Radical therapy for muscle-infiltrating bladder cancer (cystectomy or radiotherapy): does age affect the final therapeutic benefit for the patient?
OBJECTIVE
To evaluate the therapeutic outcome of radical cystectomy and radical radiotherapy in patients with T2N0M0 clinical stage bladder cancer in relation to their age.


METHODS
Between 1995-2006, 119 patients with clinical stage T2N0M0 bladder cancer were treated with radical radiotherapy (group A) and were divided in 2 subgroups: >70 years old (A1) and <or=70 years old (A2). Between 1998-2006, 26 patients with the same clinical stage were treated with radical cystectomy (group B) (>70 years old/B1 subgroup and <or=70 years old/B2 subgroup). The following parameters were evaluated in both groups and subgroups: therapeutic outcome (overall survival/OS, local control, development of metastases) and tolerance (side effects and complications of each method). Kaplan-Meier method and log-rank test were used for statistical analyses.


RESULTS
All group B patients tolerated their treatment very well, without interruptions. The 3-year OS of groups A and B was 39 and 69%, respectively (p=0.032). The 3-year OS of subgroups A1 and A2 was 37.3 and 43.3%, respectively (p=0.085). In the cystectomy group B, 3-year OS of the subgroups was the same (B1: 68.6% and B2: 69.3%; p=0.10). Local control rate for the subgroups A1, A2, B1, B2 was 43, 40, 90 and 84%, respectively. Distant metastatic rate was 14.1, 20, 7.6 and 7.4% for subgroups A1, A2, B1, B2, respectively.


CONCLUSIONS
The results of both therapeutic methods in both age groups seem satisfactory. Very good tolerance was also observed. It seems that if a patient is not completely suitable for radical cystectomy or radical radiotherapy age should not be considered as an exclusion factor.
Kalogeras
D
D
Department of Urology, General Hospital of Ioannina G. Hatzikosta, University Hospital of Ioannina, Ioannina, Greece. dimikalo@gmail.com
Lampri
E
E
Goussia
A
A
Bai
M
M
Capizzello
A
A
Tassiou
I
I
Stavropoulos
N E
NE
Tsekeris
P
P
D000367:Age Factors; D000368:Aged; D003131:Combined Modality Therapy; D015653:Cystectomy; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D019042:Muscle Neoplasms / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D009367:Neoplasm Staging; D012189:Retrospective Studies; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*