The prevalence of muscle invasive bladder cancer increases with age as does this elderly populations propensity to treatment toxicity, competing medical comorbidity and geriatric syndromes. This combination often results in either undertreatment, with known worse disease specific outcomes compared to younger cohorts and increased disease related morbidity but equally at times overtreatment and the imposition of toxicity in the absence of significant benefit arising as a result of poor patient selection.
Individualisiation of treatment decisions for these patients is assisted by close multidisciplinary discussion and the use of various geriatric and functional assessment principles and tools in the clinical environment. Defining treatment intent and understanding the breadth of dose/fractionation schedules available for bladder cancer, with or without systemic therapy, can assist the Radiation Oncologist in providing optimally tailored radiation therapy to these patients both in the radical and palliative settings.