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Radical cystectomy or bladder preservation with radiochemotherapy in elderly patients with muscle-invasive bladder cancer: retrospective international study of cancers of the urothelial tract (RISC) investigators

Radical cystectomy or bladder preservation with radiochemotherapy in elderly patients with muscle-invasive bladder cancer: retrospective international study of cancers of the urothelial tract (RISC) investigators
Radical cystectomy or bladder preservation with radiochemotherapy in elderly patients with muscle-invasive bladder cancer: retrospective international study of cancers of the urothelial tract (RISC) investigators

Background: radical cystectomy (RC) and radiochemotherapy (RCT) are curative options for muscle-invasive bladder cancer (MIBC). Optimal treatment strategy remains unclear in elderly patients.

Material and methods: patients aged 80 years old and above with T2-T4aN0-2M0-Mx MIBC were identified in the Retrospective International Study of Cancers of the Urothelial Tract (RISC) database. Patients treated with RC were compared with those treated with RCT. The impact of surgery on overall survival (OS) was assessed using a Cox proportional hazard model. Progression included locoregional and metastatic relapse and was considered a time-dependent variable.

Results: between 1988 and 2015, 92 patients underwent RC and 72 patients had RCT. Median age was 82.5 years (range 80-100) and median follow-up was 2.90 years (range 0.04-11.10). Median OS was 1.99 years (95%CI 1.17-2.76) after RC and 1.97 years (95%CI 1.35-2.64) after RCT (p = .73). Median progression-free survival (PFS) after RC and RCT were 1.25 years (95%CI 0.80-1.75) and 1.52 years (95%CI 1.01-2.04), respectively (p = .54). In multivariate analyses, only disease progression was significantly associated with worse OS (HR = 10.27 (95%CI 6.63-15.91), p < .0001). Treatment modality was not a prognostic factor.

Conclusions: RCT offers survival rates comparable to those observed with RC for patients aged ≥80 years.

Journal Article
0284-186X
Boustani, Jihane
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Bertaut, Aurélie
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Galsky, Matthew D.
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Rosenberg, Jonathan E.
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Bellmunt, Joaquim
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Powles, Thomas
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Recine, Federica
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Harshman, Lauren C.
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Chowdhury, Simon
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Niegisch, Guenter
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Yu, Evan Y.
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Pal, Sumanta K.
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De Giorgi, Ugo
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Crabb, Simon J.
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Caubet, Matthieu
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Balssa, Loïc
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Milowsky, Matthew I.
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Ladoire, Sylvain
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Créhange, Gilles
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Retrospective International Study of Cancers of the Urothelial Tract (RISC) Investigators
Boustani, Jihane
0a0a3871-c199-42c3-95d9-69d7008a7f96
Bertaut, Aurélie
8a024823-43f4-4b67-82e1-296524c084cd
Galsky, Matthew D.
57bcde2a-bfea-490b-8a09-8ee8e28563da
Rosenberg, Jonathan E.
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Bellmunt, Joaquim
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Powles, Thomas
55539b87-1c5e-45ae-9e07-5b2232c2236c
Recine, Federica
e1d344ab-1069-4a9d-b05d-918f6fade046
Harshman, Lauren C.
65c2410e-23a7-49e4-b2ac-05409f320222
Chowdhury, Simon
74cdad3c-31c9-4c77-9f24-e87debb9139e
Niegisch, Guenter
e155079b-8120-4472-901c-8a6ca3423024
Yu, Evan Y.
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Pal, Sumanta K.
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De Giorgi, Ugo
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Crabb, Simon J.
bcd1b566-7677-4f81-8429-3ab0e85f8373
Caubet, Matthieu
608c5a3c-73ac-400c-82bb-fe6f9a758351
Balssa, Loïc
c6987673-6c91-4f64-97eb-090f9b59c26b
Milowsky, Matthew I.
1d32c8eb-9a9f-4b06-b73c-a8fe4f507269
Ladoire, Sylvain
62c6053f-7695-4c1e-aa07-eeb98caaf17e
Créhange, Gilles
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Boustani, Jihane, Bertaut, Aurélie, Galsky, Matthew D., Rosenberg, Jonathan E., Bellmunt, Joaquim, Powles, Thomas, Recine, Federica, Harshman, Lauren C., Chowdhury, Simon, Niegisch, Guenter, Yu, Evan Y., Pal, Sumanta K., De Giorgi, Ugo, Crabb, Simon J., Caubet, Matthieu, Balssa, Loïc, Milowsky, Matthew I., Ladoire, Sylvain and Créhange, Gilles , Retrospective International Study of Cancers of the Urothelial Tract (RISC) Investigators (2017) Radical cystectomy or bladder preservation with radiochemotherapy in elderly patients with muscle-invasive bladder cancer: retrospective international study of cancers of the urothelial tract (RISC) investigators. Acta Oncologica. (doi:10.1080/0284186X.2017.1369565).

Record type: Article

Abstract

Background: radical cystectomy (RC) and radiochemotherapy (RCT) are curative options for muscle-invasive bladder cancer (MIBC). Optimal treatment strategy remains unclear in elderly patients.

Material and methods: patients aged 80 years old and above with T2-T4aN0-2M0-Mx MIBC were identified in the Retrospective International Study of Cancers of the Urothelial Tract (RISC) database. Patients treated with RC were compared with those treated with RCT. The impact of surgery on overall survival (OS) was assessed using a Cox proportional hazard model. Progression included locoregional and metastatic relapse and was considered a time-dependent variable.

Results: between 1988 and 2015, 92 patients underwent RC and 72 patients had RCT. Median age was 82.5 years (range 80-100) and median follow-up was 2.90 years (range 0.04-11.10). Median OS was 1.99 years (95%CI 1.17-2.76) after RC and 1.97 years (95%CI 1.35-2.64) after RCT (p = .73). Median progression-free survival (PFS) after RC and RCT were 1.25 years (95%CI 0.80-1.75) and 1.52 years (95%CI 1.01-2.04), respectively (p = .54). In multivariate analyses, only disease progression was significantly associated with worse OS (HR = 10.27 (95%CI 6.63-15.91), p < .0001). Treatment modality was not a prognostic factor.

Conclusions: RCT offers survival rates comparable to those observed with RC for patients aged ≥80 years.

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Accepted/In Press date: 14 August 2017
e-pub ahead of print date: 30 August 2017
Keywords: Journal Article

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Local EPrints ID: 414736
URI: https://eprints.soton.ac.uk/id/eprint/414736
ISSN: 0284-186X
PURE UUID: 7addebcf-f951-4dc1-a35f-138bd8c5a903

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Date deposited: 09 Oct 2017 16:30
Last modified: 15 Aug 2019 04:37

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Contributors

Author: Jihane Boustani
Author: Aurélie Bertaut
Author: Matthew D. Galsky
Author: Jonathan E. Rosenberg
Author: Joaquim Bellmunt
Author: Thomas Powles
Author: Federica Recine
Author: Lauren C. Harshman
Author: Simon Chowdhury
Author: Guenter Niegisch
Author: Evan Y. Yu
Author: Sumanta K. Pal
Author: Ugo De Giorgi
Author: Simon J. Crabb
Author: Matthieu Caubet
Author: Loïc Balssa
Author: Matthew I. Milowsky
Author: Sylvain Ladoire
Author: Gilles Créhange

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