Y. Bai, X. S. Gao, and S. Qin; Department of Radiation Oncology, Peking University First Hospital, Beijing, China
Purpose/Objective(s): Elderly patients suffering from bladder cancer often cannot undergo surgery due to various complications, which can lead to a poor prognosis. In this report, we present exploratory analyses of the acute toxicity of stereotactic ablative radiotherapy used for bladder preservation in elderly bladder cancer patients. Materials/
Methods: The study included participants over 75 years old, who had bladder urothelial carcinoma staged T2 to T3N0M0. Patients who refused or were unable to undergo surgery due to old age or complications were included. The bladder tumor received stereotactic ablative radiotherapy in five fractions, with a total dose of 30 Gy to 40 Gy. Acute toxicity was assessed using the Common Terminology Criteria for Adverse Events V5.0. Results: Between January 2022 and December 2023, 17 patients were recruited for the study. The median age of the participants was 87 years, ranging from 73 to 96 years old. The median maximum diameter of the bladder tumor was 4.4 cm, ranging from 1.78 to 6.65 cm. Only three patients (17.6%) received TURBT before, and none received concomitant therapy. With a median follow-up of 8 months (2.3 – 13.7 months), hematuria was cured after radiotherapy in all patients. The overall survival rate at 8 months was 85.7%. Some patients refused imaging follow-up due to old age; thus, only 11 had imaging review results. At the three-month evaluation, three patients (27.3%) were CR, six patients (54.5%) were PR, and two patients (18.2%) were PD. One had a new bladder lesion outside the irradiation field, and one had liver metastasis. The local control rate at 8 months was 100%. Three patients (17.6%) experienced acute grade 2 genitourinary toxicity, and no acute toxicity higher than grade 2 was found. Conclusion: In the era of intensity-modulated radiotherapy, SBRT of five fractions was found to be safe for elderly bladder cancer patients, and the local control rate was satisfactory. We are looking forward to the long-term follow-up results.
