Management of bladder cancer in older patients: Position paper of a SIOG Task Force

Mottet, Nicolas; Ribal, María J.; Boyle, Helen; Santis, Maria De; Caillet, Philippe; Choudhury, Ananya; Garg, Tullika; Nielsen, Matthew E.; Wüthrich, Patrick; Gust, Kilian M.; Shariat, Shahrokh F.; Gakis, Georgios

doi:10.1016/j.jgo.2020.02.001

Cited by 51 publications

(43 citation statements)

References 130 publications

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“…Radical cystectomy (RC) with bilateral pelvic lymph node dissection is the standard of care for muscle-invasive UBC, and very-high-risk and recurrent non-muscle-invasive UBC [2][3][4]. However, it is associated with a high rate of perioperative complications and a non-negligible mortality rate [2,5]. Cigarette smoking is the strongest modifiable risk factor for the development [6,7] and prognosis of UBC [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Impact of Smoking Habit on Perioperative Morbidity in Patients Treated with Radical Cystectomy for Urothelial Bladder Cancer: A Systematic Review and Meta-analysis

Tellini

Mari

Muto

et al. 2021

European Urology Oncology

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Section: Introductionmentioning

confidence: 99%

Impact of Smoking Habit on Perioperative Morbidity in Patients Treated with Radical Cystectomy for Urothelial Bladder Cancer: A Systematic Review and Meta-analysis

Tellini

Mari

Muto

et al. 2021

European Urology Oncology

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“…Bladder cancer has the highest median age of any tumour site [25]. Increasing age is associated with more competing comorbidities, with bladder cancer patients having a median of eight chronic conditions [26].…”

Section: Patient Cohortmentioning

confidence: 99%

Overcoming the Chasm Between Evidence and Routine Practice for Bladder Cancer; Just a Quixotic Notion?

Varughese

2021

Clinical Oncology

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There has been a failure to improve outcomes in bladder cancer over the last 30 years. This is despite clinical trial evidence showing a benefit of interventions such as neoadjuvant chemotherapy or concurrent radiosensitisation for non-metastatic muscle-invasive bladder cancer. The bladder cancer population is characteristically elderly, who typically suffer from multiple comorbidities. Historically, radical cystectomy has been heralded as the treatment of choice, with radiotherapy being reserved for those with inoperable tumours or those unfit for major pelvic surgery, despite a lack of robust comparative or quality of life data to support one treatment recommendation over the other. Although patients with non-metastatic muscle-invasive bladder cancer have potentially curable disease, a growing body of population-based analyses persistently highlights that most patients do not undergo curative-intent treatments e a trend that remains static. The causes for the disparity between evidence and routine practice is not clearly understood. Here, the facets of patient-centred evidence-based care, with respect to bladder conservation therapy, are examined, with proposals to reverse this unacceptable status quo.

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“…The most effective BST strategy consists of maximal transurethral resection of bladder tumor (TURBT) followed by radiochemotherapy (RCT) [4]. This treatment strategy was primarily used for the elderly, frail patients who were ineligible for RC [5][6][7]. Nowadays, multiple guidelines support the use of BST in the form of a trimodal therapy (TMT) as an alternative to primary RC with curative intent for selected, well-informed and compliant patients, who desire to retain their bladder [4,[8][9][10].…”

Section: Introductionmentioning

confidence: 99%

“…Despite the failure of all randomized controlled trials due to accrual (e.g. NCT 02716896 and SPARE [11]), the oncological efficacy of TMT seems noninferior to primary RC in well-selected patients [1][2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Incidence and outcome of salvage cystectomy after bladder sparing therapy for muscle invasive bladder cancer: a systematic review and meta-analysis

et al. 2020

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Objective We conducted a systematic review and meta-analysis to assess the available literature regarding the surgical and oncologic outcomes of patients undergoing salvage radical cystectomy (SV-RC) for recurrence or failure of bladder sparing therapy (BST) for muscle-invasive bladder cancer (MIBC). Methods We searched MEDLINE (PubMed), EMBASE and Google Scholar databases in May 2020. We included all studies of patients with ≥ cT2N0/xM0 bladder cancer that were eligible for all treatment modalities at the time of treatment decision who underwent BST including radiotherapy (RTX). A meta-analysis was conducted to calculate the pooled rate of several variables associated with an increased need for SV-RC. Study quality and risk of bias were assessed using MINORS criteria. Results 73 studies comprising 9110 patients were eligible for the meta-analysis. Weighted mean follow-up time was 61.1 months (range 12–144). The pooled rate of non-response to BST and local recurrence after BST, the two primary reasons for SV-RC, was 15.5% and 28.7%, respectively. The pooled rate of SV-RC was 19.2% for studies with a follow-up longer than 5 years. Only three studies provided a thorough report of complication rates after SV-RC. The overall complication rate ranged between 67 and 72% with a 30-day mortality rate of 0–8.8%. The pooled rates of 5 and 10-year disease-free survival after SV-RC were 54.3% and 45.6%, respectively. Conclusion Approximately one-fifth of patients treated with BST with a curative intent eventually require SV-RC. This procedure carries a proportionally high rate of complications and is usually accompanied by an incontinent urinary diversion.

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Management of bladder cancer in older patients: Position paper of a SIOG Task Force

Cited by 51 publications

References 130 publications

Impact of Smoking Habit on Perioperative Morbidity in Patients Treated with Radical Cystectomy for Urothelial Bladder Cancer: A Systematic Review and Meta-analysis

Impact of Smoking Habit on Perioperative Morbidity in Patients Treated with Radical Cystectomy for Urothelial Bladder Cancer: A Systematic Review and Meta-analysis

Overcoming the Chasm Between Evidence and Routine Practice for Bladder Cancer; Just a Quixotic Notion?

Incidence and outcome of salvage cystectomy after bladder sparing therapy for muscle invasive bladder cancer: a systematic review and meta-analysis

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