Abstract 702P
Background
Bladder cancer frequently affects older people. However, their management is not consensual since surgery is not always possible in case of geriatric fragility. Trimodal treatment (TMT) combining trans-urethral resection (TURB) plus radiochemotherapy would be a curative alternative to preserve the native bladder.
Methods
All patients from 75 years of age with muscle-invasive bladder cancer bladder (MIBC) stage T2-T3N0M0 treated with TMT by European Georges Pompidou oncologic team were analysed. After TURB, induction radiotherapy delivered 3 Gy per fraction twice daily on days 1-3, 15-17 including the bladder and the pelvis. Patients with biopsy-proven complete response after induction benefited from consolidation and those with persistent tumour underwent salvage cystectomy if possible. Consolidation radiotherapy targeted the bladder only and delivered 2.5 Gy per fraction twice daily on days 29-31, 42-44. Concurrent chemotherapy consisted in 5FU and platinum salts.
Results
Eighty-five pts (median age 80 years), stage T2-T3 were included. The median age adjusted Charlson score (ACCI) was 6 and 30% were undernourished. After induction, the complete response rate was 81%. With a median follow-up of 63 months, overall survival (OS), specific survival (SS), survival with no invasive disease (NIDS) and no metastasis (NMS) at 3 years were 72%, 82.5%, 78.4% and 84.9%, at 5 years were 61%, 77%, 71.6% and 82.9% respectively. Preserved bladder survival (PBS) rate was 70 % at 5 years. An ACCI ≥ 6 (HR 0.3; p=0.044) and undernutrition (HR 1.9; p=0.032) significantly impacted OS. A tumor residue after induction had a pejorative impact on survival: SS (HR 3.6; p=0.008), NIDS (HR 3.6; p= 0.018) and NMS (HR 3.3; p=0.003). Late grade ≥ 3 urinary and gastrointestinal toxicities were 2.6% and 1.3%, respectively.
Conclusions
We report here the largest series of bladder preservation in elderly. Undernutrition, ACCI ≥ 6 and presence of a tumor residue after the induction phase are adverse prognostic factors. TMT with HFTD radiation therapy schedule appears to be effective and well tolerated in selected pts.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.