title: Hypofractionated intensity modulated radiation therapy in combined modality treatment for bladder preservation in elderly patients with invasive bladder cancer.
abstract: OBJECTIVE
  To review our experience with bladder-preserving trimodality treatment (TMT) using hypofractionated intensity modulated radiation therapy (IMRT) for the treatment of elderly patients with muscle-invasive bladder cancer.
  
  
  METHODS
  Retrospective study of elderly patients treated with TMT using hypofractionated IMRT (50 Gy in 20 fractions) with concomitant weekly radiosensitizing chemotherapy. Eligibility criteria were as follows: age ≥70 years, a proven diagnosis of muscle-invasive transitional cell bladder carcinoma, stage T2-T3N0M0 disease, and receipt of TMT with curative intent. Response rate was assessed by cystoscopic evaluation and bladder biopsy.
  
  
  RESULTS
  24 patients with a median age of 79 years were eligible. A complete response was confirmed in 83% of the patients. Of the remaining patients, 1 of them underwent salvage cystectomy, and no disease was found in the bladder on histopathologic assessment. After a median follow-up time of 28 months, of the patients with a complete response, 2 patients had muscle-invasive recurrence, 1 experienced locoregional failure, and 3 experienced distant metastasis. The overall and cancer-specific survival rates at 3 years were 61% and 71%, respectively. Of the surviving patients, 75% have a disease-free and functioning bladder. All patients completed hypofractionated IMRT, and 19 patients tolerated all 4 cycles of chemotherapy. Acute grade 3 gastrointestinal or genitourinary toxicities occurred in only 4% of the patients, and acute grade 3 or 4 hematologic toxicities, liver toxicities, or both were experienced by 17% of the cohort. No patient experienced grade 4 gastrointestinal or genitourinary toxicity.
  
  
  CONCLUSIONS
  Hypofractionated IMRT with concurrent radiosensitizing chemotherapy appears to be an effective and well-tolerated curative treatment strategy in the elderly population and should be considered for patients who are not candidates for cystectomy or who wish to avoid cystectomy.
authors.affiliation: Department of Oncology, Division of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Guy-Anne
authors.initials: GA
authors.lastname: Turgeon
authors.affiliation: Department of Oncology, Division of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada. Electronic address: luis.souhami@muhc.mcgill.ca.
authors.forename: Luis
authors.initials: L
authors.lastname: Souhami
authors.affiliation: Department of Oncology, Division of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Fabio L
authors.initials: FL
authors.lastname: Cury
authors.affiliation: Department of Oncology, Division of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Sergio L
authors.initials: SL
authors.lastname: Faria
authors.affiliation: Department of Oncology, Division of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Marie
authors.initials: M
authors.lastname: Duclos
authors.affiliation: Department of Medical Oncology, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Sturgeon
authors.affiliation: Department of Urology, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D002945:Cisplatin / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000379:methods; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D059351:Organ Sparing Treatments / Q000379:methods*; D011838:Radiation-Sensitizing Agents / Q000627:therapeutic use; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D001743:Urinary Bladder; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D000093542:Gemcitabine
chemical_list: D011838:Radiation-Sensitizing Agents; D003841:Deoxycytidine; D002945:Cisplatin; D000093542:Gemcitabine