Concurrent carbogen and nicotinamide with radiation safe, novel option for bladder cancer: Study

When cells of the bladder start growing abnormally, it can lead to bladder cancer. The onset of bladder cancer increases with age.

Muscle invasive bladder cancer (MIBC) is a type of advanced cancer that affects the detrusor muscle of the bladder, which is a thick muscle deep in the bladder wall. It can also metastasize to other parts of the body. When the elderly suffer from muscle-invasive bladder cancer, it is often not completely treated.

Bladder preservation trimodality therapy (BPTT) is an adjunct to radical cystectomy in the curative setting. However, the utilization of concurrent carbogen and nicotinamide with radiation therapy as radiosensitizers have shown positive outcomes in the overall survival and local relapse rate in the UK BCON Trial and so it is now a part of the routine procedure for these patients in the UK.

A first of its kind study was conducted by a group of Australian researchers to investigate the possibility of setting up a Concurrent carbogen and nicotinamide (CON) radiation oncology department in their country.

The researchers selected 7 participants with histological locally advanced bladder cancer. They set up circuit systems for carbogen gas delivery in consultation with the anesthetics and respiratory teams, as inspired by the UK BCON trial. TGA exemption was obtained for 98% oxygen, 2% carbon dioxide carbogen gas mixture, and delivery apparatus for each patient.

The development of a Concurrent carbogen and nicotinamide (CON) radiation oncology department took almost 24 months. The trial protocol was based on the equipment availability in Australia and proper transport, storage, and handling of the equipment was guided by local occupational, health, and safety (OHS) regulations. All patients received a full of dose of Concurrent carbogen and nicotinamide (CON).

The findings of the study areas follows:

• The most common acute bladder and bowel toxicities were increased urinary frequency, urgency, and diarrhea.

The researchers concluded that Concurrent carbogen and nicotinamide (CON) with radiation therapy is a completely safe and affordable treatment modality that provides a novel therapeutic alternative for patients with muscle-invasive bladder cancer, particularly those with limited treatment options.

Reference:

Concurrent carbogen and nicotinamide with radiation therapy in muscle-invasive bladder cancer: A report on feasibility in the Australian setting by Anzela A et. al published in the Journal of Medical Imaging and Radiation Oncology.

https://doi.org/10.1111/1754-9485.13265