GU Flashcards
Bladder 55Gy in 20 fractions constraints?
Rectum V40<30Gy, V30<50%, V55<1%
Bowel V40 <150cc, V55<3cc
Sigmoid V55<10cc, V50<20cc
Femoral head V40<15% and V30<20%
Staging for bladder cancer?
Ta papillary lesion not invading basement membrane.
T1 Tumor invades lamina propria (subepithelial connective tissue)
pT2a Tumor invades superficial muscularis propria (inner half)
pT2b Tumor invades deep muscularis propria (outer half)
pT3a Microscopically
pT3b Macroscopically (extravesical mass)
T4a Extravesical tumor invades prostatic stroma, seminal vesicles, uterus, vagina
T4b Extravesical tumor invades pelvic wall, abdominal wall
N1 Single regional lymph node metastasis in the true pelvis (perivesical, obturator, internal and external iliac, or sacral lymph node)
N2 multiple in true pelvis
N3 met to common iliac LNs
T1N0 Stage I
T2N0 Stage II
T3+ or N+ Stage III
M1a/b = Stage IVa/b
Which bladder cancer patients that are non-muscle invasive should get cystectomy?
Very-high risk features: BCG unresponsive, variant histology (micropapillary, plasmacytoid, small cell, sarcomatoid), LVI, prostatic urethral invasion.
Which patients should get intravesical therapy? How does it work? What does immediate adj chemo do?
Intermediate or High risk.
Low risk: low grade, Ta and <=3cm and solitary.
Give intravescial chemo (gem, mmc) or BCG within 24hrs, then 3-4 weeks after TURBT weekly BCG for 6 wks +/- maintanence BCG 3 weekly at 3, 6, 12, 18, 24, 30, 36 months.
Reduce 5yr LR by 35%.
What is non-RT tx option for bladder cancer?
Gemcitabine + cisplatin + durvalumab prior to
cystectomy, then durvalumab after cystectomy.
Or ddMVAC: methotrexate, vinblastine, adriamycin, cisplatin.
What concurrent chemo options for bladder cancer?
cis, low-dose gem, 5-FU/MMC
Bladder 5yr OS and bladder preservation rate?
5yr OS ~50%
Bladder preservation ~80%
Good bladder preservation candidate?
Good baseline bladder function
Ability to get chemo
Maximal TURBT
No hydronephrosis*** (38% complete response vs 64%)
Unifocal T2/3/maybe T4a disease < 6cm
No extensive CIS
Reliable patient – commits to good follow up
F/u schedule for bladder after chemoRT?
Cystoscopy q3 mos for 2yrs then q6 mos
CT urogram, CT chest q3-6 mos
CMP, CBC q3
Urine cytology q6 mos
Testicular staging?
pT1 Tumor limited to testis (including rete testis invasion) without lymphovascular invasion
pT1a* Tumor smaller than 3 cm in size
pT1b* Tumor 3 cm or larger in size
pT2 Tumor limited to testis (including rete testis invasion) with lymphovascular invasion
OR
Tumor invading hilar soft tissue or epididymis or penetrating visceral mesothelial layer covering the external surface of tunica albuginea with or without lymphovascular invasion
pT3 Tumor directly invades spermatic cord soft tissue with or without lymphovascular invasion
pT4 Tumor invades scrotum with or without lymphovascular invasion
cN1 Metastasis with a lymph node mass 2 cm or smaller in greatest dimension
OR
Multiple lymph nodes, none larger than 2 cm in greatest dimension
cN2 Metastasis with a lymph node mass larger than 2 cm but not larger than 5 cm in greatest dimension
OR
Multiple lymph nodes, any one mass larger than 2 cm but not larger than 5 cm in greatest dimension
cN3 Metastasis with a lymph node mass larger than 5 cm in
greatest dimension
Pure Seminoma vs NGGCT?
Pure seminoma (pure seminoma histology and AFP
normal; may have elevated beta-hCG)
Nonseminomatous germ cell tumor (NSGCT)
(includes mixed seminoma/ nonseminoma tumors and
seminoma histology with elevated AFP)
Who needs genetics testing for prostate cx?
Metastatic (Stage IVB) or node-positive (Stage IVA) prostate cancer
Very high-risk or high-risk disease
Ancestry: Ashkenazi Jewish
◊ ≥1 close blood relative with ANY:
– breast cancer at age ≤50 y
– male breast cancer
– ovarian cancer
– pancreatic cancer
– metastatic, node positive, or very high-risk or high-risk prostate cancer
◊ ≥3 close blood relatives with prostate cancer (any grade) and/or breast cancer on the same side of the family including the patient with prostate cancer
What is NCCN recs for very-low risk?
> =10yr life exp then active surveillance
if <10yrs then observation
AS: PSA q6 months, DRE no more often then 12, Biopsy no more often then 12 months, MRI no more often then 12 months.
If on active surveillance trigger for tx would be?
1) change in grade group
2) increase in tumor volume
3) rise in PSA denisty
4) patient anxiety
Urethra dose constraints for brachy? How are needles placed (how many per row?)
V125<1cc
V150 0%
D10<115%
Constraints for prostate SBRT?
Rectum: V36<1cc
Bladder: V37 <10cc
Prostatic Urethra: 35 max
Sigmoid Colon: V30Gy <1cc
Who does not qualigy for Stampede prostate directed RT?
High burden: visceral metastasis OR ≥4 bone metastasis with at least one outside the vertebral bodies or pelvis.
Bladder 55/20 constraints?
Rectum: V40<30% and V55<1%, max 56
Bowel: V40<150cc, V55<3cc, max 58
Sigmoid: V55<10cc, V30<45%
Ureter: no hot spots
Femoral heads: V40<15%
Sup and inf volume for post-op bladder?
Sup 2cm above pubic symphasis
3mm above penile bulb or 1cm below obturator foramen
Prostate bed recurrence after surgery tx?
ADT 6 mo + SIB 72/64/51.2 in 32 fractions 2.24/2/1.6.
Seminoma kidney constraints? Stomach?
D50%<8Gy
If only one kidney D15%<20Gy
V20<70%
Kidney constraints for testicular?
The right and left kidney D50% should be ≤8 Gy
The kidney D15% should be ≤20 Gy
Active surveillance for prostate?
PSA q6 moths, annual DRE and MRI, with biopsies as need for concern. Check decipher if plannign for surveillance.
Bladder 55/20 constraints?
Rectum: V40<30%, max 56Gy.
Bowel: V40<150cc, V55<3cc, max 58Gy.
Sigmoid: V50<10cc.
Femoral heads: V30<20%
Ureters: V50<50%.
