Is Ultra Hypofractionated Radiation Therapy a Safe and Effective Treatment for Invasive Bladder Cancer in the Elderly?

Abstract

The aim was to determine the efficacy, safety, and tolerability of weekly ultra hypofractionated radiation therapy for older unfit patients with invasive bladder cancer. Methods:We retrospectively analyzed a cohort of patients with muscle invasive bladder cancer deemed unfit for chemoradiation therapy and thus treated with 6 weekly doses of 6 Gy using intensity modulated radiotherapy. Charlson comorbidity was calculated retrospectively. Cystoscopy and computed tomography were used to evaluate local control and toxicity using the common terminology criteria. Survival outcomes were estimated using the Kaplan-Meier method.Results: Twenty-two patients with a median age of 84 (range: 70 to 96) years were included. The median comorbidity index was 6 1.5 SD. Nineteen (90%) patients received the full 36 Gy dose. Median follow-up was 10 7 months (range: 6 to 27 mo). Local control in the bladder was achieved in 16 of 19 evaluable patients (84%). One-year overall survival was 62.5%, 1 patient had a retroperitoneal nodal recurrence and 3 patients developed distant metastasis. Grade 3 genitourinary and gastrointestinal toxicity was observed in 4 (18%) and 1 (4.5%) patients, respectively. Conclusion:Weekly ultra hypofractionated intensity modulated radiotherapy with image guidance and bladder training is an effective, safe, and well-tolerated regimen for older patients with invasive bladder cancer unfit for radical treatment.

Clinical outcomes of adapted hypofractionated radiotherapy for bladder cancer in elderly patients

“…Acute Grade ≥3 GI toxicity in our study was low (3.3%) and comparable to other studies that range from 3% to 8%. Regarding acute Grade ≥3 GU toxicity, while it varied more in previously published studies (from 4% to 26%), our results seemed to be in the low range (4.1%) [17–22].…”

“…In studies that investigated TMT in elderly patients with nonmetastatic MIBC, OS ranged from 47% to 63% at 1 year, whereas survival in our study was much higher at 85.1% [17][18][19]. Turgeon et al [20] found a 3-year OS rate of 61% comparable to our rate of 61.7%.…”

“…Other approaches had already been explored to find an effective and well-tolerated treatment for the elderly patient, such as weekly ultra-hypofractionated intensity-modulated RT, which offers promising results [19]. The progressive development of immunotherapy in bladder cancer is also an issue to be considered for the elderly population.…”

Abbreviated Concurrent Chemo-Radiotherapy in Node Negative Muscle-Invasive Bladder Cancer

“…In addition, acute grade 3 gastrointestinal and genitourinary toxicities were only 5% and 12.5% versus, 6% and 24%, respectively [14]. Higher toxicity rates were reported with Symon et al with grade 3 gastrointestinal and genitourinary toxicity of 4.5% and 18%, respectively [24].…”

“…Radiation technique delivered was 3-dimensional conformal radiotherapy in contrast to other studies using intensity modulated radiotherapy and volumetric modulated arc therapy [14] [24]. Several studies experimented hypofractionated radiotherapy alone, yet others administered an additional concomitant radiosensitizer as fluorouracil and mitomycin C [13].…”