title: Radical chemoradiotherapy for elderly patients with bladder carcinoma invading muscle.
abstract: BACKGROUND
  Chemoradiotherapy is becoming an alternative to radical cystectomy among patients with bladder carcinoma invading muscle. In 1988, the authors began a protocol with methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC regimen) and radiotherapy for these patients. Traditionally, age has been considered a determinant factor thereby excluding the older patients from the oncologic protocols that are considered to be more aggressive. The authors analyzed 20 patients (age > 70 years) who were treated during this period with the same protocol as the authors' other patients.
  
  
  METHODS
  The study included 20 patients (age range, 70-78 years; median age, 74 years) including 4 patients with T2 disease, 9 with T3 disease, and 7 with T4 disease. All patients had a Karnofsky performance status of > 60. Treatment protocol included cytoreductive transurethral resection, 2 cycles of M-VAC chemotherapy, and radiotherapy (45 grays [Gy] on pelvic volume) with concurrent cisplatin (20 mg/m2 on Days 1-5. Response was determined by cystoscopic evaluation. If there was a complete response, radiotherapy continued until a total dose of 65 Gy; if there was not a complete response, cystectomy was performed.
  
  
  RESULTS
  Tumor response after a dose of 45 Gy included 11 complete responses (55%), 5 partial responses (25%), and 4 nonresponses (20%). Overall survival was 75%, 34%, and 27% in the 2nd, 3rd, and 5th years of follow-up, respectively. Cause specific survival was 79%, 54%, and 38%, respectively. Survival for patients with complete response was 100%, 60%, and 48%, respectively. Severe toxicity was uncommon, with the most frequent toxicities being leukopenia and cystitis. No treatment-related death occurred with either treatment protocol.
  
  
  CONCLUSIONS
  The age of the individual must not become a strict exclusion criterion for the radical treatment of old patients with invasive bladder carcinoma.
authors.affiliation: Service of Oncology, Hospital of Navarre, Pamplona, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Arias
authors.forename: M
authors.initials: M
authors.lastname: Dueñas
authors.forename: E
authors.initials: E
authors.lastname: Martínez
authors.forename: M A
authors.initials: MA
authors.lastname: Domínguez
authors.forename: J J
authors.initials: JJ
authors.lastname: Illarramendi
authors.forename: E
authors.initials: E
authors.lastname: Villafranca
authors.forename: M
authors.initials: M
authors.lastname: Tejedor
authors.forename: F
authors.initials: F
authors.lastname: Molina
authors.forename: R
authors.initials: R
authors.lastname: Meiriño
authors.forename: J J
authors.initials: JJ
authors.lastname: Valerdi
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002277:Carcinoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003131:Combined Modality Therapy; D004307:Dose-Response Relationship, Radiation; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D009132:Muscles / Q000473:pathology*; D009361:Neoplasm Invasiveness; D011878:Radiotherapy / Q000009:adverse effects; D016019:Survival Analysis; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D014747:Vinblastine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D014747:Vinblastine; D004317:Doxorubicin; D002945:Cisplatin; D008727:Methotrexate