EURURO Vol. 73 No. 1

Platinum Priority – Review – Bladder Cancer

Editorial by Marko Babjuk on pp. 51–52 of this issue

Curative Treatment for Muscle Invasive Bladder Cancer in Elderly

Patients: A Systematic Review

Vale´rie Fonteyne

a ,

, * ,

Piet Ost

a , y

, Joaquim Bellmunt

b ,

Jean Pierre Droz

c ,

Pierre Mongiat-Artus

d ,

Brant Inman

e ,

Elena Paillaud

f ,

Fred Saad

g ,

Guillaume Ploussard

Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium;

Bladder Cancer Center, Dana-Farber Cancer Institute, Boston, MA, USA;

Department of Cancer Environment Research Unit, Le´on-Be´rard Cancer Center, Claude-Bernard-Lyon University, Lyon, France;

Department of Urology,

Saint-Louis Hospital, Paris, France;

Department of Urology, Duke University Medical Center, Durham, NC, USA;

Geriatric Department, CHU Henri Mondor,

APHP, Cre´teil, France;

Prostate Cancer Research, Montreal Cancer Institute/CRCHUM, Centre de Hospitalier de Universite´ de Montre´al, Montre´al, QC,

Canada;

Urology Department, Saint Jean Languedoc Hospital, Toulouse, France

E U R O P E A N U R O L O G Y 7 3 ( 2 0 1 8 ) 4 0 – 5 0

available at

www.scienced irect.com

journal homepage:

www.europeanurology.com

Article info

Article history:

Accepted March 13, 2017

Associate Editor:

Giacomo Novara

Keywords:

Elderly

MIBC

Outcome

Complications

Abstract

Context:

The incidence of muscle invasive bladder cancer (MIBC) increases with age.

With increased life expectancy the number of elderly MIBC patients is expected to

increase

Existing guidelines on management of MIBC do not preclude curative treat-

ments for elderly patients. However, it is necessary to assess the risks and benefits of a

treatment to avoid overtreatment that results in decreased health-related quality of life

without prolonging survival.

Objective:

To report on overall survival (OS), cancer specific survival (CSS), and mor-

bidity after curative treatment in elderly patients, defined as age

70 yr, with nonmet-

astatic MIBC and to compare this with the outcome of younger MIBC patients.

Evidence acquisition:

A systematic review was performed using Medline, PubMed, and

Embase databases. Articles were included if they addressed one of the three research

questions:

1) Does a geriatric assessment improve outcome in elderly patients with MIBC?

2) Do elderly patients have inferior survival, both CSS and OS, after curative therapy

compared to younger patients with MIBC?

3) Do elderly patients have an increased complication rate, defined as perioperative

mortality (POM) and both early and late complication rate, after curative therapy

compared to younger patients with MIBC?

Only articles including

100 patients and with a clear age–stratification were

included.

Evidence synthesis:

Forty-two articles were retrieved for review. No article directly

addressed the use of geriatric assessment. OS and CSS worsen significantly with age both

after radical cystectomy and radiotherapy regimens. While POM significantly increases

with age, morbidity seems comparable between younger and older patients.

Conclusions:

Although a proportion of elderly patients with MIBC will benefit from

curative treatment, we observed worse OS, CSS, and POMwith age. The impact of age on

These authors contributed equally to the manuscript.

* Corresponding author. Department of Radiotherapy, Ghent University Hospital, De Pintelaan 185,

Ghent 9000, Belgium. Tel. +3293325972; Fax: +3293323040.

E-mail address:

Valerie.fonteyne@uzgent.be

(V. Fonteyne).

http://dx.doi.org/10.1016/j.eururo.2017.03.019

0302-2838/