Hemostatic Efficacy and Clinical Outcomes of Radiotherapy in Older Adult Patients With Advanced Bladder Cancer and Hematuria Unsuitable for Standard Treatment

BACKGROUND Older adult patients with advanced bladder cancer and frailty or comorbidities are often unsuitable for surgery or systemic therapy and may present with persistent gross hematuria and severe urinary symptoms. This study evaluated the hemostatic efficacy and clinical value of radiotherapy in this population. MATERIAL AND METHODS This retrospective study included 49 older adult patients with advanced bladder cancer and hemorrhagic hematuria, with a mean age of 78.3±6.4 years. All patients had pathologically confirmed urothelial carcinoma of the bladder and persistent hematuria and were unsuitable for surgery or chemotherapy. After thorough communication and written informed consent, radiotherapy was administered. Outcomes included hemostatic efficacy, overall survival, and adverse events. RESULTS Bleeding decreased after 5 fractions of radiotherapy with a cumulative dose of 10 Gy. After 10 fractions and 20 Gy, urinary irritation symptoms improved or resolved, and bladder irrigation was discontinued. After 15 fractions and 30 Gy, gross hematuria disappeared in all patients, with a hemostatic response rate of 100%. After 4 weeks and 40 Gy, patients were re-evaluated; 40 continued dose escalation, including 13 who discontinued at 52 to 56 Gy and 27 who completed 62 to 72 Gy. At follow-up, 24 patients had died and 25 remained alive. Median overall survival was 14 months. Exploratory univariate analysis showed different overall survival between radical-dose and palliative-dose radiotherapy. CONCLUSIONS Radiotherapy was associated with effective hematuria control, urinary symptom relief, and acceptable clinical value in older adult patients with advanced bladder cancer. Larger controlled studies are needed to validate these findings.