Stage III (cT3, N0; CT4a, N0; cT1-T4a pero N1) Flashcards
Post concurrent chemorad (cat1), when is the tumor reassessed?
2-3 months after full treatment
Additional workup?
ABC. ABDOMINOPELVIC IMAGING, BONE SCAN AS NEEDED, CHEST IMAGING
What are the 2 treatment options similar to stage II?
NEOADJUVANT CISPLATIN BASED CHEMO FOLLOWED BY RADICAL CYSTECTOMY AND CONCURRENT CHEMORAD
What are the prerequisites for bladder preservation in Stage IIIA patients?
NO HYDRO, LESS THAN SIX CM TUMOR,
NO MULTIFOCAL OR EXTENSIVE TIS
For post cystectomy Stage IIIA patients, what are the conditions to start adjuvant cisplatin based chemotherapy?
T3 T4
POSITIVE LN
POSITIVE MARGINS
Post concurrent chemorad, no tumor was seen, what is your next step?
OBSERVATION
Additional workup?
ABC. ABDOMINOPELVIC IMAGING, BONE SCAN AS NEEDED, CHEST IMAGING
What are the 2 treatment options similar to stage II?
NEOADJUVANT CISPLATIN BASED CHEMO FOLLOWED BY RADICAL CYSTECTOMY AND CONCURRENT CHEMORAD
Is bladder preservation an option for Stage IIIA patients?
YES
What are the prerequisites for bladder preservation in Stage IIIA patients?
NO HYDRO, LESS THAN SIX CM TUMOR,
NO MULTIFOCAL OR EXTENSIVE TIS
Is partial cystectomy advised/part of the algorithm for Stage IIIA patients?
NOT ANYMORE
For non-cystectomy candidates, what are the TWO treatment options?
CONCURRENT CHEMORAD OR RT
For post cystectomy Stage IIIA patients, what are the conditions to start adjuvant cisplatin based chemotherapy?
T3-T4
POSITIVE LN
POSITVE MARGINS
Is adjuvant RT advised for stage IIIA patients who underwent cystectomy?
YES
Post concurrent chemorad (cat1), when is the tumor reassessed?
2-3 MONTHS AFTER FULL TREATMENT
Post concurrent chemorad, no tumor was seen, what is your next step?
OBSERVATION
Post concurrent chemorad, a tumor was seen, what are the 3 clinical scenarios?
IF TA TIS OR T1, INTRAVESICAL CHEMO
SURGICAL CONSOLIDATION
TREAT AS METASTATIC DISEASE
For non cystectomy candidates who underwent concurrent chemorad or RT, no tumor was found, what is your next step?
OBSERVATION
For non cystectomy candidates who underwent concurrent chemorad or RT, a tumor was found, what are you THREE options for adjuvant treatment?
SYSTEMIC THERAPY, TURBT, BEST SUPPORTIVE CARE
Do patients with cN1 disease have better outcomes when they are given neoadjuvant chemotherapy and have a response?
YES
Does concurrent chemorad have equivalent survival rates as neoadjuvant cisplatin based chemotherapy followed by rad cystectomy?
YES
