Outcomes and profiles of elderly patients receiving definitive radiotherapy for muscle-invasive bladder cancer at a tertiary medical center

Abstract Purpose To evaluate the outcomes and profiles of elderly patients with muscle-invasive bladder cancer (MIBC) treated with definitive radiotherapy (RT) +/- chemotherapy (CHT) at a tertiary medical center. Methods and Materials A retrospective study was conducted for elderly patients with MIBC who were ≥ 70 years old and underwent RT +/- CHT between 2000 and 2016. Overall survival (OS) was estimated using the Kaplan-Meier method. Disease-specific survival (DSS), cumulative incidence of progression, patterns of recurrence, and toxicities were examined. Univariate analyses were performed to identify variables associated with OS, DSS, and cumulative incidence of progression, using the Cox proportional hazards model. Results A total of 84 patients underwent definitive RT +/- CHT. Of these, only 29% were deemed medically fit to undergo radical cystectomy (RC), while the remainder were medically unfit and/or had surgically unresectable disease. Median age was 81 years. Sixty-one percent, 29%, and 11% had clinical stage II, III, and IV disease, respectively. Eighty-six percent had maximal TURBT prior to RT. Seventy-three percent received CHT with RT, and 27% had RT alone. Median follow-up was 5.7 years. Median OS was 1.9 years. OS was 42% and 25%, and DSS was 64% and 54% at 3 and 5 years, respectively. On univariate analysis, medical fitness to undergo RC, receipt of CHT, lower T stage, and maximal TURBT were associated with better OS; lower T stage was associated with better DSS. The cumulative incidence of progression was 44% and 49% at 3 and 5 years, respectively. Late grade 3 GU and GI toxicity were 15% and 4%, respectively. None had grade 4 or 5 toxicity. Conclusions Elderly patients with MIBC referred for RT were often medically unfit or had a surgically unresectable tumor. In these medically compromised patients, definitive RT+/- CHT was well-tolerated and yielded encouraging treatment outcomes.