Trimodalities for bladder cancer in elderly: Transurethral resection, hypofractionated radiotherapy and gemcitabine

Purpose: A prospective phase II study carried out to evaluate hypofractionated radiotherapy with concurrent gemcitabine for bladder preservation in the elderly patient with bladder cancer. Patients and methods: Thirty-one patients were enrolled, age ≥ 65 years, diagnosed with transitional cell carcinoma of the urinary bladder, after a maximum safe transurethral resection of a bladder tumour. They received 52.5 Gy in 20 fractions using 3D conformal radiotherapy with concurrent 100 mg/m2 gemcitabine weekly as a radiosensitizer. Results: All patients completed their radiation therapy course, while seven patients received their chemotherapy irregularly due to grade 3 toxicities. Twenty-five patients (80.6%) achieved a complete response. At 2-years, overall survival was 94.4% and disease-free survival was 72.6%. T3 and residual after transurethral resection are factors that adversely affect disease-free survival. Conclusion: Hypofractionated radiotherapy and gemcitabine as a radiosensitizer in elderly as organ preservation for transitional cell carcinoma bladder cancer have acceptable toxicity profile with good response rate and disease-free survival, keeping salvage cystectomy for persistence or recurrence of invasive cancer.