Curative radiation therapy for very elderly bladder cancer patients with localized disease

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Abstract

Purpose

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).

Methods

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.

Results

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.

Conclusion

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.

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Change history

  • 15 March 2018

    In the original version of this article the figure captions of Figs. 1 and 2 were interchanged.

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Acknowledgements

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.

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Correspondence to M. Bonet.

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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.

Informed consent

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.

Additional information

The original version of this article was revised: In the original version of this article the figure captions of Figs. 1 and 2 were interchanged. The correct captions of Figs. 1 and 2 are listed below.

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Bonet, M., Bonfill, T., Nuñez, M. et al. Curative radiation therapy for very elderly bladder cancer patients with localized disease. Clin Transl Oncol 20, 899–905 (2018). https://doi.org/10.1007/s12094-017-1804-1

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Keywords

  • Bladder cancer
  • Elderly
  • Radiotherapy
  • Trimodality