Pre-emptive (Neo-adjuvant) Chemotherapy Prior to Radical Radiotherapy for Fit Septuagenarians with Bladder Cancer: Age Itself is not a Contra-indication

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Abstract
Summary— Advanced age has often been cited as a contra‐indication to the use of cytotoxic chemotherapy or aggressive combined treatment regimens. Fifteen patients, aged between 70 and 79 years (mean 73.1), have been treated for high grade, invasive bladder cancer using neoadjuvant intravenous cisplatin (80–100 mg/m2) plus radical radiotherapy (60 Gy in 6 weeks). Objective response was achieved in 14 patients. The median survival was 22 months, with 6 patients surviving 3 years or longer. Acute and late side effects were not excessive (no cases of W.H.O. grade IV toxicity), as demonstrated by clinical examination and the use of questionnaires (including linear analogue self‐assessment scales) to assess quality of life. This aggressive treatment programme can achieve a high remission rate and prolonged survival in elderly patients with high risk bladder cancer without causing excessive morbidity.