How Octogenarians with Bladder Cancer Are Treated in a Maximum-Care Hospital: The Real-Life Experience

Sikic, Danijel; Wach, Sven; Täubert, Helge; Richterstetter, Mario; Kunath, Frank; Lieb, Verena; Krause, F; Merten, Ricarda; Ott, Oliver J.; Fietkau, Rainer; Wullich, Bernd; Keck, Bastian

doi:10.1159/000447361

Cited by 9 publications

(5 citation statements)

References 39 publications

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“…Potential alternative are represented by chemotherapy, radiotherapy, or bladder-preserving trimodal therapy. Although data concerning chemo or radiotherapy alone are still insufficient to make recommendations and the equivalence of trimodal therapy remains to be proven, only 10-20% of octogenarians with MIBC undergo RC [15][16][17]. Obviously, the main factors limiting the use of RC in very elderly patients are represented by significant risks of perioperative morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Outcomes and Early Survival in Octogenarians Who Underwent Radical Cystectomy for Bladder Cancer

Zattoni¹,

Palumbo

Giannarini³

et al. 2017

Urol Int

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Objective: To evaluate perioperative outcomes and early survival in a series of octogenarians who underwent radical cystectomy (RC) and urinary diversion for bladder cancer. Patients and Methods: We retrospectively evaluated the clinical records of 44 patients aged ≥80 years who underwent open RC and urinary diversion at 2 high-volume centers between July 2013 and December 2015. Estimated blood loss (EBL), transfusion rate, and length of hospital stay (LOS) were evaluated. Ninety-day postoperative complications were stratified according to the type of urinary diversion. Univariable analysis was performed to identify predictors of overall and major complications. Overall survival (OS) was estimated using the Kaplan-Meier method. Results: Median age was 83 years (interquartile range [IQR] 81-85). Age-adjusted Charlson score was ≥4 in 37 (84%) patients, and American Society of Anesthesiologists score was ≥3 in 34 (77%) patients. Ileal conduit (IC) was performed in 21/44 (48%) cases, cutaneous ureterostomy (CU) in 20/44 (45%), and no urinary diversion was required for 3 (7%) dialytic patients. Median EBL was 700 mL (IQR 500-1,000) and 23 (52%) patients required blood transfusion. Median LOS was 13 days (IQR 10-18). Overall complications were recorded in 29 (66%) patients, with major complications observed in 12 (27%), with death occurring in 1. No differences in complications were observed between IC and CU. The 2-year OS estimate was 62.5%. Conclusions: Open RC in octogenarians has an acceptable rate of major complications and mortality. IC should be considered a good urinary diversion in these patients.

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Section: Discussionmentioning

confidence: 99%

Perioperative Outcomes and Early Survival in Octogenarians Who Underwent Radical Cystectomy for Bladder Cancer

Zattoni¹,

Palumbo

Giannarini³

et al. 2017

Urol Int

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“…A major prerequisite for success is a well‐established interdisciplinary team that coordinates the multimodal treatment for patients with bladder cancer. At our hospital, we have offered patients of all age groups the option of multimodal bladder‐preservation treatment since 1982 . In the early days, all patients were treated with radiotherapy alone.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Experience of Chemoradiotherapy Combined with Deep Regional Hyperthermia for Organ Preservation in High-Risk Bladder Cancer (Ta, Tis, T1, T2)

et al. 2019

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Background. The aim of this study was to evaluate the efficacy and safety of chemoradiotherapy (RCT) combined with regional deep hyperthermia (RHT) of high-risk bladder cancer after transurethral resection of bladder tumor (TUR-BT). Materials and methods. Between 1982 and 2016, 369 patients with pTa, pTis, pT1, and pT2 cN0-1 cM0 bladder cancer were treated with a multimodal treatment after TUR-BT. All patients received radiotherapy (RT) of the bladder and regional lymph nodes. RCT was administered to 215 patients, RCT + RHT was administered to 79 patients, and RT was used in 75 patients. Treatment response was evaluated 4-6 weeks after treatment with TUR-BT. Results. Complete response (CR) overall was 83% (290/351), and in treatment groups was RT 68% (45/66), RCT 86% (178/208), and RCT + RHT 87% (67/77). CR was significantly improved by concurrent RCT compared with RT (odds ratio [OR], 2.32; 95% confidence interval [CI], 1.05-5.12; p = .037), less influenced by hyperthermia (OR, 2.56; 95% CI, 0.88-8.00; p = .092). Overall survival (OS) after RCT was superior to RT (hazard ratio [HR], 0.7; 95% CI, 0.50-0.99; p = .045). Five-year OS from unadjusted Kaplan-Meier estimates was RCT 64% versus RT 45%. Additional RHT increased 5-year OS to 87% (HR, 0.32; 95% CI, 0.18-0.58; p = .0001). RCT + RHT compared with RCT showed a significantly better bladder-preservation rate (HR, 0.13; 95% CI, 0.03-0.56; p = .006). Median follow-up was 71 months. The median number of RHT sessions was five. Conclusion. The multimodal treatment consisted of a maximal TUR-BT followed by RT; concomitant platinum-based chemotherapy combined with RHT in patients with high-grade bladder cancer improves local control, bladder-preservation rate, and OS. It offers a promising alternative to surgical therapies like radical cystectomy. The Oncologist 2019;24:e1341-e1350 Implications for Practice: Radical cystectomy with appropriate lymph node dissection has long represented the standard of care for muscle-invasive bladder cancer in medically fit patients, despite many centers reporting excellent long-term results for bladder preserving strategies. This retrospective analysis compares different therapeutic modalities in bladder-preservation therapy. The results of this study show that multimodal treatment consisting of maximal transurethral resection of bladder tumor followed by radiotherapy, concomitant platinum-based chemotherapy combined with regional deep hyperthermia in patients with Ta, Tis, T1-2 bladder carcinomas improves local control, bladder-preservation rate, and survival. More importantly, these findings offer a promising alternative to surgical therapies like radical cystectomy. The authors hope that, in the future, closer collaboration between urologists and radiotherapists will further improve treatments and therapies for the benefit of patients.Cumulative estimated DFS for RCT (40%; 95% CI, 34%-47% and 24%; 95% CI, 18%-30%) was superior to RT (20%; 95% Merten, Ott, Haderlein et al. e1345Abbreviations: CI, confidence interval; cis, associate...

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“…Routine markers that predict response to chemotherapy are of importance and may help in the tailoring of the treatment [7,8]. Biomarker initiatives have been initiated [9][10][11], but no marker was subsequently validated and used in clinical routine.…”

Section: Discussionmentioning

confidence: 99%

Sarcopenia as a Predictive Factor for Response to Upfront Cisplatin-Based Chemotherapy in Patients with Muscle-Invasive Urothelial Bladder Cancer

et al. 2018

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Purpose: We hypothesized sarcopenia as predictive factor as a response to upfront chemotherapy of muscle-invasive urothelial bladder cancer (MIBC). Methods: We retrospectively studied 30 patients who received upfront cisplatin-based chemotherapy for MIBC (pT2–4 N0/+ M0) before planned radical cystectomy. Skeletal muscle index (SMI) was calculated by CT at study baseline and following completion of chemotherapy. Patients were stratified according to the presence of sarcopenia. Endpoints included clinical and pathological response. Results: Sixteen of the 30 patients (53.3%) had sarcopenia at baseline. The median SMI was 51.2 cm²/m² (IQR 45.6–57.9). Throughout the course of chemotherapy, 22 patients (73.3%) experienced a decline in SMI, which ranged from 1 to 20% (median decline 3%, p < 0.01). All 16 patients with baseline sarcopenia persisted, while 5 of 14 patients (35.7%) without baseline sarcopenia became sarcopenic (p = 0.06). None of the clinical variables were predictive of clinical or pathological response, including SMI (p = 0.78 and p = 0.59), sarcopenia (p = 0.65 and p = 0.16) and SMI kinetics (p = 0.54 and p = 0.77). Conclusion: Sarcopenia is present in a considerable proportion of patients with MIBC undergoing upfront cisplatin-based chemotherapy before planned RC. SMI decreases during treatment, but neither baseline SMI nor its kinetics is associated with response to chemotherapy.

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How Octogenarians with Bladder Cancer Are Treated in a Maximum-Care Hospital: The Real-Life Experience

Cited by 9 publications

References 39 publications

Perioperative Outcomes and Early Survival in Octogenarians Who Underwent Radical Cystectomy for Bladder Cancer

Perioperative Outcomes and Early Survival in Octogenarians Who Underwent Radical Cystectomy for Bladder Cancer

Long-Term Experience of Chemoradiotherapy Combined with Deep Regional Hyperthermia for Organ Preservation in High-Risk Bladder Cancer (Ta, Tis, T1, T2)

Sarcopenia as a Predictive Factor for Response to Upfront Cisplatin-Based Chemotherapy in Patients with Muscle-Invasive Urothelial Bladder Cancer

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