Muscle-Invasive Bladder Cancer in Elderly-Unfit Patients with Concomitant Illness: Can a Curative Radiation Therapy be Delivered?

Santacaterina, Anna; Settineri, Nicola; Renzis, Costantino De; Frosina, P.; Brancati, A.; Delia, Pietro; Palazzolo, Carmela; Romeo, Antonino; Sansotta, Giuseppe; Pergolizzi, Stefano

doi:10.1177/030089160208800508

Cited by 9 publications

(8 citation statements)

References 26 publications

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“…Patients with many mild comorbidities or several severe comorbidities can have a poor treatment outcome even though they may otherwise have good KPS. Data observed in our patients seem to confirm the feasibility of curative treatment in patients with high Charlson score value such as observed in other articles (14)(15)(16)(17)(18)(19). In fact, our patients tolerated the treatment well although they had many illnesses with a median CCI score of 6.5.…”

Section: Discussionsupporting

confidence: 90%

Very Elderly (>80 Years), Frail Patients with Muscle-invasive Bladder Cancer and Comorbidities: Is Curative Irradiation Feasible?

Santacaterina

Platania

Palazzolo

et al. 2015

Tumori

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Section: Discussionsupporting

confidence: 90%

Very Elderly (>80 Years), Frail Patients with Muscle-invasive Bladder Cancer and Comorbidities: Is Curative Irradiation Feasible?

Santacaterina

Platania

Palazzolo

et al. 2015

Tumori

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“…Additionally, Sengelov and coworkers [31] confirmed that curative intended radiotherapy is feasible in elderly patients, with 29% surviving for 2 years. The overall actuarial median survival under 2DRT techniques in these reports ranged from 9 to 21.5 months [30,32,33]. In our institute, the median survival is 21 months.…”

Section: Discussionmentioning

confidence: 92%

“…For elderly patients with locally advanced bladder cancer, several reports concluded that RT also was an effective treatment option for elderly patients who were not suitable for cystectomy. Santacaterina et al [30] reported that elderly patients with muscle-invasive bladder cancer who underwent RT had a median survival of 21.5 months. Additionally, Sengelov and coworkers [31] confirmed that curative intended radiotherapy is feasible in elderly patients, with 29% surviving for 2 years.…”

Section: Discussionmentioning

confidence: 99%

Intensity modulated radiotherapy for elderly bladder cancer patients

et al. 2011

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BackgroundTo review our experience and evaluate treatment planning using intensity-modulated radiotherapy (IMRT) and helical tomotherapy (HT) for the treatment of elderly patients with bladder cancer.MethodsFrom November 2006 through November 2009, we enrolled 19 elderly patients with histologically confirmed bladder cancer, 9 in the IMRT and 10 in the HT group. The patients received 64.8 Gy to the bladder with or without concurrent chemotherapy. Conventional 4-field "box" pelvic radiation therapy (2DRT) plans were generated for comparison.ResultsThe median patient age was 80 years old (range, 65-90 years old). The median survival was 21 months (5 to 26 months). The actuarial 2-year overall survival (OS) for the IMRT vs. the HT group was 26.3% vs .37.5%, respectively; the corresponding values for disease-free survival were 58.3% vs. 83.3%, respectively; for locoregional progression-free survival (LRPFS), the values were 87.5% vs. 83.3%, respectively; and for metastases-free survival, the values were 66.7% vs. 60.0%, respectively. The 2-year OS rates for T1, 2 vs. T3, 4 were 66.7% vs. 35.4%, respectively (p = 0.046). The 2-year OS rate was poor for those whose RT completion time greater than 8 weeks when compared with the RT completed within 8 wks (37.9% vs. 0%, p = 0.004).ConclusionIMRT and HT provide good LRPFS with tolerable toxicity for elderly patients with invasive bladder cancer. IMRT and HT dosimetry and organ sparing capability were superior to that of 2DRT, and HT provides better sparing ability than IMRT. The T category and the RT completion time influence OS rate.

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“…In this study, 45 unfit patients were treated with radiation fields encompassing bladder and grossly involved lymph-nodes. Treatment was considered safe and achieved a 3- and 5-year OS of 36% and 19.5%, respectively; with a median survival of 21.5 months ( 50 ). A recent study reported similar results but included patients with T1 to T4 BCa, making difficult to compare this population to MIBC patients.…”

Section: Evidence Synthesismentioning

confidence: 99%

How to optimally manage elderly bladder cancer patients?

Soria¹,

Moschini²,

Korn³

et al. 2016

Transl. Androl. Urol.

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Bladder cancer (BCa) is a disease of the elderly and as the population is aging, BCa will become an even bigger public health challenge in the future. Nowadays the correct management of BCa in the elderly remains controversial. The purpose of this article was to review the previous literature to summarize the current knowledge. Using Medline, a non-systematic review was performed including articles between January 2000 and February 2016 in order to describe the management of BCa in the elderly in all its aspects. English language original articles, reviews and editorials were selected based on their clinical relevance. In the literature, the definition of elderly is variable and based on chronological, not biological, age. BCa seems to be more aggressive in the elderly. The management of non-muscle invasive bladder cancer (NMIBC) does not strongly differ from younger patients, except for the role of adjuvant immunotherapy. In patients with muscle invasive bladder cancer (MIBC) the role of a multidisciplinary geriatric evaluation is potentially beneficial. The curative treatment in MIBC remains radical cystectomy (RC) and elderly patients should not be withheld a potentially life-saving intervention only based on chronological age. Patients unsuitable to a major surgical approach may be eligible for bladder-sparing techniques. Geriatric assessment could help identify the frail elderly and customize their perioperative care (i.e., pre and re habilitation). In conclusion the treatment of BCa in the elderly has to be patient-centered and focused on biological age and functional reserves.

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Muscle-Invasive Bladder Cancer in Elderly-Unfit Patients with Concomitant Illness: Can a Curative Radiation Therapy be Delivered?

Abstract: Elderly-unfit patients with comorbidities and >70 years of age can be submitted to radical pelvic irradiation. The results observed in this retrospective analysis have encouraged us to use non-palliative radiotherapy doses in these patients with muscle-invasive bladder cancer.

Cited by 9 publications

References 26 publications

Very Elderly (>80 Years), Frail Patients with Muscle-invasive Bladder Cancer and Comorbidities: Is Curative Irradiation Feasible?

Very Elderly (>80 Years), Frail Patients with Muscle-invasive Bladder Cancer and Comorbidities: Is Curative Irradiation Feasible?

Intensity modulated radiotherapy for elderly bladder cancer patients

How to optimally manage elderly bladder cancer patients?

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