The standard of care for T2-T4aN0M0 muscle-invasive bladder cancer (MIBC) and high-risk non-MIBC in fit patients is radical cystectomy (RC). In patients unfit for RC, or in cases where bladder preservation is desired, trimodality therapy (TMT) incorporating maximal transurethral resection of bladder tumor (TURBT) and radiation therapy (RT) with concurrent chemotherapy (CMT) can be considered, with comparable efficacy in terms of overall cancer-specific and disease-free survival. As many elderly patients are not considered suitable surgical candidates, TMT is often considered in this patient population. However, these patients may also be unfit for chemo-radiation. Hypofractionation has been investigated as a strategy to increase the efficacy of radiation therapy in this patient population. The purpose of this cohort study was to assess the treatment outcomes of definitive image-guided accelerated hypofractionated radiation therapy in 17 elderly patients with MIBC not considered suitable candidates for surgery or TMT. All patients underwent TURBT, however, in 64.7% of patients this was concluded as incomplete due to deep tumor involvement of the bladder wall or wide area of spread. The median overall treatment time was 20 days, with no patients receiving neoadjuvant chemotherapy. Researchers found that complete local response at 3-month cystoscopy was 69%, where 6 patients (35%) developed a local recurrence, and 2 patients (11.7%) developed distant metastases. Overall survival at 1 year and 2 years were 85% and 63%, respectively. This study therefore shows that accelerated hypofractionated radiotherapy alone may provide good control in elderly patients unfit for combination chemotherapy and radiation.
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