Curative radiation therapy for very elderly bladder cancer patients with localized disease
To report the outcomes of a cohort of very elderly muscle-invasive bladder cancer (MIBC) patients treated with contemporary 3D-conformal radiation therapy (3D-CRT) with or without concurrent chemotherapy, after transurethral resection of bladder tumor (TURBT).
From February 2010 to January 2014, a total of 41 patients older than 75 years, with T2-3 N0-1 high-grade MIBC, a Karnofsky index (KI) of at least 90% and/or a Barthel scale score of at least 95, were treated with TURBT followed by radiotherapy (RT) with or without chemotherapy, and were prospectively followed-up.
The mean age of patients was 82 years (range 76–88). Median follow-up was 47 months for surviving patients. Mean Charlson Comorbidity Index (CCI) score was 5 points. 28 patients (68.29%) were T2N0. All received 3D-CRT to a mean dose of 60 Gy (range 48.6–66 Gy), and chemotherapy was delivered to 34 patients (83%). Cause-specific survival (CSS) was 86 and 78.8% at 1 and 5 years, respectively. Patients achieving a complete response lived longer (48 vs 14 m, p = 0.036) than those with a progressive disease, who were more likely to die from cancer than from other causes (HR 3.865, IC95% 1.562–9.562). Dead patients had a longest treatment time (mean 56.78 vs 48.91 days, p = 0.019) than survivors.
RT with contemporary 3D-CRT techniques after TURBT for MIBC in elderly patients is feasible and well-tolerated. Achieving a maximal response and shortening the total radiation treatment time may improve outcomes and quality of life.
KeywordsBladder cancer Elderly Radiotherapy Trimodality
We acknowledge Dr. Romà Bastús for sharing some of his results, Dra. Gemma Sancho for her scientific guidance, Joan Carles Oliva for his statistical assessment, and Magda Font and Kathyn Gibson for their assistance with the English.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Research involving human participants and/or animals
While the present study is not a clinical trial, both the treatment and follow-up were performed according to the accepted standards of good clinical practice in agreement with the latest version of the Declaration of Helsinki.
All patients provided written informed consent. The paper is IRB exempt, given that treatment with radiation in bladder cancer patients is the clinical practice in our institution.
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