Radiotherapy of primary or recurrent bladder cancer in the very elderly

Aim: The number of very elderly patients with cancer is growing and requires particular attention. The role of organ-sparing irradiation in patients with bladder cancer aged ≥80 years was investigated. Patients and Methods: In 29 very elderly (≥80 years) patients irradiated for bladder cancer, 12 characteristics were analysed for survival: indication, gender, age, Karnofsky performance score (KPS), T-/N-category, tumour grade, pack years, smoking during irradiation, radiation dose, interruption of irradiation >5 days and concurrent chemotherapy. Results: On univariate analysis, primary treatment (p=0.001), KPS >70 (p=0.026) and not smoking during radiotherapy (p<0.001) were associated with better survival. A strong trend for such association was observed for female gender (p=0.054), <40 pack years (p=0.064) and concurrent chemotherapy (p=0.061), and a trend for no interruption of irradiation (p=0.09). On multivariate analysis, primary treatment (p=0.006) and not smoking during radiotherapy (p=0.038) maintained significance. Conclusion: Very elderly patients irradiated for bladder cancer may benefit from concurrent chemotherapy. Smoking during irradiation and interruptions of irradiation should be avoided.