Management of muscle-invasive bladder cancer in the elderly

Umberto Basso, Pierfrancesco Bassi, Teodoro Sava, Silvio Monfardini

Research output: Contribution to journalArticle

Abstract

Bladder cancer is rare in patients below the age of 50 years, and most patients are in their 60s and 70s. Radical cystectomy is the preferred approach for patients with localized disease in most European countries and the USA, and evidence is growing in favor of neoadjuvant, platinum-based chemotherapy for patients at high risk of local and systemic relapse. Transurethral resection (TUR) followed by radiotherapy with or without concomitant chemotherapy appears to be a reasonable alternative, particularly in the UK and Canada. However, the elderly pose several treatment dilemmas, including the increased risk of perioperative complications, the management of orthotopic noobladder or different types of urinary diversion, as well as the higher risk of adverse events caused by pelvic radiotherapy and systemic chemotherapy. Multidimensional parameters such as biologic prognostic factors, performance status, functional independence, comorbidities and cognitive function of the patient should be collected in order to tailor treatment to the patient's life expectancy and preferences. Optimized integration of TUR followed by bladder removal (or radiotherapy), with or without adjunctive chemotherapy, can be recommended for otherwise healthy patients. Palliative measures, such as TUR followed by external radiotherapy alone or monochemotherapy, should be reserved for partially impaired patients with moderate comorbidities, in order to maximize the balance of benefits and toxicities. This review summarizes recent data concerning surgery, radiotherapy and systemic chemotherapy for bladder cancer in the elderly, and discusses pros and cons of the currently available therapeutic options.

Original languageEnglish
Pages (from-to)1017-1035
Number of pages19
JournalExpert Review of Anticancer Therapy
Volume4
Issue number6
Publication statusPublished - Dec 2004

Keywords

  • Bladder cancer
  • Chemotherapy
  • Cystectomy
  • Elderly
  • Neoadjuvant
  • Radiotherapy

ASJC Scopus subject areas

  • Pharmacology
  • Cancer Research

Fingerprint Dive into the research topics of 'Management of muscle-invasive bladder cancer in the elderly'. Together they form a unique fingerprint.

  • Cite this

    Basso, U., Bassi, P., Sava, T., & Monfardini, S. (2004). Management of muscle-invasive bladder cancer in the elderly. Expert Review of Anticancer Therapy, 4(6), 1017-1035.