Radiotherapy for Muscle-invasive Bladder Cancer in Very Elderly Patients

The standard therapy for muscle invasive bladder cancer (MIBC) is radical total cystectomy; however, radiotherapy (RT) is performed in patients who cannot tolerate surgery due to advanced age. This study aimed to retrospectively examine whether the feasibility of concurrent use of intra-arterial chemotherapy (IAC) can be assessed using both treatment results of RT for MIBC in elderly patients and the G8 Screening Tool.

We studied 16 patients who had received intra-arterial chemoradiotherapy (IACRT) or RT alone between February 2004 and December 2012. The median age was 83 (range=75-91) years. Twelve patients had stage II and 4 had stage III disease. Ten patients received IACRT and six received RT alone. In order to determine whether the G8 score distinguishes patients for treatment with IACRT or RT alone, we calculated the cut-off of the G8 score for addition of IAC.

The overall median G8 score was 12 (range=9-15), with scores of 13 (range=12-15) in the IACRT group and 10 (range=9-11) in the RT-alone group. The G8 score was 12 or more in all patients in the IACRT group. The median follow-up period was 35 (range=6-64) months. The 2- and 5-year overall survival rates were 80% and 66.7% in the IACRT group. The 1- and 2-year survival rates in the RT-alone group were 50% and 25%, respectively. Regarding late adverse events, only one patient experienced grade 2 genitourinary toxicity.

IACRT was considered to be useful for the treatment of MIBC in elderly patients, with tolerable adverse events. Moreover, used in conjunction with age and performance status, the G8 Screening Tool is potentially applicable for determining the feasibility of performing IAC. To our knowledge, this is the first report about the correlation between G8 score and feasibility of IAC.