Trimodality Therapy for Bladder Preservation in the Elderly Population with Invasive Bladder Cancer

Abstract

Bladder cancer is considered as primarily a disease of the elderly, typically aged in their 70s or 80s and often with associated medical comorbidities. Unfortunately, fewer elderly patients receive radical treatment for muscle-invasive bladder cancer (MIBC) that their younger counterparts. Over the last decades, several studies have shown that the use of trimodality therapy consisting of transurethral bladder resection followed by concomitant chemotherapy and radiation therapy results in comparable outcomes to radical cystectomy, considered the gold standard for this disease. In this review, we revised the literature on bladder-preservation treatments using the trimodality approach in the elderly population with MIBC.

Concurrent chemotherapy is associated with improved survival in elderly patients with bladder cancer undergoing radiotherapy

“…The use of TMT in elderly patients with MIBC has been studied previously. Turgeon and Souhami conducted a review of the use of TMT for MIBC in elderly patients, in which they presented a table of outcomes and toxicity data from 8 publications and 4 conference abstracts, summing to a total of 496 elderly patients . Although the definition of “elderly” is variable in the literature, Turgeon and Souhami reported the most common definition of elderly to be those aged ≥70 years, which was used in greater than one‐half of the studies reviewed.…”

First Brazilian consensus on the management of localized and locally advanced urothelial bladder cancer: a SBU-SBOC-SBRT-LACOG-GU panel review

“…163 TMT is considered in selected cases of localized BCa and should be recommended according to the patient's preference but is unfit for patients due to age 164 or comorbidities (consensus, LE: 2b GR: B), as RC involves risks and might impact quality of life. The ideal patient for multimodal therapy is as follows: T2, single tumor, with a favorable location that can undergo maximum resection in TUR, without CIS, with-out hydronephrosis, with urothelial histology, with tumors smaller than 5cm and good bladder function (consensus, LE: 2b GR: B), in which the treatment will provide significant benefit (165) with comparable 5-and 10-year OS rates to RC with lymphadenectomy. 163,[165][166][167][168][169] TMT in primary or recurrent high-risk T1 bladder-cancer patients provides better 5-year disease-specific survival (DSS) compared to only radiotherapy.…”

“…The ideal patient for multimodal therapy is as follows: T2, single tumor, with a favorable location that can undergo maximum resection in TUR, without CIS, with-out hydronephrosis, with urothelial histology, with tumors smaller than 5cm and good bladder function (consensus, LE: 2b GR: B), in which the treatment will provide significant benefit (165) with comparable 5-and 10-year OS rates to RC with lymphadenectomy. 163,[165][166][167][168][169] TMT in primary or recurrent high-risk T1 bladder-cancer patients provides better 5-year disease-specific survival (DSS) compared to only radiotherapy. 170 In a small case series of 18 NMIBC patients ith recurrent and progressive disease, TMT provided a 7-year DSS for 70% and OS for 58% of patients.…”