Department of Radiation Oncology, National University Cancer Institute, Singapore.
Department of Radiation Oncology, National University Cancer Institute, Singapore.
J Geriatr Oncol. 2019 Mar;10(2):292-297. doi: 10.1016/j.jgo.2018.10.015. Epub 2019 Jan 8.
Muscle invasive bladder cancer (MIBC) is prevalent in the older patients, who are a vulnerable population with multiple co-morbidities and at increased risk of complications. Radical cystectomy is often not suitable, hence radical radiotherapy (RT) is an alternative option. We reviewed the outcomes of older patients treated with RT with or without concurrent chemotherapy (CRT) at our institution.
We retrospectively reviewed patients aged 65 years and above treated with radical RT for MIBC at our institution between March 2002 to January 2017. Data was collected from institutional medical records and RT databases. The primary outcome was 2- and 5-year overall survival (OS), recurrence free survival (RFS), and toxicities. Univariate cox proportional hazard regression models were performed to identify independent factors with significant impact on survival.
We identified 45 patients (34 males, 11 females) with a median age of 77 years (range 65-95). All patients received maximal transurethral resection of the bladder tumour prior to RT. Median dose of total RT was 64 Gy (range 50-69.8 Gy). Twenty one patients (47%) received CRT. Planned treatment was completed in 42 (93.3%) patients. Median follow-up was 31 months (range 1-147 months). The 2- and 5-year OS was 64% and 44%, respectively. The 2- and 5-year RFS was 68% and 49%, respectively. Median RFS was 34 months (range 8-121 months). Median OS was 56 months (range 18-100 months). Univariate analysis showed that performance status (0-1 vs. 2-3; HR 2.7, 95% CI 1.07-6.8, p = 0.035) and International Society of Geriatric Oncology (SIOG) group (≤2 vs. >2; HR 3.23, 95% CI 1.12-8.64, p = 0.019) were significantly associated with increased hazard for death. One patient (2%) had grade 3 cystitis.
Radical RT is well tolerated in older patients with MIBC. We report outcomes similar to published data. Older patients should be considered for curative treatment despite their age. However, careful selection is warranted as frail patients (PS ≥2; SIOG >2) may benefit less.
肌层浸润性膀胱癌（MIBC）在老年患者中较为常见，这些患者是一个脆弱的群体，患有多种合并症，且并发症风险增加。根治性膀胱切除术通常不适用，因此根治性放疗（RT）是一种替代选择。我们回顾了在我院接受 RT 治疗（包括放化疗联合治疗）的老年 MIBC 患者的治疗效果。
我们回顾性分析了 2002 年 3 月至 2017 年 1 月期间，在我院接受根治性 RT 治疗的年龄在 65 岁及以上的 MIBC 患者的资料。数据来自机构病历和 RT 数据库。主要研究终点为 2 年和 5 年总生存率（OS）、无复发生存率（RFS）和毒性。采用单因素 COX 比例风险回归模型确定对生存有显著影响的独立因素。
我们共纳入了 45 名患者（34 名男性，11 名女性），中位年龄为 77 岁（范围 65-95 岁）。所有患者在 RT 前均接受了最大经尿道膀胱肿瘤切除术。中位全剂量 RT 为 64 Gy（范围 50-69.8 Gy）。21 名患者（47%）接受了放化疗联合治疗。42 名（93.3%）患者完成了计划治疗。中位随访时间为 31 个月（范围 1-147 个月）。2 年和 5 年 OS 分别为 64%和 44%。2 年和 5 年 RFS 分别为 68%和 49%。中位 RFS 为 34 个月（范围 8-121 个月）。中位 OS 为 56 个月（范围 18-100 个月）。单因素分析显示，体能状态（0-1 分与 2-3 分；HR 2.7，95%CI 1.07-6.8，p=0.035）和国际老年肿瘤学会（SIOG）评分（≤2 分与＞2 分；HR 3.23，95%CI 1.12-8.64，p=0.019）与死亡风险增加显著相关。1 名患者（2%）出现 3 级膀胱炎。
根治性 RT 治疗 MIBC 老年患者耐受性良好。我们报告的结果与已发表的数据相似。尽管患者年龄较大，但应考虑对其进行根治性治疗。然而，由于体弱患者（PS≥2；SIOG＞2）获益可能较少，因此需要谨慎选择。
