title: Hypofractionated radiation therapy for treatment of bladder carcinoma in patients aged 90 years and more: A new paradigm to be explored?
abstract: BACKGROUND
  There are only scarce data on the optimal management of patients who present with a bladder carcinoma and who are aged 90 years and older.
  
  
  METHODS
  We retrospectively reviewed records from radiotherapy departments from two university hospitals, two private centers and one public center to identify patients who underwent radiotherapy for bladder cancer over the past decade and who were aged 90 years or older. From 2003 to 2013, 14 patients aged 90 years or older receiving RT for bladder malignant tumors were identified.
  
  
  RESULTS
  Mean age was 92.7 years. Ten patients (71 %) had a general health status altered (PS 2-3) at the beginning of RT. A total of 14 RT courses were delivered, including six treatments (43 %) with curative intent and eight treatments (57 %) with palliative intent. Palliative intent mainly encompassed hemostatic RT (36 %). At last follow-up, two patients (14 %) experienced complete response, one patient (7 %) experienced partial response, three patients (21 %) had their disease stable, and three patients (21 %) experienced tumor progression, of whom two patients with the progression of symptoms. There was no reported high-grade acute local toxicity in 14 patients (100 %). One patient experienced delayed grade 2 toxicity with pain and lower urinary tract symptoms. At last follow-up, seven patients (50 %) were deceased. Cancer was the cause of death for five patients.
  
  
  CONCLUSIONS
  Hypofractionated radiotherapy remains feasible for nonagenarians with bladder cancer. Further investigations including analysis of geriatric comorbidities and impact of treatments on quality of life should be conducted.
authors.affiliation: Département d'oncologie médicale, Institut de Cancérologie Lucien Neuwirth, 108 bis avenue Albert Raimond, BP60008, 42271, Saint Priest en Jarez Cedex, France.
authors.forename: Benoîte
authors.initials: B
authors.lastname: Méry
authors.forename: Alexander T
authors.initials: AT
authors.lastname: Falk
authors.forename: Avi
authors.initials: A
authors.lastname: Assouline
authors.forename: Jane-Chloé
authors.initials: JC
authors.lastname: Trone
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Guy
authors.forename: Romain
authors.initials: R
authors.lastname: Rivoirard
authors.forename: Pierre
authors.initials: P
authors.lastname: Auberdiac
authors.forename: Julien Langrand
authors.initials: JL
authors.lastname: Escure
authors.forename: Coralie
authors.initials: C
authors.lastname: Moncharmont
authors.forename: Guillaume
authors.initials: G
authors.lastname: Moriceau
authors.forename: Hweej
authors.initials: H
authors.lastname: Almokhles
authors.forename: Guy
authors.initials: G
authors.lastname: de Laroche
authors.forename: Cécile
authors.initials: C
authors.lastname: Pacaut
authors.forename: Aline
authors.initials: A
authors.lastname: Guillot
authors.forename: Cyrus
authors.initials: C
authors.lastname: Chargari
authors.forename: Nicolas
authors.initials: N
authors.lastname: Magné
mesh_terms: D000369:Aged, 80 and over; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000523:psychology / Q000532:radiotherapy; D018450:Disease Progression; D005260:Female; D005602:France / Q000453:epidemiology; D006489:Hemostatic Techniques / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000379:methods / Q000706:statistics & numerical data; D011788:Quality of Life; D000069473:Radiation Dose Hypofractionation; D012074:Remission Induction; D016019:Survival Analysis; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000523:psychology / Q000532:radiotherapy