Concurrent chemotherapy is associated with improved survival in elderly patients with bladder cancer undergoing radiotherapy Journal Article


Authors: Korpics, M. C.; Block, A. M.; Martin, B; Hentz, C; Gaynor, E. R.; Henry, E.; Harkenrider, M. M.; Solanki, A. A.
Article Title: Concurrent chemotherapy is associated with improved survival in elderly patients with bladder cancer undergoing radiotherapy
Abstract: BACKGROUND: The current study was conducted to compare the overall survival (OS) of concurrent chemoradiotherapy (CCRT) versus radiotherapy (RT) alone in elderly patients (those aged gt;/=80 years) with muscle-invasive bladder cancer (MIBC). METHODS: Patients aged gt;/=80 years with cT2-4, N0-3, M0 transitional cell MIBC who were treated with curative RT (60-70 Gray) or CCRT were identified in the National Cancer Data Base. Univariable and multivariable frailty survival analyses, as well as 1-to-1 propensity score matching, were used to isolate the association between CCRT and OS. RESULTS: A total of 1369 patients who were treated with RT from 2004 through 2013 met eligibility criteria: 739 patients (54%) received RT alone and 630 patients (46%) received CCRT. The median age of the patients was 84 years (range, 80-90 years). The median follow-up was 21 months. The 2-year OS rate was 48%. When comparing CCRT with RT alone, the 2-year OS rate was 56% versus 42% (Plt;.0001), respectively. Multivariable analysis demonstrated that CCRT (hazard ratio [HR], 0.74; 95% confidence interval [95% CI], 0.65-0.84 [Plt;.0001]) and a higher RT dose (HR, 0.78; 95% CI, 0.67-0.90 [Plt;.001]) were associated with improved OS. T4 disease was associated with worse OS (HR, 1.42; 95% CI, 1.15-1.76 [P = .001]). After using 1-to-1 propensity score matching, there remained an OS benefit for the use of CCRT (HR, 0.77; 95% CI, 0.67-0.90 [Plt;.001]). CONCLUSIONS: CCRT is associated with improved OS compared with the use of RT alone in elderly patients with MIBC, independent of Charlson-Deyo comorbidity score, suggesting that CCRT should be used in this population. Cancer 2017. (c) 2017 American Cancer Society.
Keywords: chemoradiotherapy; Radiotherapy; Hematology/Oncology; Bladder cancer; National Cancer Data Base (NCDB); bladder preservation therapy; muscle-invasive; trimodality therapy
Journal Title: Cancer
ISSN: 1097-0142; 0008-543X
Publisher: American Cancer Society  
Journal Place: United States
Date Published: 2017
Language: eng
DOI/URL:
Notes: LR: 20170605; CI: (c) 2017; JID: 0374236; OTO: NOTNLM; 2016/12/05 [received]; 2017/02/25 [revised]; 2017/03/14 [accepted]; aheadofprint