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• W2329815519 abstract "The American Cancer Society reports that fifty-four percent of patients who are diagnosed with muscle invasive bladder cancer (MIBC) in the United States are over the age of 70. Only 50% of those over 70 years receive potentially curative therapy (radical cystectomy, chemoradiation, definitive radiation) for their disease, suggesting that a large proportion of patients are underserved and undertreated. To address this unmet need, we examined the success of chemoradiation in the elderly. We conducted an updated analysis of 416 patients diagnosed with cT2-T4a disease treated on successive prospective protocols at our institution between 1986 and 2008. Patients underwent induction cisplatin-based chemoradiation (40 Gy) after transurethral resection of bladder tumor (TURBT). Those patients achieving a complete response (CR) received consolidation chemoradiation to a total goal dose of 64-65 Gy. Those with less than a CR or an invasive recurrence were recommended to undergo subsequent salvage cystectomy. For the purpose of this analysis, elderly was defined as 75 years or older. Disease-specific survival (DSS) was evaluated using Kaplan-Meier method and Cox proportional hazards regression. Median age at diagnosis was 66.8 years (range, 27-88). Median follow-up for the entire cohort was 4.9 years and 8.6 years for surviving patients. Ninety-three patients (22%) were 75 years or older. The elderly had a CR rate of 67% compared to 77% for the younger population (p = 0.07). DSS at 5-, 10-, and 15-years for the elderly was 60.1%, 55.7%, 51.1%; and for the younger population was 68.6%, 61.3%, and 59.6 %, respectively (p = 0.2). Of those 299 patients who had a CR to induction therapy, 219 (73.2%) completed consolidation chemoradiation to the full dose, 184 (76.7%) in the younger population and 35 (59.3%) in the elderly (p = 0.009). On a univariate analysis for DSS, the following variables were statistically significant: low clinical T stage (p < 0.001), visibly complete TURBT (p = 0.02), and CR to induction therapy (p < 0.001). On multivariable Cox regression analyses, low clinical T-stage (p = 0.002) and CR to induction therapy (p < 0.001) remained significantly associated with improved DSS. Age at diagnosis did not significantly influence DSS (p = 0.3). In elderly patients with MIBC, bladder-sparing cisplatin-based chemoradiation is effective in terms of response rates and DSS. These results indicate that clinicians should not deny patients potentially curative therapies based on age alone, although further investigation into regimens of enhanced tolerability (such as concurrent 5FU/mitomycin-C) is warranted." @default.
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• W2329815519 date "2013-10-01" @default.
• W2329815519 modified "2023-10-14" @default.
• W2329815519 title "Outcomes of Selective Bladder Preservation in the Elderly Treated With Conservative Surgery and Chemoradiation" @default.
• W2329815519 doi "https://doi.org/10.1016/j.ijrobp.2013.06.216" @default.
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