How do you approach muscle invasive bladder cancer in an elderly patient who cannot tolerate chemotherapy?

Although the ideal approach is chemoRT, if patient can't tolerate chemo (if cisplatinum is contraindiacted, 5FU amd MMC is an alternative), then RT to a definitive dose is a reasonable alternative. In the UK randomised study, the control arm of RT alone had about 50% LRC at 2 yrs. For patients with a poor performance status, we sometimes follow a split dose approach where we assess for completion of RT after delivering 35 Gy in 14 fractions followed by a 3 to 4 week break.