Radical radiotherapy in older patients with muscle invasive bladder cancer.
Activities of Daily Living
Aged
Aged, 80 and over
Antineoplastic Agents
/ therapeutic use
Carcinoma, Transitional Cell
/ epidemiology
Chemoradiotherapy, Adjuvant
/ methods
Cystitis
/ epidemiology
Cystoscopy
Diarrhea
/ epidemiology
Disease-Free Survival
Female
Frailty
/ epidemiology
Humans
Lower Urinary Tract Symptoms
/ epidemiology
Male
Muscle, Smooth
/ pathology
Nausea
/ epidemiology
Neoplasm Invasiveness
Neoplasm Staging
Patient Selection
Proportional Hazards Models
Radiation Injuries
/ epidemiology
Radiodermatitis
/ epidemiology
Radiotherapy, Adjuvant
/ methods
Retrospective Studies
Severity of Illness Index
Survival Rate
Urinary Bladder Neoplasms
/ epidemiology
Bladder cancer
Chemoradiotherapy
Elderly
Muscle invasive
Radiotherapy
Journal
Journal of geriatric oncology
ISSN: 1879-4076
Titre abrégé: J Geriatr Oncol
Pays: Netherlands
ID NLM: 101534770
Informations de publication
Date de publication:
03 2019
03 2019
Historique:
received:
29
07
2018
revised:
19
09
2018
accepted:
22
10
2018
pubmed:
12
1
2019
medline:
24
6
2020
entrez:
12
1
2019
Statut:
ppublish
Résumé
Muscle invasive bladder cancer (MIBC) is prevalent in the older patients, who are a vulnerable population with multiple co-morbidities and at increased risk of complications. Radical cystectomy is often not suitable, hence radical radiotherapy (RT) is an alternative option. We reviewed the outcomes of older patients treated with RT with or without concurrent chemotherapy (CRT) at our institution. We retrospectively reviewed patients aged 65 years and above treated with radical RT for MIBC at our institution between March 2002 to January 2017. Data was collected from institutional medical records and RT databases. The primary outcome was 2- and 5-year overall survival (OS), recurrence free survival (RFS), and toxicities. Univariate cox proportional hazard regression models were performed to identify independent factors with significant impact on survival. We identified 45 patients (34 males, 11 females) with a median age of 77 years (range 65-95). All patients received maximal transurethral resection of the bladder tumour prior to RT. Median dose of total RT was 64 Gy (range 50-69.8 Gy). Twenty one patients (47%) received CRT. Planned treatment was completed in 42 (93.3%) patients. Median follow-up was 31 months (range 1-147 months). The 2- and 5-year OS was 64% and 44%, respectively. The 2- and 5-year RFS was 68% and 49%, respectively. Median RFS was 34 months (range 8-121 months). Median OS was 56 months (range 18-100 months). Univariate analysis showed that performance status (0-1 vs. 2-3; HR 2.7, 95% CI 1.07-6.8, p = 0.035) and International Society of Geriatric Oncology (SIOG) group (≤2 vs. >2; HR 3.23, 95% CI 1.12-8.64, p = 0.019) were significantly associated with increased hazard for death. One patient (2%) had grade 3 cystitis. Radical RT is well tolerated in older patients with MIBC. We report outcomes similar to published data. Older patients should be considered for curative treatment despite their age. However, careful selection is warranted as frail patients (PS ≥2; SIOG >2) may benefit less.
Sections du résumé
BACKGROUND
Muscle invasive bladder cancer (MIBC) is prevalent in the older patients, who are a vulnerable population with multiple co-morbidities and at increased risk of complications. Radical cystectomy is often not suitable, hence radical radiotherapy (RT) is an alternative option. We reviewed the outcomes of older patients treated with RT with or without concurrent chemotherapy (CRT) at our institution.
METHODS
We retrospectively reviewed patients aged 65 years and above treated with radical RT for MIBC at our institution between March 2002 to January 2017. Data was collected from institutional medical records and RT databases. The primary outcome was 2- and 5-year overall survival (OS), recurrence free survival (RFS), and toxicities. Univariate cox proportional hazard regression models were performed to identify independent factors with significant impact on survival.
RESULTS
We identified 45 patients (34 males, 11 females) with a median age of 77 years (range 65-95). All patients received maximal transurethral resection of the bladder tumour prior to RT. Median dose of total RT was 64 Gy (range 50-69.8 Gy). Twenty one patients (47%) received CRT. Planned treatment was completed in 42 (93.3%) patients. Median follow-up was 31 months (range 1-147 months). The 2- and 5-year OS was 64% and 44%, respectively. The 2- and 5-year RFS was 68% and 49%, respectively. Median RFS was 34 months (range 8-121 months). Median OS was 56 months (range 18-100 months). Univariate analysis showed that performance status (0-1 vs. 2-3; HR 2.7, 95% CI 1.07-6.8, p = 0.035) and International Society of Geriatric Oncology (SIOG) group (≤2 vs. >2; HR 3.23, 95% CI 1.12-8.64, p = 0.019) were significantly associated with increased hazard for death. One patient (2%) had grade 3 cystitis.
CONCLUSION
Radical RT is well tolerated in older patients with MIBC. We report outcomes similar to published data. Older patients should be considered for curative treatment despite their age. However, careful selection is warranted as frail patients (PS ≥2; SIOG >2) may benefit less.
Identifiants
pubmed: 30630748
pii: S1879-4068(18)30302-3
doi: 10.1016/j.jgo.2018.10.015
pii:
doi:
Substances chimiques
Antineoplastic Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
292-297Informations de copyright
Copyright © 2018 Elsevier Ltd. All rights reserved.