Efficacy of curative radiotherapy for the treatment of elderly patients with muscle-invasive bladder cancer: a systematic review

Abstract Introduction In recent years, a chemoradiotherapy has been developed as a radical treatment for stage II–III muscle-invasive bladder cancer (MIBC) that can preserve the bladder for patients who cannot tolerate radical cystectomy (RC) or who do not wish to undergo RC. However, most of the studies were conducted on younger patients with MIBC, and it is not clear if it is effective for elderly patients with MIBC. In this study, we reviewed the effects and adverse events after radical radiotherapy in elderly patients with MIBC to determine if radiotherapy has been/can be equally recommended for younger patients with MIBC. Methods We extracted full research reports in English comparing treatment results between different age groups and reports targeting elderly patients with MIBC. A keyword search of the PubMed database was conducted in the decade ending on December 8, 2021. Studies reporting post-treatment overall survival (OS), relapse-free/progression-free/disease-free survival (RFS/PFS/DFS), disease-specific/cancer-specific survival (DSS/CSS), and complete response (CR) rate, adverse events (AEs), and quality of life (QOL) in elderly patients with MIBC were searched. Thirty-nine full articles, including those with comparisons by age group or treatments for elderly patients, were retrieved. Results OS was significant or tended to be poor in elderly patients. There were no differences in PFS and CSS between younger and elderly patients. No differences in the rates of grade 3 morbidities between younger and elderly patients were also observed. Conclusion The lack of a difference in PFS/CSS and toxicities between elderly and younger MIBC patients indicated that curative chemoradiotherapy is effective for not only younger but also elderly patients. With advances in treatment, further prospective studies are needed to optimize the management of MIBC in elderly patients.