title: Very elderly (>80 years), frail patients with muscle-invasive bladder cancer and comorbidities: is curative irradiation feasible?
abstract: OBJECTIVE
  To evaluate clinical results in elderly and frail patients with bladder cancer treated with curative conformal irradiation alone.
  
  
  METHODS
  The records of ambulatory frail elderly patients, age &gt;80 years, Charlson Comorbidity Index (CCI) &gt;5, with invasive bladder cancer, were retrospectively analyzed. The patients were irradiated with curative intent. Acute and late toxicities were evaluated.
  
  
  RESULTS
  A total of 27 ambulatory patients were treated. Median age was 84.5 years and a median CCI of 6.5 was recorded. Median delivered radiation dose was 64 Gy. All patients completed the planned treatment. Grade 1-2 gastrointestinal (GI) and genitourinary (GU) toxicities were observed in 55.5% of patients (15/27). At the last follow-up, no late G3+ toxicities have been observed, with G1-2 toxicities reported in 11.1% of patients (3/27). Higher values of CCI were associated with higher acute GU/GI toxicities; there was a correlation between CCI and acute GU toxicity (r = 0.43, p = 0.027). The mean survival time was 23.5 months (95% confidence interval 20.9-26.1) and no median was reached. Locoregional disease-free events and metastasis-free survival showed a 2-year actuarial rate of 90% and 87%, respectively, with an actuarial 2-year overall survival of 84.5%.
  
  
  CONCLUSIONS
  Our results demonstrate safety and feasibility of curative radiation therapy in very elderly and frail patients with bladder cancer using 3D conformal radiation therapy.
authors.affiliation: Azienda OORR, Papardo-Piemonte Messina, Messina - Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Santacaterina
authors.affiliation: Azienda OORR, Papardo-Piemonte Messina, Messina - Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Platania
authors.affiliation: Azienda OORR, Papardo-Piemonte Messina, Messina - Italy.
authors.forename: Carmela
authors.initials: C
authors.lastname: Palazzolo
authors.affiliation: AOU "Vittorio Emanuele", PO "Rodolico" Catania, Catania - Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Spatola
authors.affiliation: Azienda OORR, Papardo-Piemonte Messina, Messina - Italy.
authors.forename: Grazia
authors.initials: G
authors.lastname: Acquaviva
authors.affiliation: Azienda OORR, Papardo-Piemonte Messina, Messina - Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Crispi
authors.affiliation: AOU "Vittorio Emanuele", PO "Rodolico" Catania, Catania - Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Privitera
authors.affiliation: Azienda OORR, Papardo-Piemonte Messina, Messina - Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Settineri
authors.affiliation: Department of Biomedical Sciences and Morphologic and Functional Imaging, University of Messina, Messina - Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Pergolizzi
mesh_terms: D000206:Actuarial Analysis; D000369:Aged, 80 and over; D015897:Comorbidity; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005260:Female; D016330:Frail Elderly; D041981:Gastrointestinal Tract / Q000528:radiation effects; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008499:Medical Records; D019042:Muscle Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011832:Radiation Injuries / Q000209:etiology; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000009:adverse effects; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000532:radiotherapy*; D014566:Urogenital System / Q000528:radiation effects