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Radical cystectomy and chemotherapy are challenging in the elderly population with muscleinvasive bladder cancer (MIBC) due to comorbidities and limited physiological reserve. Very few studies compared outcomes between chemoradiation therapy (CRT) and radical cystectomy (RC) among the older population. Current management options for older patients are extrapolated from outcomes based on the younger population. This study aims to compare survival outcomes among octogenarians who underwent CRT and RC for localized MIBC reported in the National Cancer Database (NCDB).METHODS: Patients who underwent CRT or RC for urothelial MIBC (cT2-T4N0M0) were identified in the NCDB (2004NCDB ( -2017. Primary CRT was defined as a radiation dose of !39.6 Gy, and chemotherapy received within 90 days of radiation without any definitive surgery. RC was defined as those who underwent RC with or without perioperative chemotherapy. The initial analysis compared proportions between octogenarians and the younger group. Following this, a propensitymatched analysis was performed to compare survival outcomes among octogenarians who underwent CRT and RC.RESULTS: A total of 21095 patients met the inclusion criteria and underwent either primary CRT or RC (4840 were octogenarians, and 16255 were less than 80 years). Among the octogenarian group, 2064 (42.6%) underwent primary CRT, and 2776 (57.4%) had RC. Whereas, in the younger group, 2633 (16.2%) had CRT, and 13622 (83.8%) had RC (p<0.001). Demographic parameters, comorbidity index, and clinical stage were used to generate propensity scores for octogenarians. After a propensity score match of 1:1 using strict criteria, there were 1767 octogenarians in each of the CRT and RC groups. The median overall survival in the primary CRT group was 28.78 months 95% CI [26.55, 31.00] and 26.12 months 95% CI [23.88, 28.36] in the RC group (p[0.326).CONCLUSIONS: CRT and RC groups had comparable survival outcomes in this retrospective analysis of octogenarians in a large national database. Further survival outcomes research in elderly populations will help us to individualize treatment and improve outcomes.

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