Radiation-based, multi-modality therapy for elderly patients with muscle-invasive bladder cancer: Utility, Rationale, and Efficacy Utility, Rationale, and Efficacy

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Kimberly R Gergelis, MD William G Breen, MD Richard Choo, MD


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

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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: 03 dec. 2023. doi: https://doi.org/10.18103/mra.v10i1.2647.
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