为探究使用双分割次低分段放疗 (RT) 的三种治疗方案 (TMT) 的可行性、疗效和安全性，用于老年患者的非转移性肌层侵犯性膀胱癌 (MIBC)。我们回顾性研究了1990年至2021年间，年龄大于75岁、适合或不适合进行根治性膀胱切除术 (RC)，并接受膀胱肿瘤经尿道切除手术后行同步放化疗治疗 (铂类盐和5-氟尿嘧啶) 的两个机构 (法国巴黎圣路易医院和欧洲乔治·蓬皮杜医院) 的非转移性MIBC患者的特征和治疗结果。放疗包括适应性双分割次低分段 RT。根据不良事件通用术语标准第5版报告急性毒性，根据放射治疗肿瘤学研究协会/欧洲研究和治疗癌症组织的迟发放射性疾病评分规则报告迟发性毒性。主要终点是总生存期 (OS)。次要终点包括其他生存结果和安全性。 共识别122例患者，中位 (范围) 随访时间为51.1 (0.5-210.8) 个月。总共83.5%的患者完成了放化疗。3年和5年的 OS 率分别为61.7%和51.2%。在多变量分析中，放疗和同步化疗的完成与更好的 OS 和癌特异生存显着相关。对于适合RC的患者，通过放化疗治疗，77名患者 (91.7%) 实现了完全组织学反应，膀胱保留率为90.5%。急性和迟发性≥3级毒性均小于5%。 伴随化疗的双分割次低分段放疗方案看起来耐受性好且有效。与姑息治疗相比，三种治疗方案似乎是老年患者不适合进行根治性手术的治疗选择，可能有助于提高这些患者的生存率。©2023 BJU International。

To investigate the feasibility, efficacy, and safety of trimodal therapy (TMT) using a bifractionated split-course hypofractionated radiotherapy (RT) for non-metastatic muscle-invasive bladder cancer (MIBC) in elderly patients.We retrospectively reviewed the characteristics and outcomes of patients aged >75 years with non-metastatic MIBC suitable or not for radical cystectomy (RC) and treated with transurethral resection of bladder tumour followed by concomitant radio-chemotherapy (platinum salt and 5-fluorouracil) at two institutions (Saint Louis Hospital, Paris, France and European Georges Pompidou Hospital, Paris, France) between 1990 and 2021. RT consisted of an adapted bifractionated split-course hypofractionated RT. Acute toxicities were reported according to Common Terminology Criteria for Adverse Events version 5.0 and late toxicities were reported according to the Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer late radiation morbidity scoring schema. The primary end-point was overall survival (OS). Secondary end-points included other survivals outcomes and safety.A total of 122 patients were identified, with a median (range) follow-up of 51.1 (0.5-210.8) months. In all, 83.5% of patients completed radio-chemotherapy. The OS rate was 61.7% at 3 years and 51.2% at 5 years. In multivariate analysis, the completion of RT and concomitant chemotherapy were significantly associated with better OS and cancer-specific survival. For patients fit for RC, a complete histological response was achieved for 77 patients (91.7%) with radio-chemotherapy and the bladder conservation rate was 90.5%. Acute and late Grade ≥3 toxicities were <5%.Bifractionated split-course hypofractionated RT with concomitant chemotherapy regimen appears to be well-tolerated and effective. Trimodal treatment seems to be a curative option for elderly patients unfit for radical surgery compared with palliative care and may contribute to improved survival in these patients.© 2023 BJU International.