Clinical outcomes of adapted hypofractionated radiotherapy for bladder cancer in elderly patients

ObjectiveTo investigate the feasibility, efficacy, and safety of trimodal therapy (TMT) using a bifractionated split-course hypofractionated radiotherapy (RT) for non-metastatic muscle-invasive bladder cancer (MIBC) in elderly patients. Patients and MethodsWe retrospectively reviewed the characteristics and outcomes of patients aged >75 years with non-metastatic MIBC suitable or not for radical cystectomy (RC) and treated with transurethral resection of bladder tumour followed by concomitant radio-chemotherapy (platinum salt and 5-fluorouracil) at two institutions (Saint Louis Hospital, Paris, France and European Georges Pompidou Hospital, Paris, France) between 1990 and 2021. RT consisted of an adapted bifractionated split-course hypofractionated RT. Acute toxicities were reported according to Common Terminology Criteria for Adverse Events version 5.0 and late toxicities were reported according to the Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer late radiation morbidity scoring schema. The primary end-point was overall survival (OS). Secondary end-points included other survivals outcomes and safety. ResultsA total of 122 patients were identified, with a median (range) follow-up of 51.1 (0.5-210.8) months. In all, 83.5% of patients completed radio-chemotherapy. The OS rate was 61.7% at 3 years and 51.2% at 5 years. In multivariate analysis, the completion of RT and concomitant chemotherapy were significantly associated with better OS and cancer-specific survival. For patients fit for RC, a complete histological response was achieved for 77 patients (91.7%) with radio-chemotherapy and the bladder conservation rate was 90.5%. Acute and late Grade >= 3 toxicities were Bifractionated split-course hypofractionated RT 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.

Automated summary

This study retrospectively reviewed the outcomes of 122 elderly patients with non-metastatic muscle-invasive bladder cancer treated with trimodal therapy using bifractionated split-course hypofractionated radiotherapy and chemotherapy. The results showed that trimodal therapy was feasible, effective, and safe, with a 3-year overall survival rate of 61.7% and a 5-year overall survival rate of 51.2%. Completion of radiotherapy and concomitant chemotherapy were significantly associated with better overall survival and cancer-specific survival. For patients fit for radical cystectomy, a high complete histological response rate and bladder conservation rate were achieved. Trimodal therapy appears to be a curative option for elderly patients unfit for radical surgery and may improve their survival compared to palliative care.