Radical cystectomy or bladder preservation with radiochemotherapy in elderly patients with muscle-invasive bladder cancer: Retrospective International Study of Cancers of the Urothelial Tract (RISC) Investigators.

Radical cystectomy (RC) and radiochemotherapy (RCT) are curative options for muscle-invasive bladder cancer (MIBC). Optimal treatment strategy remains unclear in elderly patients.

Patients aged 80 years old and above with T2-T4aN0-2M0-Mx MIBC were identified in the Retrospective International Study of Cancers of the Urothelial Tract (RISC) database. Patients treated with RC were compared with those treated with RCT. The impact of surgery on overall survival (OS) was assessed using a Cox proportional hazard model. Progression included locoregional and metastatic relapse and was considered a time-dependent variable.

Between 1988 and 2015, 92 patients underwent RC and 72 patients had RCT. Median age was 82.5 years (range 80-100) and median follow-up was 2.90 years (range 0.04-11.10). Median OS was 1.99 years (95%CI 1.17-2.76) after RC and 1.97 years (95%CI 1.35-2.64) after RCT (p = .73). Median progression-free survival (PFS) after RC and RCT were 1.25 years (95%CI 0.80-1.75) and 1.52 years (95%CI 1.01-2.04), respectively (p = .54). In multivariate analyses, only disease progression was significantly associated with worse OS (HR = 10.27 (95%CI 6.63-15.91), p < .0001). Treatment modality was not a prognostic factor.

RCT offers survival rates comparable to those observed with RC for patients aged ≥80 years.

Acta oncologica (Stockholm, Sweden). 2017 Aug 30 [Epub ahead of print]

Jihane Boustani, Aurélie Bertaut, Matthew D Galsky, Jonathan E Rosenberg, Joaquim Bellmunt, Thomas Powles, Federica Recine, Lauren C Harshman, Simon Chowdhury, Guenter Niegisch, Evan Y Yu, Sumanta K Pal, Ugo De Giorgi, Simon J Crabb, Matthieu Caubet, Loïc Balssa, Matthew I Milowsky, Sylvain Ladoire, Gilles Créhange, Retrospective International Study of Cancers of the Urothelial Tract (RISC) Investigators

a Department of Radiation Oncology , University Hospital of Besançon , Besançon , France., b Department of Biostatistics , Georges François Leclerc Center, University of Burgundy , Dijon , France., c Icahn School of Medicine at Mount Sinai , New York , NY , USA., d Memorial Sloan Kettering Cancer Center , New York , NY , USA., e Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School , Boston , MA , USA., f Barts Cancer Institute ECMC, Barts Health and the Royal Free NHS Trust, Queen Mary University of London , London , UK., g Medical Oncology Department , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS , Meldola , Italy., h Department of Medical Oncology , Dana-Farber Cancer Institute , Boston , MA , USA., i Guy's and St. Thomas' Hospital , London , UK., j Heinrich-Heine-University , Düsseldorf , Germany., k Fred Hutchinson Cancer Research Center , Seattle , WA , USA., l City of Hope Comprehensive Cancer Center , Duarte , CA , USA., m Department of Medical Oncology , Southampton General Hospital , Southampton , UK., n Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill , Chapel Hill , NC , USA., o Department of Medical Oncology , Georges François Leclerc Cancer Center, University of Burgundy , Dijon , France., p Department of Radiation Oncology , Georges François Leclerc Cancer Center, University of Burgundy , Dijon , France.