Palliative Intra-Arterial Chemotherapy Without Radiotherapy for Elderly Patients With Muscle-Invasive Bladder Cancer:...

Area of Science:

• Oncology
• Geriatric Medicine
• Urologic Oncology

Background:

• Elderly patients with muscle-invasive bladder cancer (MIBC) face treatment challenges due to radical cystectomy (RC) invasiveness and systemic therapy intolerance.
• Intra-arterial chemotherapy (IAC) shows potential for local tumor control, but its use without concurrent radiation is understudied.

Purpose of the Study:

• To evaluate the clinical efficacy of palliative intra-arterial chemotherapy (P-IAC) without radiotherapy in elderly MIBC patients.
• To compare outcomes of P-IAC with radical cystectomy (RC) and best supportive care (BSC).

Main Methods:

• Retrospective analysis of 137 elderly patients (≥70 years) with MIBC treated between 2010 and 2025.
• Patients were divided into three groups: P-IAC (n=43), RC (n=51), and BSC (n=43).
• Outcomes assessed included overall survival (OS), symptom-free survival (SFS), and treatment-related adverse events.

Main Results:

• P-IAC significantly improved SFS and OS compared to BSC (p<0.001 and p=0.01, respectively).
• No significant difference in OS was observed between P-IAC and RC (p=0.08).
• Approximately 67% of P-IAC patients remained event-free at 60 months; many achieved bladder preservation without urinary diversion, with manageable adverse events and no treatment-related mortality.

Conclusions:

• P-IAC without radiotherapy is a promising treatment for elderly MIBC patients unfit for RC or systemic therapy.
• P-IAC offers oncologic benefits and preserves quality of life, including bladder preservation.
• Further prospective studies and protocol standardization are warranted to validate these findings.