Radiation-based, multi-modality therapy for elderly patients with muscle-invasive bladder cancer: Utility, Rationale, and Efficacy Utility, Rationale, and Efficacy
Main Article Content
Abstract
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.
Keywords:
Bladder cancer, tri-modality therapy (TMT), radical cystectomy (RC), elderly
Article Details
How to Cite
GERGELIS, Kimberly R; BREEN, William G; CHOO, Richard.
Radiation-based, multi-modality therapy for elderly patients with muscle-invasive bladder cancer: Utility, Rationale, and Efficacy.
Medical Research Archives, [S.l.], v. 10, n. 1, jan. 2022.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/2647>. Date accessed: 21 nov. 2024.
doi: https://doi.org/10.18103/mra.v10i1.2647.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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2. Society AC. Key Statistics for Bladder Cancer. 2021.
3. Nielsen ME, Smith AB, Meyer AM, Kuo TM, Tyree S, Kim WY, et al. Trends in stage-specific incidence rates for urothelial carcinoma of the bladder in the United States: 1988 to 2006. Cancer. 2014;120(1):86-95.
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5. Mak RH, Hunt D, Shipley WU, Efstathiou JA, Tester WJ, Hagan MP, et al. Long-term outcomes in patients with muscle-invasive bladder cancer after selective bladder-preserving combined-modality therapy: a pooled analysis of Radiation Therapy Oncology Group protocols 8802, 8903, 9506, 9706, 9906, and 0233. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2014;32(34):3801-9.
6. Grossman HB, Natale RB, Tangen CM, Speights VO, Vogelzang NJ, Trump DL, et al. Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. The New England journal of medicine. 2003;349(9):859-66.
7. Martini A, Sfakianos JP, Renström-Koskela L, Mortezavi A, Falagario UG, Egevad L, et al. The natural history of untreated muscle-invasive bladder cancer. BJU Int. 2020;125(2):270-5.
8. Shabsigh A, Korets R, Vora KC, Brooks CM, Cronin AM, Savage C, et al. Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. European urology. 2009;55(1):164-74.
9. Schiffmann J, Gandaglia G, Larcher A, Sun M, Tian Z, Shariat SF, et al. Contemporary 90-day mortality rates after radical cystectomy in the elderly. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2014;40(12):1738-45.
10. Gray PJ, Fedewa SA, Shipley WU, Efstathiou JA, Lin CC, Zietman AL, et al. Use of potentially curative therapies for muscle-invasive bladder cancer in the United States: results from the National Cancer Data Base. European urology. 2013;63(5):823-9.
11. Tran E, Souhami L, Tanguay S, Rajan R. Bladder conservation treatment in the elderly population: results and prognostic factors of muscle-invasive bladder cancer. American journal of clinical oncology. 2009;32(4):333-7.
12. Tyson MD, 2nd, Barocas DA. Quality of Life After Radical Cystectomy. Urol Clin North Am. 2018;45(2):249-56.
13. Herr HW, Faulkner JR, Grossman HB, Natale RB, deVere White R, Sarosdy MF, et al. Surgical factors influence bladder cancer outcomes: a cooperative group report. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2004;22(14):2781-9.
14. Dash A, Pettus JAt, Herr HW, Bochner BH, Dalbagni G, Donat SM, et al. A role for neoadjuvant gemcitabine plus cisplatin in muscle-invasive urothelial carcinoma of the bladder: a retrospective experience. Cancer. 2008;113(9):2471-7.
15. Neoadjuvant cisplatin, methotrexate, and vinblastine chemotherapy for muscle-invasive bladder cancer: a randomised controlled trial. International collaboration of trialists. Lancet (London, England). 1999;354(9178):533-40.
16. Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992;111(5):518-26.
17. Parekh DJ, Reis IM, Castle EP, Gonzalgo ML, Woods ME, Svatek RS, et al. Robot-assisted radical cystectomy versus open radical cystectomy in patients with bladder cancer (RAZOR): an open-label, randomised, phase 3, non-inferiority trial. Lancet (London, England). 2018;391(10139):2525-36.
18. Smith AB, Jaeger B, Pinheiro LC, Edwards LJ, Tan HJ, Nielsen ME, et al. Impact of bladder cancer on health-related quality of life. BJU Int. 2018;121(4):549-57.
19. Shipley WU, Prout GR, Jr., Kaufman SD, Perrone TL. Invasive bladder carcinoma. The importance of initial transurethral surgery and other significant prognostic factors for improved survival with full-dose irradiation. Cancer. 1987;60(3 Suppl):514-20.
20. Kulkarni GS, Hermanns T, Wei Y, Bhindi B, Satkunasivam R, Athanasopoulos P, et al. Propensity Score Analysis of Radical Cystectomy Versus Bladder-Sparing Trimodal Therapy in the Setting of a Multidisciplinary Bladder Cancer Clinic. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2017;35(20):2299-305.
21. Gofrit ON, Nof R, Meirovitz A, Pode D, Frank S, Katz R, et al. Radical cystectomy vs. chemoradiation in T2-4aN0M0 bladder cancer: a case-control study. Urologic oncology. 2015;33(1):19.e1-.e5.
22. James ND, Hussain SA, Hall E, Jenkins P, Tremlett J, Rawlings C, et al. Radiotherapy with or without chemotherapy in muscle-invasive bladder cancer. The New England journal of medicine. 2012;366(16):1477-88.
23. Boustani J, Bertaut A, Galsky MD, Rosenberg JE, Bellmunt J, Powles T, et al. Radical cystectomy or bladder preservation with radiochemotherapy in elderly patients with muscle-invasive bladder cancer: Retrospective International Study of Cancers of the Urothelial Tract (RISC) Investigators. Acta oncologica (Stockholm, Sweden). 2018;57(4):491-7.
24. Gergelis KR, Kreofsky CR, Choo CS, Viehman J, Harmsen WS, Lester SC, et al. Outcomes and Profiles of Older Patients Receiving Definitive Radiation Therapy for Muscle-Invasive Bladder Cancer at a Tertiary Medical Center. Pract Radiat Oncol. 2020;10(5):e378-e87.
25. Bonet M, Bonfill T, Nuñez M, De Verdonces L, Mur E, Gallardo E, et al. Curative radiation therapy for very elderly bladder cancer patients with localized disease. Clin Transl Oncol. 2018;20(7):899-905.
26. Ploussard G, Daneshmand S, Efstathiou JA, Herr HW, James ND, Rödel CM, et al. Critical analysis of bladder sparing with trimodal therapy in muscle-invasive bladder cancer: a systematic review. European urology. 2014;66(1):120-37.
27. Rödel C, Grabenbauer GG, Kühn R, Papadopoulos T, Dunst J, Meyer M, et al. Combined-modality treatment and selective organ preservation in invasive bladder cancer: long-term results. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2002;20(14):3061-71.
28. Coen JJ, Zhang P, Saylor PJ, Lee CT, Wu CL, Parker W, et al. Bladder Preservation With Twice-a-Day Radiation Plus Fluorouracil/Cisplatin or Once Daily Radiation Plus Gemcitabine for Muscle-Invasive Bladder Cancer: NRG/RTOG 0712-A Randomized Phase II Trial. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2019;37(1):44-51.
29. Shipley WU, Winter KA, Kaufman DS, Lee WR, Heney NM, Tester WR, et al. Phase III trial of neoadjuvant chemotherapy in patients with invasive bladder cancer treated with selective bladder preservation by combined radiation therapy and chemotherapy: initial results of Radiation Therapy Oncology Group 89-03. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 1998;16(11):3576-83.
30. Hagan MP, Winter KA, Kaufman DS, Wajsman Z, Zietman AL, Heney NM, et al. RTOG 97-06: initial report of a phase I-II trial of selective bladder conservation using TURBT, twice-daily accelerated irradiation sensitized with cisplatin, and adjuvant MCV combination chemotherapy. International journal of radiation oncology, biology, physics. 2003;57(3):665-72.
31. Kaufman DS, Winter KA, Shipley WU, Heney NM, Chetner MP, Souhami L, et al. The initial results in muscle-invading bladder cancer of RTOG 95-06: phase I/II trial of transurethral surgery plus radiation therapy with concurrent cisplatin and 5-fluorouracil followed by selective bladder preservation or cystectomy depending on the initial response. Oncologist. 2000;5(6):471-6.
32. Kaufman DS, Winter KA, Shipley WU, Heney NM, Wallace HJ, 3rd, Toonkel LM, et al. Phase I-II RTOG study (99-06) of patients with muscle-invasive bladder cancer undergoing transurethral surgery, paclitaxel, cisplatin, and twice-daily radiotherapy followed by selective bladder preservation or radical cystectomy and adjuvant chemotherapy. Urology. 2009;73(4):833-7.
33. Mitin T, Hunt D, Shipley WU, Kaufman DS, Uzzo R, Wu CL, et al. Transurethral surgery and twice-daily radiation plus paclitaxel-cisplatin or fluorouracil-cisplatin with selective bladder preservation and adjuvant chemotherapy for patients with muscle invasive bladder cancer (RTOG 0233): a randomised multicentre phase 2 trial. The Lancet Oncology. 2013;14(9):863-72.
34. Weiss C, Engehausen DG, Krause FS, Papadopoulos T, Dunst J, Sauer R, et al. Radiochemotherapy with cisplatin and 5-fluorouracil after transurethral surgery in patients with bladder cancer. International journal of radiation oncology, biology, physics. 2007;68(4):1072-80.
35. Housset M, Maulard C, Chretien Y, Dufour B, Delanian S, Huart J, et al. Combined radiation and chemotherapy for invasive transitional-cell carcinoma of the bladder: a prospective study. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 1993;11(11):2150-7.
36. Lagrange JL, Bascoul-Mollevi C, Geoffrois L, Beckendorf V, Ferrero JM, Joly F, et al. Quality of life assessment after concurrent chemoradiation for invasive bladder cancer: results of a multicenter prospective study (GETUG 97-015). International journal of radiation oncology, biology, physics. 2011;79(1):172-8.
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