Management of muscle-invasive bladder cancer in the elderly.
Bladder cancer is rare in patients below the age of 50 years, and most patients are in their 60s and 70s. Radical cystectomy is the preferred approach for patients with localized disease in most European countries and the USA, and evidence is growing in favor of neoadjuvant, platinum-based chemotherapy for patients at high risk of local and systemic relapse. Transurethral resection (TUR) followed by radiotherapy with or without concomitant chemotherapy appears to be a reasonable alternative, particularly in the UK and Canada. However, the elderly pose several treatment dilemmas, including the increased risk of perioperative complications, the management of orthotopic neobladder or different types of urinary diversion, as well as the higher risk of adverse events caused by pelvic radiotherapy and systemic chemotherapy. Multidimensional parameters such as biologic prognostic factors, performance status, functional independence, comorbidities and cognitive function of the patient should be collected in order to tailor treatment to the patient's life expectancy and preferences. Optimized integration of TUR followed by bladder removal (or radiotherapy), with or without adjunctive chemotherapy, can be recommended for otherwise healthy patients. Palliative measures, such as TUR followed by external radiotherapy alone or monochemotherapy, should be reserved for partially impaired patients with moderate comorbidities, in order to maximize the balance of benefits and toxicities. This review summarizes recent data concerning surgery, radiotherapy and systemic chemotherapy for bladder cancer in the elderly, and discusses pros and cons of the currently available therapeutic options.
Basso
Umberto
U
Department of Medical Oncology, Ospedale Busonera, via Gattamelata 64, Azienda Ospedale-University, 35100 Padova, Italy. u.basso@tin.it
Bassi
Pierfrancesco
P
Sava
Teodoro
T
Monfardini
Silvio
S
D000367:Age Factors; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D015653:Cystectomy; D015577:Geriatric Assessment; D006304:Health Status; D006801:Humans; D018482:Muscle, Skeletal / Q000473:pathology; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D010347:Patient Care Planning; D018714:Radiotherapy, Adjuvant; D012307:Risk Factors; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*