Cancer Treatment Today

A variety of therapeutic options are available to vital, elderly patients with invasive bladder cancer, including radical cystectomy and treatments that preserve the bladder. Radical cystectomy remains the gold standard for treatment of muscle-invasive bladder cancer, but has traditionally been avoided in elderly patients because this population was thought to be at higher risk of morbidity and mortality. A growing body of evidence, however, indicates that the procedure is safe in elderly patients, and is even feasible in those at high risk. However, there still remain situations when cystectomy is not possible. In such cases curative chemo radiation it is reasonable. A neoadjuvant approach is generally supported by guidelines such as NCCN.

A meta-analysis, published in the June 6, 2003 issue of the Lancet, showed that neoadjuvant cisplatin-based chemotherapy improves 5-year survival by approximately 5% in patients with advanced bladder cancer when compared to surgery, radiation therapy, or the combination of radiation therapy and surgery. Recent studies have suggested that the combination of Gemzar® and Platinol® represents the optimal current combination for treatment of advanced or metastatic bladder cancer. Studies have also suggested that the concurrent use of radiation and chemotherapy is superior to sequential use. In many of the current studies, an attempt is made to retain the bladder in those patients who respond to neoadjuvant chemotherapy or neoadjuvant chemoradiotherapy.Some studies use carboplatin, which has largely replaced cisplatin in various cancer types as a less toxic equivalent. This substitution is supported by many studies and by accumulated clinical experience.

I was able to find two retrospective reviews on the use of Xeloda with radiation but no phase II studies.

Chauvet B, Lagrange JL, Geoffrois L, et al. Quality-of-Life (QOL) Assessment After Concurrent Chemoradiation for Invasive Bladder Cancer. Preliminary Results of a French Multicenter Prospective Study. Proceedings of the 45th Annual Meeting of the American Society For Therapeutic Radiology and Oncology. International Journal of Radiation Oncology Biology Physics 2003;57, Number 2, Supplement, Abstract Number 88:S177.

Advanced Bladder Cancer (ABC) Meta-analysis Collaboration. Neoadjuvant Chemotherapy in Invasive Bladder Cancer:Review and Meta-analysis. Lancet 2003;361:1927-34
Chemoradiation in bladder cancer Bull Cancer. 2005 Dec 1;92(12): 1073-7.

NCCN.ORG, Bladder cancer

Patel B, Forman J, Fontana J et al. A single institution experience with concurrent capecitabine and radiation therapy in weak and/or elderly patients with urothelial cancer. International Journal of Radiation, Oncology, Physics. 2005;62:1332-1338. L. N. Minea, R. M. Anghel, L. R. Oprea, V. Primejdie, X. Bacinschi Definitive radiochemotherapy with capecitabine for elderly patients with bladder cancer Abstract No: 322, ASCO 2008.