Skip to main content

Advertisement

SpringerLink
Log in

Bladder Cancer

  • Geriatric Oncology
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Bladder cancer is a complex disease of older patients with coexisting medical problems requiring multimodal therapy. For patients with localized bladder cancer, standard management for superficial disease includes transurethral resection with or without intravesical therapy, while muscle-invasive cancer is managed with neoadjuvant cisplatin-based chemotherapy followed by radical cystectomy. Comorbid conditions prevent many older patients from receiving cisplatin-based chemotherapy and/or undergoing surgery. Tri-modality bladder preservation approaches including a complete transurethral resection of the bladder tumor (TURBT) followed by combined chemotherapy and radiation have generally included only those patients who are candidates for a salvage cystectomy. Future research must specifically focus on older adults with bladder cancer including non-cisplatin-based neoadjuvant regimens; bladder preservation strategies using alternative non-cisplatin chemotherapy in non-cystectomy candidates; clinical trials evaluating novel targeted agents in older adults; and geriatric assessment tools to assist in decision making.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, has been highlighted as: • Of importance

  1. Jemal A, Siegel R, Ward E, et al.: Cancer statistics, 2009. CA Cancer J Clin 2009, 59(4):225–249

  2. Jemal A, Siegel R, Ward E, et al.: Cancer statistics, 2008. CA Cancer J Clin 2008, 58:71–96.

    Article  PubMed  Google Scholar 

  3. Stein JP, Lieskovsky G, Cote R, et al.: Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol 2001, 19:666–675.

    CAS  PubMed  Google Scholar 

  4. von der Maase H, Sengelov L, Roberts JT, et al.: Long-term survival results of a randomized trial comparing gemcitabine plus cisplatin, with methotrexate, vinblastine, doxorubicin, plus cisplatin in patients with bladder cancer. J Clin Oncol 2005, 23:4602–4608.

    Article  PubMed  Google Scholar 

  5. Prout GR Jr, Wesley MN, Yancik R, et al.: Age and comorbidity impact surgical therapy in older bladder carcinoma patients: a population-based study. Cancer 2005, 104:1638–1647.

    Article  PubMed  Google Scholar 

  6. Herr HW, Schwalb DM, Zhang ZF, et al.: Intravesical bacillus Calmette-Guerin therapy prevents tumor progression and death from superficial bladder cancer: ten-year follow-up of a prospective randomized trial. J Clin Oncol 1995, 13:1404–1408.

    CAS  PubMed  Google Scholar 

  7. Joudi FN, Smith BJ, O’Donnell MA, Konety BR: The impact of age on the response of patients with superficial bladder cancer to intravesical immunotherapy. J Urol 2006, 175:1634–1639; discussion 1639–1640.

    Article  PubMed  Google Scholar 

  8. van der Aa MN, Steyerberg EW, Sen EF, et al.: Patients’ perceived burden of cystoscopic and urinary surveillance of bladder cancer: a randomized comparison. BJU Int 2008, 101:1106–1110.

    Article  PubMed  Google Scholar 

  9. Wu XR: Urothelial tumorigenesis: a tale of divergent pathways. Nat Rev Cancer 2005, 5:713–725.

    Article  CAS  PubMed  Google Scholar 

  10. Koppie TM, Serio AM, Vickers AJ, et al.: Age-adjusted Charlson comorbidity score is associated with treatment decisions and clinical outcomes for patients undergoing radical cystectomy for bladder cancer. Cancer 2008, 112:2384–2392.

    Article  PubMed  Google Scholar 

  11. Ferlay J, Autier P, Boniol M, et al.: Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol 2007, 18:581–592.

    Article  CAS  PubMed  Google Scholar 

  12. Lance RS, Grossman HB: Cystectomy in the elderly. Semin Urol Oncol 2001, 19:51–55.

    CAS  PubMed  Google Scholar 

  13. Karakiewicz PI, Shariat SF, Palapattu GS, et al.: Precystectomy nomogram for prediction of advanced bladder cancer stage. Eur Urol 2006, 50:1254–1260; discussion 1261–1252.

    Article  PubMed  Google Scholar 

  14. Fahmy NM, Mahmud S, Aprikian AG: Delay in the surgical treatment of bladder cancer and survival: systematic review of the literature. Eur Urol 2006, 50:1176–1182.

    Article  PubMed  Google Scholar 

  15. Game X, Mallet R, Guillotreau J, et al.: Uterus, fallopian tube, ovary and vagina-sparing laparoscopic cystectomy: technical description and results. Eur Urol 2007, 51:441–446; discussion 446.

    Article  PubMed  Google Scholar 

  16. Chang SS, Alberts G, Cookson MS, Smith JA Jr: Radical cystectomy is safe in elderly patients at high risk. J Urol 2001, 166:938–941.

    Article  CAS  PubMed  Google Scholar 

  17. Farnham SB, Cookson MS, Alberts G, et al.: Benefit of radical cystectomy in the elderly patient with significant co-morbidities. Urol Oncol 2004, 22:178–181.

    PubMed  Google Scholar 

  18. Clark PE, Stein JP, Groshen SG, et al.: Radical cystectomy in the elderly: comparison of clincal outcomes between younger and older patients. Cancer 2005, 104:36–43.

    Article  PubMed  Google Scholar 

  19. Hollenbeck BK, Miller DC, Taub D, et al.: Aggressive treatment for bladder cancer is associated with improved overall survival among patients 80 years old or older. Urology 2004, 64:292–297.

    Article  PubMed  Google Scholar 

  20. Timothy C, Siegrist C, Cronin AM, Milowsky MI, Donat SM: Radical cystectomy in octogenarians: Does morbidity outweigh the potential benefits? American Urological Association Annual Meeting 2009

  21. Weizer AZ, Joshi D, Daignault S, et al.: Performance status is a predictor of overall survival of elderly patients with muscle invasive bladder cancer. J Urol 2007, 177:1287–1293.

    Article  PubMed  Google Scholar 

  22. Skinner EC: Quality of life with reconstruction. Semin Urol Oncol 2001, 19:56–58.

    CAS  PubMed  Google Scholar 

  23. Sogni F, Brausi M, Frea B, et al.: Morbidity and quality of life in elderly patients receiving ileal conduit or orthotopic neobladder after radical cystectomy for invasive bladder cancer. Urology 2008, 71:919–923.

    Article  PubMed  Google Scholar 

  24. Hagan MP, Winter KA, Kaufman DS, et al.: RTOG 97-06: initial report of a phase I-II trial of selective bladder conservation using TURBT, twice-daily accelerated irradiation sensitized with cisplatin, and adjuvant MCV combination chemotherapy. Int J Radiat Oncol Biol Phys 2003, 57:665–672.

    PubMed  Google Scholar 

  25. Rodel C, Grabenbauer GG, Kuhn R, et al.: Combined-modality treatment and selective organ preservation in invasive bladder cancer: long-term results. J Clin Oncol 2002, 20:3061–3071.

    Article  PubMed  Google Scholar 

  26. Shipley WU, Kaufman DS, Zehr E, et al.: Selective bladder preservation by combined modality protocol treatment: long-term outcomes of 190 patients with invasive bladder cancer. Urology 2002, 60:62–67.

    Article  CAS  PubMed  Google Scholar 

  27. Kaufman DS, Winter KA, Shipley WU, et al.: The initial results in muscle-invading bladder cancer of RTOG 95-06: phase I/II trial of transurethral surgery plus radiation therapy with concurrent cisplatin and 5-fluorouracil followed by selective bladder preservation or cystectomy depending on the initial response. Oncologist 2000, 5:471–476.

    Article  CAS  PubMed  Google Scholar 

  28. Sauer R, Birkenhake S, Kuhn R, et al.: Efficacy of radiochemotherapy with platin derivatives compared to radiotherapy alone in organ-sparing treatment of bladder cancer. Int J Radiat Oncol Biol Phys 1998, 40:121–127.

    Article  CAS  PubMed  Google Scholar 

  29. Tester W, Caplan R, Heaney J, et al.: Neoadjuvant combined modality program with selective organ preservation for invasive bladder cancer: results of Radiation Therapy Oncology Group phase II trial 8802. J Clin Oncol 1996, 14:119–126.

    CAS  PubMed  Google Scholar 

  30. Tester W, Porter A, Asbell S, et al.: Combined modality program with possible organ preservation for invasive bladder carcinoma: results of RTOG protocol 85-12. Int J Radiat Oncol Biol Phys 1993, 25:783–790.

    CAS  PubMed  Google Scholar 

  31. Fernando SA, Sandler HM: Multimodality bladder preservation therapy for muscle-invasive bladder tumors. Semin Oncol 2007, 34:129–134.

    Article  PubMed  Google Scholar 

  32. Rodel C, Weiss C, Sauer R: Trimodality treatment and selective organ preservation for bladder cancer. J Clin Oncol 2006, 24:5536–5544.

    Article  PubMed  Google Scholar 

  33. Coppin CM, Gospodarowicz MK, James K, et al.: Improved local control of invasive bladder cancer by concurrent cisplatin and preoperative or definitive radiation. The National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 1996, 14:2901–2907.

    CAS  PubMed  Google Scholar 

  34. Lichtman SM, Boparai MK: Anticancer drug therapy in the older cancer patient: pharmacology and polypharmacy. Curr Treat Options Oncol 2008, 9:191–203.

    Article  PubMed  Google Scholar 

  35. Kent E, Sandler H, Montie J, et al.: Combined-modality therapy with gemcitabine and radiotherapy as a bladder preservation strategy: results of a phase I trial. J Clin Oncol 2004, 22:2540–2545.

    Article  CAS  PubMed  Google Scholar 

  36. Oh KS, Soto DE, Smith DC, et al.: Combined-modality therapy with gemcitabine and radiation therapy as a bladder preservation strategy: long-term results of a phase I trial. Int J Radiat Oncol Biol Phys 2009, 74:511–517.

    CAS  PubMed  Google Scholar 

  37. Herman JM, Smith DC, Montie J, et al.: Prospective quality-of-life assessment in patients receiving concurrent gemcitabine and radiotherapy as a bladder preservation strategy. Urology 2004, 64:69–73.

    Article  PubMed  Google Scholar 

  38. Zietman AL, Sacco D, Skowronski U, et al.: Organ conservation in invasive bladder cancer by transurethral resection, chemotherapy and radiation: results of a urodynamic and quality of life study on long-term survivors. J Urol 2003, 170:1772–1776.

    Article  PubMed  Google Scholar 

  39. Loehrer PJ Sr, Einhorn LH, Elson PJ, et al.: A randomized comparison of cisplatin alone or in combination with methotrexate, vinblastine, and doxorubicin in patients with metastatic urothelial carcinoma: a cooperative group study. J Clin Oncol 1992, 10:1066–1073.

    PubMed  Google Scholar 

  40. Logothetis CJ, Dexeus F, Sella A, et al.: A prospective randomized trial comparing CISCA to MVAC chemotherapy in advanced metastatic urothelial tumors. J Clin Oncol 1990, 8:1050–1055.

    CAS  PubMed  Google Scholar 

  41. Saxman S, Propert K, Einhorn L, et al.: Long term follow-up of a phase III intergroup study of cisplatin alone or in combination with methotrexate, vinblastine and doxorubicin in patients with metastatic urothelial cancer: a cooperative group study. J Clin Oncol 1997, 15:2564–2569.

    CAS  PubMed  Google Scholar 

  42. von der Maase H, Hansen SW, Roberts JT, et al.: Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin, and cisplatin in advanced or metastatic bladder cancer: results of a large, randomized, multinational, multicenter, phase III study. J Clin Oncol 2000, 18:3068–3077.

    PubMed  Google Scholar 

  43. Sternberg CN, Yagoda A, Scher HI, et al.: Methotrexate, vinblastine, doxorubicin, and cisplatin for advanced transitional cell carcinoma of the urothelium. Efficacy and patterns of response and relapse. Cancer 1989, 64:2448–2458.

    Article  CAS  PubMed  Google Scholar 

  44. Grossman HB, Natale RB, Tangen CM, et al.: Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med 2003, 349:859–866.

    Article  CAS  PubMed  Google Scholar 

  45. Neoadjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysis. Lancet 2003, 361:1927–1934

  46. Neoadjuvant cisplatin, methotrexate, and vinblastine chemotherapy for muscle-invasive bladder cancer: a randomised controlled trial. International collaboration of trialists. Lancet 1999, 354:533–540

  47. Neoadjuvant chemotherapy for invasive bladder cancer. Cochrane Database of Systemic Reviews, Issue 2. Article No.: CD005246. 2005

  48. Studer U, Bacchi M, Biederman C, et al.: Adjuvant cisplatin chemotherapy following cystectomy for bladder cancer: results of a prospective randomized trial. J Urol 1994, 152:81–84.

    CAS  PubMed  Google Scholar 

  49. Skinner DG, Daniels JR, Russell CA, et al.: The role of adjuvant chemotherapy following cystectomy for invasive bladder cancer: a prospective comparative trial. J Urol 1991, 145:459–464; discussion 464–457.

    CAS  PubMed  Google Scholar 

  50. Freiha F, Reese J, Torti FM: A randomized trial of radical cystectomy versus radical cystectomy plus cisplatin, vinblastine and methotrexate chemotherapy for muscle invasive bladder cancer. J Urol 1996, 155:495–499; discussion 499–500.

    Article  CAS  PubMed  Google Scholar 

  51. Stockle M, Meyenburg W, Wellek S, et al.: Advanced bladder cancer (stages pT3b, pT4a, pN1 and pN2): improved survival after radical cystectomy and 3 adjuvant cycles of chemotherapy. Results of a controlled prospective study. J Urol 1992, 148:302–306; discussion 306–307.

    CAS  PubMed  Google Scholar 

  52. Stockle M, Meyenburg W, Wellek S, et al.: Adjuvant polychemotherapy of nonorgan-confined bladder cancer after radical cystectomy revisited: long-term results of a controlled prospective study and further experience. J Urol 1995, 153:47–52.

    Article  CAS  PubMed  Google Scholar 

  53. Adjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysis of individual patient data. Advanced Bladder Cancer (ABC) Meta-analysis Collaboration. Eur Urol 2005, 48:189–199; discussion 199–201

  54. Milowsky MI, Stadler WM, Bajorin DF: Integration of neoadjuvant and adjuvant chemotherapy and cystectomy in the treatment of muscle-invasive bladder cancer. BJU Int 2008, 102:1339–1344.

    Article  CAS  PubMed  Google Scholar 

  55. Bellmunt J, Ribas A, Eres N, et al.: Carboplatin-based versus cisplatin-based chemotherapy in the treatment of surgically incurable advanced bladder carcinoma. Cancer 1997, 80:1966–1972.

    Article  CAS  PubMed  Google Scholar 

  56. Petrioli R, Frediani B, Manganelli A, et al.: Comparison between a cisplatin-containing regimen and a carboplatin-containing regimen for recurrent or metastatic bladder cancer patients. A randomized phase II study. Cancer 1996, 77:344–351.

    Article  CAS  PubMed  Google Scholar 

  57. Dogliotti L, Carteni G, Siena S, et al.: Gemcitabine plus cisplatin versus gemcitabine plus carboplatin as first-line chemotherapy in advanced transitional cell carcinoma of the urothelium: results of a randomized phase 2 trial. Eur Urol 2007, 52:134–141.

    Article  CAS  PubMed  Google Scholar 

  58. Fehrman-Ekholm I, Skeppholm L: Renal function in the elderly (>70 years old) measured by means of iohexol clearance, serum creatinine, serum urea and estimated clearance. Scand J Urol Nephrol 2004, 38:73–77.

    Article  CAS  PubMed  Google Scholar 

  59. Launay-Vacher V, Oudard S, Janus N, et al.: Prevalence of Renal Insufficiency in cancer patients and implications for anticancer drug management: the renal insufficiency and anticancer medications (IRMA) study. Cancer 2007, 110:1376–1384.

    Article  CAS  PubMed  Google Scholar 

  60. Launay-Vacher V, Spano JP, Janus N, et al.: Renal insufficiency and anticancer drugs in elderly cancer patients: a subgroup analysis of the IRMA study. Crit Rev Oncol Hematol 2009, 70:124–133.

    Article  PubMed  Google Scholar 

  61. Launay-Vacher V, Chatelut E, Lichtman SM, et al.: Renal insufficiency in elderly cancer patients: International Society of Geriatric Oncology clinical practice recommendations. Ann Oncol 2007, 18:1314–1321.

    Article  CAS  PubMed  Google Scholar 

  62. Lichtman SM, Wildiers H, Launay-Vacher V, et al.: International Society of Geriatric Oncology (SIOG) recommendations for the adjustment of dosing in elderly cancer patients with renal insufficiency. Eur J Cancer 2007, 43:14–34.

    Article  PubMed  Google Scholar 

  63. Dash A, Galsky MD, Vickers AJ, et al.: Impact of renal impairment on eligibility for adjuvant cisplatin-based chemotherapy in patients with urothelial carcinoma of the bladder. Cancer 2006, 107:506–513.

    Article  CAS  PubMed  Google Scholar 

  64. Raj GV, Iasonos A, Herr H, Donat SM: Formulas calculating creatinine clearance are inadequate for determining eligibility for Cisplatin-based chemotherapy in bladder cancer. J Clin Oncol 2006, 24:3095–3100.

    Article  CAS  PubMed  Google Scholar 

  65. Agrawal Y, Platz EA, Niparko JK: Prevalence of hearing loss and differences by demographic characteristics among US adults: data from the National Health and Nutrition Examination Survey, 1999–2004. Arch Intern Med 2008, 168:1522–1530.

    Article  PubMed  Google Scholar 

  66. Rademaker-Lakhai JM, Crul M, Zuur L, et al.: Relationship between cisplatin administration and the development of ototoxicity. J Clin Oncol 2006, 24:918–924.

    Article  CAS  PubMed  Google Scholar 

  67. Guralnik JM, Ferrucci L, Simonsick EM, et al.: Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med 1995, 332:556–561.

    Article  CAS  PubMed  Google Scholar 

  68. Guralnik JM, Simonsick EM, Ferrucci L, et al.: A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994, 49:M85–M94.

    CAS  PubMed  Google Scholar 

  69. Inzitari M, Carlo A, Baldereschi M, et al.: Risk and predictors of motor-performance decline in a normally functioning population-based sample of elderly subjects: the Italian Longitudinal Study on Aging. J Am Geriatr Soc 2006, 54:318–324.

    Article  PubMed  Google Scholar 

  70. Bamias A, Efstathiou E, Moulopoulos LA, et al.: The outcome of elderly patients with advanced urothelial carcinoma after platinum-based combination chemotherapy. Ann Oncol 2005, 16:307–313.

    Article  CAS  PubMed  Google Scholar 

  71. Castagneto B, Zai S, Marenco D, et al.: Single-agent gemcitabine in previously untreated elderly patients with advanced bladder carcinoma: response to treatment and correlation with the comprehensive geriatric assessment. Oncology 2004, 67:27–32.

    Article  CAS  PubMed  Google Scholar 

  72. Bamias A, Lainakis G, Kastritis E, et al.: Biweekly carboplatin/gemcitabine in patients with advanced urothelial cancer who are unfit for cisplatin-based chemotherapy: report of efficacy, quality of life and geriatric assessment. Oncology 2007, 73:290–297.

    Article  CAS  PubMed  Google Scholar 

  73. Hussain M, Vaishampayan U, Du W, et al.: Combination paclitaxel, carboplatin, and gemcitabine is an active treatment for advanced urothelial cancer. J Clin Oncol 2001, 19:2527–2533.

    CAS  PubMed  Google Scholar 

  74. Redman BG, Smith DC, Flaherty L, et al.: Phase II trial of paclitaxel and carboplatin in the treatment of advanced urothelial carcinoma. J Clin Oncol 1998, 16:1844–1848.

    CAS  PubMed  Google Scholar 

  75. Small EJ, Lew D, Redman BG, et al.: Southwest Oncology Group Study of paclitaxel and carboplatin for advanced transitional-cell carcinoma: the importance of survival as a clinical trial end point. J Clin Oncol 2000, 18:2537–2544.

    CAS  PubMed  Google Scholar 

  76. Dreicer R, Manola J, Roth BJ, et al.: Phase III trial of methotrexate, vinblastine, doxorubicin, and cisplatin versus carboplatin and paclitaxel in patients with advanced carcinoma of the urothelium. Cancer 2004, 100:1639–1645.

    Article  CAS  PubMed  Google Scholar 

  77. De Santis M, Bellmunt Molins J, de Wit R, et al.: Randomized phase II/III trial assessing gemcitabine/carboplatin (GC) and methotrexate/carboplatin/vinblastine (M-CAVI) in patients (pts) with advanced urothelial cancer (UC) “unfit” for cisplatin based chemotherapy (CHT): updated phase II results and risk group analysis of EORTC study 30986. J Clin Oncol 2008, 26

Download references

Author information

Authors and Affiliations

  1. Genitourinary Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill Medical College of Cornell University, 1275 York Avenue, New York, NY, 10021, USA

    David J. Gallagher MD & Matthew I. Milowsky MD

Authors
  1. David J. Gallagher MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Matthew I. Milowsky MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Matthew I. Milowsky MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gallagher, D.J., Milowsky, M.I. Bladder Cancer. Curr. Treat. Options in Oncol. 10, 205–215 (2009). https://doi.org/10.1007/s11864-009-0112-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11864-009-0112-6

Keywords

Search

Navigation