Safety and Efficacy of Hypofractionated Radiotherapy With Capecitabine in Elderly Patients With Urothelial Carcinoma

• Published in: Clinical genitourinary cancer 2019-02, Vol.17 (1), p.e12-e18
• Main Authors: Leng, Jim, Akthar, Adil S., Szmulewitz, Russell Z., O’Donnell, Peter H., Sweis, Randy F., Pitroda, Sean P., Smith, Norm, Steinberg, Gary D., Liauw, Stanley L.
• Format: Article
• Language: English
• Subjects: Bladder cancer; Bladder preservation; Chemoradiation; Muscle invasive
• ISSN: 1558-7673; 1938-0682
• DOI: 10.1016/j.clgc.2018.10.003

Bladder cancer is commonly diagnosed in patients ineligible for radical cystectomy or chemoradiotherapy (chemo-RT) with cisplatin or fluorouracil with mitomycin. We assessed tolerability, efficacy, and toxicity of hypofractionated radiotherapy with capecitabine in this challenging population. Patients with high-grade urothelial bladder cancer ineligible for radical cystectomy or high-intensity chemo-RT underwent maximal transurethral resection of bladder tumor followed by capecitabine (median, 825 mg/m2 per day 2 times a day) and radiation (median, 55 Gy in 2.2 Gy per fraction). Patients underwent surveillance cystoscopy and imaging, and were evaluated for toxicity, freedom from local failure and freedom from distant metastasis, progression-free survival, and overall survival. Eleven patients (median age, 80 years) with localized disease (n = 7), locally advanced disease (n = 3), or local-only recurrence after cystectomy (n = 1) were treated. Four patients (35%) had an Eastern Cooperative Oncology Group performance status of 2; median Charlson comorbidity index was 5. There was 1 acute grade 3 genitourinary event (9%), 6 acute grade 3 hematologic events (55%) of lymphopenia, and no acute grade 4 or higher events or hospitalizations. Ten patients (91%) completed radiotherapy, while 4 patients (36%) temporarily discontinued capecitabine. The complete response rate in the bladder was 64%. Two patients (18%) experienced late grade 1/2 genitourinary toxicities, and 1 (9%) experienced a transient late grade 4 genitourinary toxicity. With a median follow-up of 16.6 months, overall survival, progression-free survival, freedom from local failure, and freedom from distant metastasis at 1 year were 82%, 55%, 100%, and 55%, respectively, and at 2 years were 61%, 41%, 80%, and 55%, respectively. Hypofractionated chemo-RT was well tolerated and was associated with a high rate of local control in this comorbid population, thus providing a treatment option for select bladder cancer patients. Chemoradiotherapy with concurrent capecitabine is a potential treatment option for select elderly or infirm patients with bladder cancer. Eleven patients with poor performance status and comorbidities with a median age of 80 years were treated with this regimen and experienced a favorable toxicity profile with high rates of local control at a median follow-up of 16 months.