RESUMEN
BACKGROUND: For most elderly patients with muscle-invasive bladder cancer (MIBC), surgery is not an option because of patient frailty. Conventional radiotherapy, with its high-dose irradiation of surrounding healthy tissues, remains the only curative treatment for this patient population. OBJECTIVE: To determine whether targeted radiotherapy with Lipiodol demarcation and plan-of-the-day integrated boost technique (LPOD) is a viable curative treatment for elderly patients with MIBC. DESIGN, SETTING, AND PARTICIPANTS: Between September 2008 and September 2016 all MIBC patients in our hospital were screened for eligibility. We included patients with localised, unifocal T2-T4N0M0 grade 2-3 MIBC. Patients with a tumour volume >50% of the bladder wall surface, previous pelvic radiotherapy, and unilateral or bilateral hip prostheses were excluded. INTERVENTION: Targeted radiotherapy using LPOD. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Overall survival, urothelial cell cancer-specific survival (UCCSS), disease recurrence, and Radiation Therapy Oncology Group (RTOG) toxicity were measured. Statistical analyses included independent-sample t tests, χ2 tests, and Mann-Whitney U tests. RESULTS AND LIMITATIONS: A total of 44 patients (median age 80 yr) were included. Over median follow-up of 38 mo, one patient ceased treatment and 23 patients died. LPOD resulted in a 11.4% chance of local recurrence, high 3-yr UCCSS of 77%, RTOG grade >3 toxicity of 2.3-12.9%, and 3-yr overall survival of 49%. CONCLUSIONS: LPOD is a feasible first-line treatment option for older patients with limited-volume T2-T4N0M0 grade 2-3 MIBC. PATIENT SUMMARY: We looked at outcomes after targeted radiotherapy in elderly patients with muscle-invasive bladder cancer. We found that this treatment results in a low chance of disease recurrence with few toxicity complaints. We conclude that this treatment is a viable first-line treatment option for elderly patients.