Could Concurrent Capecitabine with Hypofractionated Radiotherapy in Elderly Patients with Muscle-Invasive Bladder Cancer be an Option?

Document Type : Research Articles


1 Department of Radiotherapy and Nuclear Medicine, South Egypt Cancer Institute. Assiut University, Egypt.

2 Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Assiut University, Egypt.

3 Department of Urology, Faculty of Medicine, Assiut University, Egypt.

4 Department of Medical Oncology, South Egypt Cancer Institute. Assiut University, Egypt.


Background: Repopulation of tumor cells during radiotherapy of transitional cell bladder carcinoma is believed to be a significant cause for treatment failure, and it was reported from clinical observations that the local control rate decreased with a prolonged treatment time, so accelerated hypofractionated radiotherapy with concurrent capecitabine may provide good local control in elderly patients unfit for surgery. The study aimed to evaluate the tolerability and efficacy of hypofractionated radiotherapy with capecitabine in elderly patients with urothelial carcinoma. Methods: Between October 2019 and September 2021, 30 patients with muscle-invasive bladder cancer staged T2-4aN0M0, underwent transurethral resection of bladder tumor followed by capecitabine (825 mg/m2 orally, 2 times a day) and radiation therapy (55 Gy in 2.2 Gy per fraction). Results: Thirty patients with a median age of 73.5 years (range, 65-85) were included in our study. Most patients had T2N0, and T3N0 (28 patients), furthermore 73.3% had an intermediate-grade tumor, Transurethral resection of bladder tumor was incomplete in 43.3. No grade 4 toxicity was documented. Grade 3 urinary toxicities occurred in two patients requiring hospitalization and temporal radiation cessation. Regarding late toxicities, no grade 3 or 4 toxicity was reported. A complete response was obtained in 56.7% of  patients. After a median follow-up of 16 months, the locoregional control rate was 63%. Overall survival, local failure-free survival, and event-free survival were 100%, 93.3%, 80% and 43.3%, 33.3%, 30% at one and two years respectively. Conclusion: Hypofractionated chemoradiation with capecitabine, appears to be an effective and well-tolerated curative treatment strategy in the selected elderly population with urothelial carcinoma.


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