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Muscle-invasive bladder cancer (MIBC) typically affects older adults, with a median age at diagnosis of 73. Due to its aggressive disease course, definitive treatment is required. With curative-intent treatment, patients with muscle-invasive bladder cancer have an overall survival ranging from 48-57% with a cancer-specific survival ranging from 52-71% at 5 years.
Radical cystectomy (RC) +/- neoadjuvant chemotherapy (CHT) has been considered a standard of care for MIBC. However, RC carries a high incidence of perioperative complications, including a mortality rate of 1.5-3%. In addition, many elderly patients with bladder cancer suffer from additional comorbidities, prohibiting RC. These patients are often not offered other curative treatment options. Untreated patients with MIBC are at a very high risk of mortality, with five-year overall survival and cancer-specific survival of approximately 5% and 14%, respectively. Tri-modality therapy (TMT), incorporating maximal transurethral bladder tumor resection, radiotherapy, and CHT, is efficacious with a relatively low incidence of major toxicity for MIBC. As a result, TMT has been acknowledged as a viable alternative to RC, and an attractive option for elderly patients who often have major medical comorbidities and/or prefer bladder-preservation.
The object of this review is to discuss the utility, rationale, and efficacy of TMT in elderly patients, which can offer a curative treatment for life-threatening MIBC but also safeguard the quality of life with organ-preservation.
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