Radiotherapy In Elderly Patients Research Articles

Definitive Radiotherapy for Elderly Patients with Locally Advanced Squamous Cell Head and Neck Cancer (LAHNSCC): A Single-Institution Experience

Definitive Radiotherapy for Elderly Patients with Locally Advanced Squamous Cell Head and Neck Cancer (LAHNSCC): A Single-Institution Experience

Hypofractionated Radiotherapy in Elderly Patients With Head & Neck Squamous Cell Carcinoma

Hypofractionated Radiotherapy in Elderly Patients With Head & Neck Squamous Cell Carcinoma

Comparison of a Concurrent Fluorouracil-Based Regimen and a Taxane-Based Regimen Combined with Radiotherapy in Elderly Patients with Esophageal Squamous Cell Carcinoma

Elderly patients with esophageal carcinoma may benefit from concurrent chemoradiotherapy (CCRT). However, the optimal concurrent chemotherapy regimen has not been determined. The aim of our study was to assess the efficiency and tolerance of treatment with a concurrent 5-fluorouracil (5-Fu)–based regimen and a taxane-based regimen combined with radiotherapy in elderly patients with esophageal squamous cell carcinoma (ESCC). A total of 46 patients with ESCC aged older than 65 years were included in this study. The patient population was divided into two treatment groups: 24 patients who received CCRT with a 5-Fu–based regimen were allocated to the PF group, and 22 patients who received CCRT with a taxane-based regimen were allocated to the DP group. The median overall survival (OS), median progression-free survival (PFS), overall response rate, and treatment-related toxicity were assessed. For patients in the PF group, the median OS time was 27.8 ± 9.1 months, and the median PFS time was 12.5 ± 2.7 months. Patients in the DP group had comparable survival outcomes, with a median OS time of 34.4 ± 6.4 months and a median PFS time of 21.1 ± 6.4 months (P = .296 and P = .115, respectively). Grade ≥3 leukocytopenia and grade ≥2 anemia occurred in 63.6% and 59.1% of patients in the DP group, respectively, and in 25.0% and 16.7% of patients in the PF group, respectively. Our results suggest that CCRT with a taxane-based regimen results in a higher incidence of treatment-related toxicity than CCRT with a 5-Fu–based regimen but comparable survival outcomes.

Superiority of temozolomide over radiotherapy for elderly patients with RTK II methylation class, MGMT promoter methylated malignant astrocytoma.

O6-methylguanine DNA-methyl transferase (MGMT) promoter methylation status is predictive for alkylating chemotherapy, but there are non-benefiting subgroups. This is the long-term update of NOA-08 (NCT01502241), which compared efficacy and safety of radiotherapy (RT, n = 176) and temozolomide (TMZ, n = 193) at 7/14 days in patients >65 years old with anaplastic astrocytoma or glioblastoma. DNA methylation patterns and copy number variations were assessed in the biomarker cohort of 104 patients and in an independent cohort of 188 patients treated with RT+TMZ-containing regimens in Heidelberg. In the full NOA-08 cohort, median overall survival (OS) was 8.2 [7.0-10.0] months for TMZ treatment versus 9.4 [8.1-10.4] months for RT; hazard ratio (HR) = 0.93 (95% CI: 0.76-1.15) of TMZ versus RT. Median event-free survival (EFS) [3.4 (3.2-4.1) months vs 4.6 (4.2-5.0) months] did not differ, with HR = 1.02 (0.83-1.25). Patients with MGMT methylated tumors had markedly longer OS and EFS when treated with TMZ (18.4 [13.9-24.4] mo and 8.5 [6.9-13.3] mo) versus RT (9.6 [6.4-13.7] mo and 4.8 [4.3-6.2] mo, HR 0.44 [0.27-0.70], P < 0.001 for OS and 0.46 [0.29-0.73], P = 0.001 for EFS). Patients with glioblastomas of the methylation classes receptor tyrosine kinase I (RTK I) and mesenchymal subgroups lacked a prognostic impact of MGMT in both cohorts. MGMT promoter methylation is a strong predictive biomarker for the choice between RT and TMZ. It indicates favorable long-term outcome with initial TMZ monotherapy in patients with MGMT promoter-methylated tumors primarily in the RTK II subgroup.

Radiotherapy in elderly patients with breast cancer: a literature review of acute and late toxicity.

Radiotherapy (RT) induced toxicity in elderly patients is not well documented in the available literature due to the inhomogeneous and fragmentary data. Aim of this study was to review literature data on acute and late toxicity in elderly breast cancer patients treated with RT. The primary endpoint was RT-related acute and late toxicity in elderly breast cancer (BC) patients. The secondary endpoint was RT interruption rate in this patients’ population. All studies reporting RT-related acute and/or late toxicity in elderly women with breast cancer were included. All types of RT settings were included and no restriction was applied regarding other primary/adjuvant associated treatment. A bibliographic search was performed on PubMed. Only articles in English were considered while no chronological limitation was applied. Twenty-two studies were included in this analysis: 12 retrospective, 5 prospective observational trials, 1 phase III trial sub-analysis, and 4 phase I-II trials. Thirteen studies reported results about whole breast irradiation (WBI) delivered by external beams (EB) RT ± boost on the tumor bed. Nine studies reported results about accelerated partial breast irradiation (APBI) based on EB RT (2 studies), intraoperative RT (IORT: 2 studies), and brachytherapy (BRT: 2 studies); three studies compared different treatment techniques. Overall, reported acute grade (G) ≥3 toxicity ranged from 0.0% to 10.5% and late toxicity from 0.0% to 13.0%. RT discontinuation/interruption rates ranged between 0.0% and 2.0%. Acute G ≥3 toxicity rates were 2.0%, 6.7%, and 5.2% with EB-APBI, BRT, and IORT, respectively. Late G ≥3 toxicity with EB-APBI was 2.8%. No late G ≥3 toxicity was recorded in studies reporting on BRT and IORT. With WBI, the overall rates of G ≥3 toxicity were 3.0% (acute) and 1.8% (late). Higher toxicity rates were observed with weekly hypofractionation. None of the studies directly comparing age subgroups found age-related differences. Our findings suggest that RT of breast cancer is well tolerated even in elderly patients with toxicity rates comparable to those of the general population. Given these considerations, RT omission in elderly patients with breast cancer should be carefully evaluated limiting this option to very selected critical patients.

Neoadjuvant chemoradiotherapy or radiotherapy in patients aged 75 years or older with locally advanced rectal cancer.

Background: To evaluate the efficacy and treatment related morbidity of neoadjuvant chemoradiotherapy or radiotherapy in elderly patients (aged 75 years or older) with locally advanced rectal cancer (LARC).Methods: We reviewed clinical records of elderly patients with LARC treated with neoadjuvant chemoradiotherapy or radiotherapy between January 2008 and June 2017 at our institute. A dose of 45-50Gy in 25 fractions was delivered to pelvis. The primary tumor received a dose of 55Gy concomitantly for patients receiving intensity modulated radiotherapy (IMRT). The concurrent chemotherapy included capecitabine alone and capecitabine plus oxaliplatin (Xelox). Surgery was performed for suitable patients at least 6 weeks after neoadjuvant treatment. Overall survival (OS), disease specific survival (DSS), disease free survival (DFS) and local control (LC) were calculated with Kaplan-Meier method.Results: A total of 85 patients were enrolled in this study, the median age was 80 years old (range: 75-90 years). After neoadjuvant treatment, surgery was performed in 56 patients (65.9%). Downstaging rate was 85.7% (48/56) with T downstaging in 35 patients (62.5%) and N downstaging in 36 patients (64.3%). Twelve patients (21.4%) obtained pathological complete response (pCR). The incidence of grade 3 or greater acute hematological, gastrointestinal and genitourinary toxicities were 10.7%, 5.2% and 1.8%, respectively. Seven patients (12.5%) experienced postoperative complications. The median follow-up duration was 35.7 months (range: 4.3-100.3 months), The 3-year and 5-year OS, DSS, DFS, LC were 68.9% and 47.2%, 75.8% and 60.4%, 68.2% and 56.1%, 83.9% and 78.3%, respectively.Conclusion: In patients aged 75 years or older with LARC, neoadjuvant chemoradiotherapy followed by surgery was well tolerated with promising survival outcomes, which should be strongly suggested if medically suitable.

Hydroxychloroquine and short-course radiotherapy in elderly patients with newly diagnosed high-grade glioma: a randomized phase II trial.

BackgroundEffective treatment for patients at least 70 years with newly diagnosed glioblastoma remains challenging and alternatives to conventional cytotoxics are appealing. Autophagy inhibition has shown promising efficacy and safety in small studies of glioblastoma and other cancers.MethodsWe conducted a randomized phase II trial to compare radiotherapy with or without hydroxychloroquine (2:1 allocation). Patients aged at least 70 years with newly diagnosed high-grade glioma deemed suitable for short-course radiotherapy with an ECOG performance status of 0–1 were included. Radiotherapy treatment consisted of 30 Gy, delivered as 6 fractions given over 2 weeks (5 Gy per fraction). Hydroxychloroquine was given as 200 mg orally b.d. from 7 days prior to radiotherapy until disease progression. The primary endpoint was 1-year overall survival (OS). Secondary endpoints included progression-free survival (PFS), quality of life, and toxicity.ResultsFifty-four patients with a median age of 75 were randomized between May 2013 and October 2016. The trial was stopped early in 2016. One-year OS was 20.3% (95% confidence interval [CI] 8.2–36.0) hydroxychloroquine group, and 41.2% (95% CI 18.6–62.6) radiotherapy alone, with a median survival of 7.9 and 11.5 months, respectively. The corresponding 6-month PFS was 35.3% (95% CI 19.3–51.7) and 29.4% (95% CI 10.7–51.1). The outcome in the control arm was better than expected and the excess of deaths in the hydroxychloroquine group appeared unrelated to cancer. There were more grade 3–5 events in the hydroxychloroquine group (60.0%) versus radiotherapy alone (38.9%) without any clear common causation.ConclusionsHydroxychloroquine with short-course radiotherapy did not improve survival compared to radiotherapy alone in elderly patients with glioblastoma.

Definitive radiotherapy in elderly patients and patientswith locally advanced cervical cancer with complications

Objective: To analyze the efficacy and toxicity of radiation therapy (RT) in elderly patients (&gt;80-years-old) and patients with locallyadvanced cervical cancer with complications. Materials and Methods: Thirty-six patients treated with RT and 52 patients treated withconcurrent chemoradiation therapy (CCRT) between 2010 and 2013 were included in this study. Treatment efficacy, treatment toxicity, overall survival, disease progression-free survival, and pelvic progression-free survival were analyzed. Results: The frequency of patients who had Grade 3-4 leukopenia in the CCRT group (57.6%) was significantly higher than that in the RT group (8.3%, p&lt; 0.01). The complete response rates were 84% in the RT group (n = 32) and 90% in the CCRT group (n = 51) (p = 0.498). There was no statistical difference in overall survival, disease progression-free survival, and pelvic progression-free survival between the RT group andthe CCRT group. Conclusion: Definitive RT in elderly and complicated cervical cancer patients was safe and effective.

Re: Intensity-Modulated Radiation Therapy for Elderly Patients (Aged ≥75 Years) with Localized Prostate Cancer: Comparison with Younger Patients (Aged

Re: Intensity-Modulated Radiation Therapy for Elderly Patients (Aged ≥75 Years) with Localized Prostate Cancer: Comparison with Younger Patients (Aged <75 Years).

Study of Short Course Radiation Therapy for Elderly Patients With Rectal Cancer

Study of Short Course Radiation Therapy for Elderly Patients With Rectal Cancer

Predictive value of prognostic nutritional index for radiotherapy and prognosis of elderly patients with esophageal squamous cell carcinoma

Objective To evaluate the role of prognostic nutritional index (PNI) in the radiotherapy for elderly patients with esophageal squamous cell carcinoma. Methods Clinical data of 108 elderly patients (aged>65 years) with esophageal squamous cell carcinoma who underwent radical radiotherapy were retrospectively analyzed. The PNI value of each patient was calculated, and the optimal cutoff value of PNI before treatment was determined by establishing the receiver operating characteristic curve (ROC curve). All patients were divided into the low and high PNI value groups. The overall survival rate was calculated by Kaplan-Meier method. Log-rank test, univariate and Cox’s multivariate prognosis analyses were performed. Results The ROC curve demonstrated that the optimal cutoff value of PNI was 50.1(n=52 in high PNI group and n=56 in low PNI group). Age, gender and treatment did not significantly differ between two groups, whereas the TNM staging significantly differed (P=0.022). The effective rate of radiotherapy in the high PNI group was 96%, significantly higher than 73% in the low PNI group (P=0.001). In the high PNI group, the 1-, 2-, and 3-year overall survival rates were 94%, 69%, and 62%, significantly higher compared with 70%, 32% and 27% in the low PNI group (all P<0.001). Univariate analysis showed that PNI, T staging, N staging and TNM staging were significantly correlated the overall survival of patients (all P<0.01). Cox’s multivariate analysis revealed that N staging (RR=1.94, 95%CI=1.29-2.94, P=0.002) and PNI (RR=0.83, 95%CI=0.77-0.90, P<0.001) were independent risk factors affecting overall survival. Conclusions PNI before treatment has a good correlation with the prognosis and radiotherapy efficacy of patients, which can be used as a pivotal index to predict the clinical benefit of radiotherapy for elderly patients with esophageal squamous cell carcinoma. Key words: Esophageal neoplasm/radiotherapy; Elderly; Prognostic nutritional index

Hypofractionated Stereotactic Body Radiation Therapy for Elderly Patients with Lung Cancer.

Hypofractionated Stereotactic Body Radiation Therapy for Elderly Patients with Lung Cancer.

Outcomes Following Adjuvant Radiation Therapy in Elderly Patients with Glioblastoma: A Retrospective Single Institution Analysis

Outcomes Following Adjuvant Radiation Therapy in Elderly Patients with Glioblastoma: A Retrospective Single Institution Analysis

Survival Benefit of Adjuvant Radiotherapy in Elderly Patients with WHO Grade III Meningioma

The benefit of adjuvant radiotherapy (RT) is uncertain in elderly patients diagnosed with World Health Organization (WHO) grade III meningiomas. The US National Cancer Database was used to identify elderly patients (aged over 60) with histologically confirmed WHO grade III meningiomas who underwent surgery with or without adjuvant external beam RT. Overall survival (OS) was evaluated by Kaplan-Meier analysis, multivariable Cox proportional hazard models, and propensity score-matched analysis. Among the 254 patients who met inclusion criteria, 151 (58.4%) underwent surgery followed by RT and103 (41.6%) surgery without RT. The 5-year relative survival rate was 57.8% (95% confidence interval [CI], 38.7%-85.4%) in the adjuvant RT group and 38.1% (95% CI, 21.9%-55.9%) in the group without RT when compared with age- and gender-matched US population. Adjuvant RT was associated with longer OS on both univariate (P= 0.011) and multivariable analyses (adjusted hazard ratio [AHR],0.663; 95% CI, 0.449-0.978; P= 0.038). However, adjuvant RT did not significantly improve OS in a propensity score-matched analysis (P= 0.271) after matching the 2 cohorts on age, race, comorbidity, extent of resection, and tumor size. In patients who underwent subtotal resection or biopsy (n= 106), adjuvant RT significantly benefited OS on univariate analysis (P=0.023), but did not show statistically significant benefit on multivariate analysis (AHR, 0.594; 95% CI, 0.337-1.046; P= 0.071). Adjuvant RT was not associated with improved OS in the elderly patients who underwent gross total resection (AHR, 0.764; 95% CI, 0.434-1.344; P=0.350). Adjuvant external beam RT may not provide any survival benefit for elderly patients with WHO grade III meningioma after gross total resection.

Therapeutic value of thoracic radiotherapy in elderly patients with extensive-stage small cell lung cancer

Objective To evaluate the effect of thoracic radiotherapy (TRT) on the prognosis of elderly patients with extensive-stage small cell lung cancer (ES-SCLC). Methods Clinical data of 83 patients aged≥65 years diagnosed with metastatic ES-SCLC admitted to our hospital from 2010 to 2016 were retrospectively analyzed. All enrolled patients received etoposide plus cisplatin or carboplatin as the standard regimen for chemotherapy. After the propensity score matching (PSM), 70 cases were either assigned into the TRT (n=35) or non-TRT groups (n=35). Among them, 56 patients were male and 14 female. The median age was 69 years (range: 65-85 years). The median chemotherapy cycle was 4 cycles (range: 1-11 cycles). The median chest irradiation dose was 50 Gy (range: 30-60 Gy). Overall survival (OS), progression-free survival (PFS) and local recurrence-free survival (LRFS) were regarded as end-point of observation. The survival rate was calculated by using Kaplan-Meier method and statistically compared between two groups by using Log-rank test. Multivariate prognostic analysis was performed using Cox regression model. Results For all patients, the 1-year OS, PFS and LRFS rates were 40%, 16% and 21%, respectively. Patients undergoing TRT obtained better survival outcomes than their counterparts without TRT: the 1-year OS, PFS and LRFS were 52% vs.29%(P=0.005), 30% vs.3%(P<0.001), 38% vs. 6%(P<0.001), respectively. Furthermore, TRT did not increase the incidence of adverse reactions in elderly patients (P=0.690). Conclusion The addition of TRT for elder ES-SCLC patients can significantly improve the rate of chest tumor control and prolong the survival time, which is worthy of further validation by prospective studies with large sample size. Key words: Carcinoma, small cell lung/radiotherapy; Carcinoma, small cell lung/chemotherapy; Elderly; Prognosis

A phase II study of concurrent nimotuzumab and intensity-modulated radiotherapy in elderly patients with locoregionally advanced nasopharyngeal carcinoma.

e17562 Background: The purpose of this study was to evaluate the feasibility of concurrent nimotuzumab to intensity-modulated radiotherapy (IMRT) in elderly patients with locoregionally advanced nasopharyngeal carcinoma (NPC). Methods: According to the eighth edition of the American Joint Committee on Cancer staging system, elderly patients with stage III–IVA NPC were given concurrent nimotuzumab (200 mg/week, starting 1 week before IMRT) with IMRT. They completed a geriatric assessment tool (function, comorbidity, cognition, psychological state, social activity/support, and nutritional status) before initiation of protocol therapy. Results: Thirty patients [median age of 70.5 (65-95) years] with stage III (60%), and IVA (40%) NPC were enrolled between March 2017 and November 2018. The mean scores on the comorbidity scale and instrumental activities of daily living scale were 7 (range, 1 to 12) and 12 (range, 8 to 14), respectively. Grade 3 mucositis occurred in 10 (33%) patients and 1 (3%) patient had grade 3 radiotherapy-related dermatitis. Grade 3 pneumonia occurred in 3 patients (10%) and no patients had nimotuzumab-related acneiform rash. There were 20 complete responses and 10 partial responses 1month after the completion of IMRT. Conclusions: Concurrent administration of nimotuzumab and IMRT is effective and well-tolerated for elderly patients with locoregionally advanced NPC. Clinical trial information: NCT03025958.

A multicenter phase III study comparing Simultaneous Integrated Boost (SIB) radiotherapy concurrent and consolidated with S-1 versus SIB alone in elderly patients with esophageal and esophagogastric cancer \u2013 the 3JECROG P-01 study protocol

BackgroundThe importance of definitive radiotherapy for elderly patients with esophageal and esophagogastric-junction cancer is pronounced. However, little is known in terms of the best way to combine radiotherapy with other treatment options. This study aims to compare the efficiency of SIB radiotherapy alone with SIB radiotherapy concurrent and consolidated with S-1 for elderly patients. Comprehensive geriatric assessment is also incorporated in the procedure of treatment.Methods/designThe study is a two arm, open, randomized multicenter Phase III trial with patients over 70 years old with stage IIA-IVB (UICC 2002, IVB only with metastasis to supraclavicular or celiac lymph nodes) squamous cell carcinoma or adenocarcinoma of esophagus or gastroesophageal junction. A total of 300 patients will be randomized using a 1:1 allocation ratio stratified by disease stage and study site. Patients allocated to the SIB arm will receive definitive SIB radiotherapy (95%PTV/PGTV 50.4Gy/59.92Gy/28f) while those randomized to SIB + S-1 arm will receive definitive SIB radiotherapy concurrent and consolidated with S-1. The primary endpoint of the trial is 1-year overall survival. Secondary objectives include progression-free survival, recurrence-free survival (local-regional and distant), disease failure pattern, toxicity profile as well as quality of life. Besides, detailed radiotherapy protocol and quality assurance procedure have been incorporated into this trial.DiscussionThe proportion of elderly patients in esophageal cancer is now growing, but there is a lack of evidence in term of treatment standard for this group of patients, which is what we aim to obtain through this prospective phase III study.Trial registrationclinicaltrials.govNCT02979691. Registered November 22, 2016.

Intensity-modulated radiation therapy for elderly patients (aged ≥75 years) with localized prostate cancer: Comparison with younger patients (aged

The aim of the present study was to evaluate the efficacy and safety of intensity-modulated radiation therapy (IMRT) for elderly patients with prostate cancer (age ≥75 years) compared with younger patients (<75 years). The numbers of patients enrolled into the elderly and younger groups were 238 and 853, respectively. More than half of the patients in the elderly group were high-risk, and the total risk of the elderly group was higher than that of younger group. The median follow-up periods for the elderly and younger groups were 42 (range, 2-108) and 49 (range, 2-120) months, respectively. All patients were treated with IMRT at a dose of 74-78 Gy with or without androgen-deprivation therapy. The biochemical failure-free rates (BFFRs) at 3-year follow-up for the elderly and younger groups were 93.3 and 95.7%, respectively; there was no significant difference between the 2 groups in regard to the BFFR. The clinical failure-free rates (CFFR) at 3-year follow-up for the elderly and younger groups was 95.8 and 98.5%, respectively; the 2 groups did not differ significantly in regard to the CFFR. The cumulative incidence rates of gastrointestinal toxicity (grade ≥2) and genitourinary toxicity (grade ≥2) at 3-year follow-up were 10.5 and 1.3%, respectively; there was no significant difference between the elderly and younger groups. It was concluded that in prostate cancer patients aged 75 years or older, IMRT has a treatment effect equivalent to that in patients <75 years old; adverse events are also comparable.

Predictive factors for response and toxicity after brachytherapy for rectal cancer; results from the HERBERT study

PurposeThe HERBERT study was a dose-finding feasibility study of a high-dose rate endorectal brachytherapy (HDREBT) boost after external beam radiotherapy (EBRT) in elderly patients with rectal cancer who were unfit for surgery. This analysis evaluates the association of patient, tumor and dosimetric parameters with tumor response and toxicity after HDREBT in definitive radiotherapy for rectal cancer. Patients and methodsThe HERBERT study included 38 inoperable patients with T2-3N0-1 rectal cancer. Thirteen fractions of 3 Gy EBRT were followed by three weekly HDREBT applications of 5–8 Gy per fraction. Clinical and dosimetric parameters were tested for correlation with clinical complete response (cCR), sustained partial/complete response (SR), patient reported bowel symptoms, physician reported acute and late proctitis (CTCAE v3) and endoscopically scored toxicity. ResultsThirty-five patients completed treatment and were included in the current analyses. Twenty of 33 evaluable patients achieved a cCR, the median duration of a sustained response was 32 months. Tumor volume at diagnosis showed a strong association with clinical complete response (OR 1.15; p = 0.005). No dose–response correlation was observed in this cohort. Prescribed dose to the brachytherapy CTV (D90) correlated with acute and late physician reported proctitis while CTV volume, CTV width and high dose regions in the CTV (D1cc/D2cc) were associated with endoscopic toxicity at the tumor site. ConclusionTumor volume is the most important predictive factor for tumor response and a higher dose to the brachytherapy CTV increases the risk of severe clinically and endoscopically observed proctitis after definitive radiotherapy in elderly patients with rectal cancer.

Accelerated Hypofractionated Radiation Therapy for Elderly Frail Bladder Cancer Patients Unfit for Surgery or Chemotherapy.

The main purpose of this study was to report treatment outcomes of definitive image-guided accelerated hypofractionated radiation therapy for elderly patients with muscle-invasive bladder cancer unsuitable for surgery or trimodality therapy. Patients with confirmed muscle-invasive or high-risk T1 transitional cell carcinoma of the bladder, stage T1-T4aN0M0, who underwent transurethral resection of bladder tumor were irradiated with 45 Gy in 15 fractions. Comorbidity was assessed by Charlson Comorbidity Index. Cystoscopy, cytology, and computerised tomography imaging were used to evaluate treatment outcomes. Seventeen patients with a median age of 87 (range, 81 to 95) years and age-adjusted Charlson Comorbidity Index ≥3 were included. Transurethral resection of bladder tumor was incomplete in 65%. Radiation technique evolved from 3-dimensional conformal radiotherapy (3D CRT, 47%) to volumetric modulated arc therapy (VMAT, 53%). Ninety-four percent completed radiotherapy, with a median time of 20 days. The median follow-up was 65.3 months. Complete local response at 3-month cystoscopy was 69%. Six patients developed a local recurrence (35%), and 2 patients developed distant metastases (11.7%). Overall survival at 1 year was 47% and 23% at 2 years. Cancer-specific survival at 1 and 2 years were 85% and 63%, respectively. Acute grade 3 gastrointestinal or genitourinary toxicities were 6% and 24%, respectively. No grade 4 toxicity was documented. Diarrhea of any grade occurred in 35% of patients treated with 3D CRT, but in none of the patients treated with VMAT (P=0.002). Accelerated hypofractionated radiotherapy alone provides good local control in elderly patients unfit for chemoradiotherapy. Contemporary radiation techniques such as VMAT were associated with reduced bowel toxicity compared with 3D CRT.