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Thomas Flaig, MD


Bladder Preservation in Geriatric Patients With Muscle-Invasive Bladder Cancer

By: Cordi Craig, MS
Posted: Tuesday, August 2, 2022

Bladder cancer occurs primarily in older adults, and although cystectomy is the therapeutic standard, surgery is not always appropriate for patients with geriatric conditions and comorbidities. A report, published in the Journal of Geriatric Oncology, suggested that trimodal treatment combining transurethral resection of the bladder tumor followed by concurrent chemoradiation therapy may be a curative alternative in older patients with muscle-invasive bladder cancer who are unfit for full cystectomy. According to the investigators, this report is the largest series of bladder preservation for patients aged 75 and older in a curative intent.

“With advancing age, patients seemed to benefit less and less from cystectomy,” stated Aurélia Alati, MD, of the University of Paris Descartes, and colleagues. “Bladder preservation requires very regular endoscopic monitoring to detect recurrences early.”

The study authors retrospectively analyzed patients aged 75 and older with nonmetastatic muscle-invasive bladder cancer who received trimodal treatment by the Georges Pompidou European Hospital team. Induction chemoradiation combined hypofractionated radiotherapy targeting the bladder and pelvis with concurrent platinum salt and fluorouracil. Patients with a biopsy-proven complete response after induction therapy received consolidation chemoradiation. Those patients with persistent tumors underwent salvage cystectomy. The researchers evaluated 85 patients from 1988 to 2017.

After induction therapy, the complete response rate was 83.5%. With a median follow-up of 63 months, the 5-year overall survival rate was 61%; long-term toxicity was acceptable, noted the study authors. The cancer-specific survival, invasive recurrence–free survival, metastasis-free survival, and survival with the bladder preserved rates were 77.6%, 71%, 82.9%, and 70.2% respectively. A persistent tumor after induction therapy significantly impacted cancer-specific survival (P = .023), metastasis-free survival (P = .018), and survival with the bladder preserved (P = .004).

Disclosure: The study authors reported no conflicts of interest.

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