There is little evidence to guide treatment in elderly patients with muscle invasive bladder cancer (MIBC). We evaluated the efficacy and tolerability of concurrent radical radiotherapy with gemcitabine radiosensitisation (GemX) in elderly patients with MIBC and compared outcomes to those from the bladder carbogen and nicotinamide (BCON) phase III trial.
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Data were retrospectively analysed for patients who received GemX from two oncology centres in the UK. Elderly was defined as aged ≥75 at the start of GemX. Following transurethral resection of bladder tumour, patients received neo-adjuvant platinum-based chemotherapy followed by radiotherapy concurrently with weekly gemcitabine. A separate, age-specific analysis was performed in the BCON cohort. Overall survival (OS), disease specific survival (DSS) and local progression free survival (LPFS) were evaluated using Kaplan-Meier methodology and Cox proportional hazards regression.
Out of 167 patients who received GemX, 61 were elderly (36.5%) with a median age of 78 years. Elderly patients had worse performance status (p = 0.020) and co-morbidities (p = 0.030). A similar proportion of patients received planned dose radiotherapy in both groups (p = 0.260), although fewer elderly patients received all four cycles of concurrent chemotherapy (p = 0.017) due to toxicity. For OS, age had some prognostic power; HR 1.04 (95% CI 1.00-1.08; p = 0.068). Overall survival and LPFS in elderly patients were comparable between CON and GemX (HR 1.13, 95% CI 0.69-1.85; p = 0.616 and HR 0.85, 95% CI 0.41-1.74; p = 0.659 respectively).
Radiosensitisation is safe and effective and should be considered for fit elderly patients with MIBC.
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 2018 Jun 02 [Epub ahead of print]
Marianna Christodoulou, Kimberley J Reeves, Clare Hodgson, Anthi Zeniou, Finbar Slevin, Jason Kennedy, Peter J Hoskin, Ann Henry, Ananya Choudhury
Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom., Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, United Kingdom., Clinical Outcomes Unit, The Christie NHS Foundation Trust, Manchester, United Kingdom., Leeds Teaching Hospitals NHS Trust, St. James's Institute of Oncology, United Kingdom., Centre for Cancer Treatment, Mount Vernon Hospital, Middlesex, United Kingdom., Leeds Teaching Hospitals NHS Trust, St. James's Institute of Oncology, United Kingdom; The University of Leeds, United Kingdom., Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, United Kingdom. Electronic address: .