ASCO GU 2018: Is Radical Radiotherapy Effective for Elderly Patients with Muscle Invasive Bladder Cancer?

San Francisco, CA (UroToday.com) Radical radiotherapy (RT) is a curative option for muscle-invasive bladder cancer (MIBC), and offers the chance of bladder preservation. To date, RT and radical cystectomy have not been compared in a randomized controlled trial, however, previous studies assessing RT +/- concurrent systemic therapy have demonstrated outcomes comparable to surgery. In the clinical practice of the real world, patients are often older and considerably less fit, when compared to patients enrolled to trials, and consequently may not be fit for concurrent chemotherapy which may impact treatment outcomes.

Methods:

The authors performed a retrospective review of all patients aged 70 years or older treated with radical RT for MIBC from January 2010 – October 2016. Patients had to have a minimum of 12 months follow-up. 

Results:

A total of 71 patients were identified. Male: female ratio was 3:1 and median age 79 (range 71 – 93). Overall, 81.7% of patients had pT2 disease or greater, 77.5% of patients underwent TURBT prior to RT and 97.2% had transitional cell-carcinoma histology. 38 patients were treated to 60-64Gy/30-32 fractions and 33 patients to 52.5-55Gy/20 fractions. 6 patients (8.5%) received neoadjuvant chemotherapy and 15 (21.1%) received concurrent chemotherapy. Of the 53 patients who did not receive chemotherapy, all were deemed not suitable. 23 of 71 patients (32.4%) developed a loco-regional relapse, either in the bladder (n = 18), pelvic lymph nodes (n = 4), or on cytology alone (n = 1). 24 patients (33.8%) developed distant metastases, only 7 of these were fit for palliative chemotherapy. The median progression-free survival (PFS) was 17 months (95% C.I. 10 – 34 months). Neoadjuvant and concurrent chemotherapy use was not associated with an increased PFS (p = 0.99 and p = 0.97, log rank). The median overall survival was 18 months (95% C.I. 14 – 27 months).

Conclusions:

The authors concluded that RT produces favorable outcomes for elderly patients and is reasonably well tolerated without significant toxicities. Use of concurrent systemic therapy did not significantly improve outcomes, however, the sample size was quite small.


Presented by: James Price, Derby Teaching Hospitals/ NHS Foundation Trust, Derby, United Kingdom

Co Authors: Mayuran Sivanandan, Rania Elmusharaf, Prabir R Chakraborti, Mike Smith-Howell, Prantik Das; Derby Teaching Hospitals/ NHS Foundation Trust, Derby, United Kingdom

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA
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