Session Item

With increased life expectancy the number of elderly MIBC patients is expected to increase. Unfortunately elderly patients are often denied therapy. Existing guidelines on management of MIBC do not preclude curative treatments 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.

In this presentation following questions will be addressed:

1)    Do elderly patients have inferior survival, both cancer specific survival (CSS) and overall survival (OS), after curative therapy compared to younger patients with MIBC?

2)     Do elderly patients have an increased complication rate after curative therapy compared to younger patients with MIBC?

3)    Is there a place for radiotherapy in this population?

A systematic review revealed that OS and CSS worsen significantly with age both after radical cystectomy and radiotherapy regimens. Except for perioperative mortality, morbidity seems comparable between younger and older patients.

Ultrafractionated EBRT with 6 Gy fractions delivered once a week during 6 weeks to a total dose of 36 Gy recently showed to be well tolerated and associated with local control rates of 81.3% and can be considered a valuable alternative for the longer radiochemotherapy regimens, especially in an elderly population.

A proportion of elderly patients with MIBC will benefit from curative treatment. Primary radiotherapy is a valuable treatment option and alternative for radical surgery.