Stage III (cT3, N0; CT4a, N0; cT1-T4a pero N1)

Question 1

Post concurrent chemorad (cat1), when is the tumor reassessed?

Answer 1

2-3 months after full treatment

Question 2

Additional workup?

Answer 2

ABC. ABDOMINOPELVIC IMAGING, BONE SCAN AS NEEDED, CHEST IMAGING

Question 3

What are the 2 treatment options similar to stage II?

Answer 3

NEOADJUVANT CISPLATIN BASED CHEMO FOLLOWED BY RADICAL CYSTECTOMY AND CONCURRENT CHEMORAD

Question 4

What are the prerequisites for bladder preservation in Stage IIIA patients?

Answer 4

NO HYDRO, LESS THAN SIX CM TUMOR,

NO MULTIFOCAL OR EXTENSIVE TIS

Question 5

For post cystectomy Stage IIIA patients, what are the conditions to start adjuvant cisplatin based chemotherapy?

Answer 5

T3 T4

POSITIVE LN

POSITIVE MARGINS

Question 6

Post concurrent chemorad, no tumor was seen, what is your next step?

Answer 6

OBSERVATION

Question 7

Additional workup?

Answer 7

ABC. ABDOMINOPELVIC IMAGING, BONE SCAN AS NEEDED, CHEST IMAGING

Question 8

What are the 2 treatment options similar to stage II?

Answer 8

NEOADJUVANT CISPLATIN BASED CHEMO FOLLOWED BY RADICAL CYSTECTOMY AND CONCURRENT CHEMORAD

Question 9

Is bladder preservation an option for Stage IIIA patients?

Answer 9

YES

Question 10

What are the prerequisites for bladder preservation in Stage IIIA patients?

Answer 10

NO HYDRO, LESS THAN SIX CM TUMOR,

NO MULTIFOCAL OR EXTENSIVE TIS

Question 11

Is partial cystectomy advised/part of the algorithm for Stage IIIA patients?

Answer 11

NOT ANYMORE

Question 12

For non-cystectomy candidates, what are the TWO treatment options?

Answer 12

CONCURRENT CHEMORAD OR RT

Question 13

For post cystectomy Stage IIIA patients, what are the conditions to start adjuvant cisplatin based chemotherapy?

Answer 13

T3-T4
POSITIVE LN
POSITVE MARGINS

Question 14

Is adjuvant RT advised for stage IIIA patients who underwent cystectomy?

Answer 14

YES

Question 15

Post concurrent chemorad (cat1), when is the tumor reassessed?

Answer 15

2-3 MONTHS AFTER FULL TREATMENT

Question 16

Post concurrent chemorad, no tumor was seen, what is your next step?

Answer 16

OBSERVATION

Question 17

Post concurrent chemorad, a tumor was seen, what are the 3 clinical scenarios?

Answer 17

IF TA TIS OR T1, INTRAVESICAL CHEMO
SURGICAL CONSOLIDATION
TREAT AS METASTATIC DISEASE

Question 18

For non cystectomy candidates who underwent concurrent chemorad or RT, no tumor was found, what is your next step?

Answer 18

OBSERVATION

Question 19

For non cystectomy candidates who underwent concurrent chemorad or RT, a tumor was found, what are you THREE options for adjuvant treatment?

Answer 19

SYSTEMIC THERAPY, TURBT, BEST SUPPORTIVE CARE

Question 20

Do patients with cN1 disease have better outcomes when they are given neoadjuvant chemotherapy and have a response?

Answer 20

YES

Question 21

Does concurrent chemorad have equivalent survival rates as neoadjuvant cisplatin based chemotherapy followed by rad cystectomy?

Answer 21

YES