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Radiotherapy with Concurrent Chemotherapy is Effective, Feasible in Elderly Bladder Cancer Patients

Chemotherapy given concurrently with radiotherapy should be considered for patients with bladder cancer, aged 70 years and over, who are either inoperable or who strongly wish to avoid cystectomy, say researchers.

Previous studies have demonstrated that in selected patients, a bladder conservation approach using radiation and chemotherapy can offer survival similar to total cystectomy, and allows most survivors to retain a functional bladder. However, these studies involved younger subjects while bladder cancer also affects many older people.

To determine the tolerability of bladder-sparing radiotherapy with concurrent chemotherapy, John R. Goffin, MD, and colleagues of McGill University Health Centre, Montreal General Hospital, Quebec, Canada, performed a retrospective study in patients 70 years or older with locally invasive bladder cancer (stage T2-T4a, N0, M0).

Records included in the study were associated with 14 patients, median age of 79 years, who underwent bladder-sparing treatment either due to ineligibility for cystectomy or refusal of surgery and subsequently treated with curative intent with radiation and cisplatin-based chemotherapy after transurethral resection of a bladder tumour.

Analysis revealed a median survival of 19 months at a median follow up of 17 months, with no recurrence at last follow up for 2 patients. Among first recurrences, 5 cases were local, 4 cases were metastatic, and 3 additional cases were probably metastatic.

All patients had at least mild toxicity, with 43% having grade III to IV toxicity. Gastrointestinal toxicity occurred in 78.5% of patients, but only 3 of these patients had grade III toxicities and none had grade IV. Approximately 64.3% experienced haematologic toxicities, including 1 patient with grade IV neutropaenia. Grade III heart failure induced by cisplatin hydration occurred in 1 patient.

Chemotherapy was discontinued for 2 patients and 5 patients required dose reductions due to toxicity. According to Dr. Goffin and colleagues, the observed toxicity rates were comparable to those reported in patients with median ages of less than 70 years.

"In the absence of a randomized trial, radical cystectomy must be considered the standard of care," the researchers note. "However, our study shows that bladder-sparing radiotherapy with concurrent chemotherapy is feasible in patients 70 or more years with good performance status."

Am J Clin Oncol 2004 Apr;27:2:172-7. "Tolerance of radiotherapy and chemotherapy in elderly patients with bladder cancer"

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