an initial MRI scan to determine the most appropriate next steps or usual surgical staging.
“The BladderPath trial looked at whether adding in some extra or alternative diagnostic testing, [multiparametric] MRI first then and biopsy or [transurethral resection of the bladder tumor], could speed up the time taken to receive the correct treatment for the most concerning [type] of bladder cancer,” Dr. Bryan detailed.
The researchers discovered that the patients who underwent multiparametric MRI experienced a reduction in the time taken to receive their correct treatment, with a median time of 53 days from first referral to correct treatment. This was 45 days quicker than the usual surgical staging approach, which had a median time of 98 days.
Conclusions
“We were delighted that the experimental diagnostic pathway that introduced MRI led to a vastly reduced time taken for patients to receive their correct treatments, from 98 days on average for the usual procedures reduced by more than 6 weeks to 53 days,” Dr. Bryan emphasized.
“This research shows that by adding an MRI prebiopsy, we can cut the time taken to correct treatment for the worst [urothelial carcinoma tumors]—those that invade the bladder muscle wall—by almost half, from 98 days down to 53 days. We’ve also shown that around one in seven of these patients with problematic tumors can avoid the surgical procedure used to diagnose [urothelial carcinoma],” underscored senior study author Nick James, PhD, Professor of Prostate and Bladder Cancer Research at The Institute of Cancer Research in London and a consultant clinical oncologist at The Royal Marsden National Health Service Foundation Trust. “As an MRI is considerably cheaper than this surgery, we estimate that this new diagnostic pathway will save money as well as saving surgical theatre space and preventing patients from undergoing unnecessary procedures. The next step for this research is to assess whether this impacts the survival of these patients,” he concluded.
Disclosure: The research in this study was funded by the UK National Institute for Health and Care Research. For full disclosures of the study authors, visit ascopubs.org.
