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

N. Mottet, MJ. Ribal, H. Boyle, M. De Santis, P. Caillet, A. Choudhury, T. Garg, M. Nielsen, P. Wüthrich, KM. Gust, SF. Shariat, G. Gakis

. 2020 ; 11 (7) : 1043-1053. [pub] 20200210

Jazyk angličtina Země Nizozemsko

Typ dokumentu časopisecké články, práce podpořená grantem, přehledy

Perzistentní odkaz   https://www.medvik.cz/link/bmc21026580

Grantová podpora
Department of Health - United Kingdom

Median age at bladder cancer (BC) diagnosis is older than for other major tumours. Age should not determine treatment, and patients should be fully involved in decisions. Patients should be screened with Mini-Cog™ for cognitive impairment and the G8 to ascertain need for comprehensive geriatric assessment. In non-muscle invasive disease, older adult patients should have standard therapy. Age does not contraindicate intravesical therapy. Independent of age and fitness, patients with muscle-invasive BC should have at least cross-sectional imaging. Data suggest extensive undertreatment in older adult patients, leading to poor outcomes. Standard treatment for a fit patient differs between countries. Radical cystectomy and trimodality therapy are first-line options. Radical cystectomy patients should be referred to an experienced centre and prehabilitation is mandatory. Older adult patients should be considered for neoadjuvant and adjuvant therapy, according to guidelines. In urinary diversion, avoiding bowel surgery for reconstruction of the lower urinary tract significantly reduces complications. If a patient is unfit for or refuses standard treatment, RT alone, or TURBT in selected cases should be considered. In metastatic BC, older adult patients should receive standard systemic therapy, depending on fitness for cisplatin and prognosis. Efficacy and tolerability of immunotherapy (IO) appears similar to younger patients. Second line IO is standard in platinum pre-treated patients, with benefit and tolerability in the older adult similar to younger patients. The toxicity profile seems to favour IO in the older adult but more data are needed. Patients progressing on IO may respond to further systemic treatment. In metastatic disease, palliative care should begin early.

Citace poskytuje Crossref.org

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$a Median age at bladder cancer (BC) diagnosis is older than for other major tumours. Age should not determine treatment, and patients should be fully involved in decisions. Patients should be screened with Mini-Cog™ for cognitive impairment and the G8 to ascertain need for comprehensive geriatric assessment. In non-muscle invasive disease, older adult patients should have standard therapy. Age does not contraindicate intravesical therapy. Independent of age and fitness, patients with muscle-invasive BC should have at least cross-sectional imaging. Data suggest extensive undertreatment in older adult patients, leading to poor outcomes. Standard treatment for a fit patient differs between countries. Radical cystectomy and trimodality therapy are first-line options. Radical cystectomy patients should be referred to an experienced centre and prehabilitation is mandatory. Older adult patients should be considered for neoadjuvant and adjuvant therapy, according to guidelines. In urinary diversion, avoiding bowel surgery for reconstruction of the lower urinary tract significantly reduces complications. If a patient is unfit for or refuses standard treatment, RT alone, or TURBT in selected cases should be considered. In metastatic BC, older adult patients should receive standard systemic therapy, depending on fitness for cisplatin and prognosis. Efficacy and tolerability of immunotherapy (IO) appears similar to younger patients. Second line IO is standard in platinum pre-treated patients, with benefit and tolerability in the older adult similar to younger patients. The toxicity profile seems to favour IO in the older adult but more data are needed. Patients progressing on IO may respond to further systemic treatment. In metastatic disease, palliative care should begin early.
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$a Ribal, Maria J $u Hospital Clinic, University of Barcelona, Spain
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$a De Santis, Maria $u Charité University Hospital, Berlin, Germany; Department of Urology, Medical University of Vienna, Austria
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$a Caillet, Philippe $u Department of Geriatric Medicine, European Georges Pompidou Hospital, Paris, France; Department of Geriatric Medicine, Hôpital Henri Mondor, Créteil, France
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$a Choudhury, Ananya $u Division of Cancer Science, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; The Christie NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester M13 9PL, UK
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$a Garg, Tullika $u Department of Urology, Epidemiology and Health Services Research, Geisinger, Danville, PA, USA
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$a Nielsen, Matthew $u University of North Carolina, USA
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$a Wüthrich, Patrick $u Department of Anesthesiology and Pain Medicine, University Hospital Bern, Switzerland
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$a Gust, Kilian M $u Medical University of Vienna, Austria
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$a Shariat, Shahrokh F $u Department of Urology, Medical University of Vienna, Vienna, Austria; Departments of Urology, Weill Cornell Medical College, New York, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA; Department of Urology, Second Faculty of Medicine, Charles University, Prag, Czech Republic; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
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