to investigate the feasibility, efficacy, and safety of trimodal therapy (TMT) using a bifractionated split-course hypofractionated radiation therapy for nonmetastatic muscle-invasive bladder (MIBC) cancer in elderly patients.
we retrospectively reviewed the characteristics and outcomes of patients over 75 years old with nonmetastatic MIBC suitable or not for radical cystectomy (RC) and treated with transurethral resection of bladder tumor followed by concomitant radiochemotherapy (platinum salt and 5-fluorouracil) at two institutions (Saint Louis Hospital, Paris, France and European Georges Pompidou Hospital, Paris, France) between 1990 and 2021. Radiation therapy consisted of an adapted bifractionated split-course hypofractionated radiation therapy. Acute toxicities were reported according to CTCAE v5.0 and late toxicities were reported according to the RTOG/EORTC late radiation morbidity scoring schema. The primary end point was overall survival. Secondary end points included others survivals outcomes and safety.
122 patients were identified, with a median follow-up of 51.1 months (range: 0.5-210.8). 83.5 % of patients completed radiochemotherapy. The overall survival was 61.7 % at 3 years and 51.2 % at 5 years. In multivariate analysis, the completion of radiation therapy and concomitant chemotherapy were significantly associated with better overall survival and specific survival. For patients fit for RC, a complete histologic response was achieved for 77 patients (91.7 %) with radiochemotherapy and the bladder conservation rate was 90.5 %. Acute and late grade 3 or higher toxicities were below 5%.
bifractionated split-course hypofractionated radiation therapy with concomitant chemotherapy regimen appears to be well-tolerated and effective. Trimodal treatment seems to be a curative option for elderly patients unfit for radical surgery compared with palliative care and may contribute to improved survival in these patients.
BJU international. 2023 Feb 06 [Epub ahead of print]
Fabien Mignot, Emmanuelle Fabiano, Evanguelos Xylinas, Aurélia Alati, Arnaud Méjean, Alexandra Masson-Lecomte, Jean-François Hermieu, François Desgrandchamps, Christophe Hennequin, Catherine Durdux, Laurent Quéro
Department of Radiation Oncology, Saint Louis Hospital, AP-, HP, 75010, Paris, France., Department of Radiation Oncology, European George Pompidou Hospital, AP-, HP, 75015, Paris, France., Department of Urology, Bichat-Claude Bernard Hospital, AP-, HP, 75018, Paris, France., Department of Urology, European George Pompidou Hospital, AP-, HP, 75015, Paris, France., Department of Urology, Saint Louis Hospital, AP-, HP, 75010, Paris, France.