We have detected that you are using an Ad Blocker. PracticeUpdate is free to end users but we rely on advertising to fund our site. Please consider supporting PracticeUpdate by whitelisting us in your ad blocker.
We have sent a message to the email address you have provided, . If this email is not correct, please update your settings with your correct address.
The email address you provided during registration, , does not appear to be valid. Please update your settings with a valid address before to continue using PracticeUpdate.
Please provide your AHPRA Number to ensure that you are given the correct level of access to our site.
Explore
Bladder Cancer
Center of Excellence
In an effort to better serve our users, we have streamlined our content offering. As a result, we no longer publish new content or update existing content in Bladder Cancer. Visit the 'Content & Subscriptions' tab of your Settings page at any time to update your Dashboard or Newsletter Subscription preferences to continue to see news and information that interests you most.
In an effort to better serve our users, we have streamlined our content offering. As a result, we no longer publish new content or update existing content in Bladder Cancer. Visit the 'Content & Subscriptions' tab of your Settings page at any time to update your Dashboard or Newsletter Subscription preferences to continue to see news and information that interests you most.
You can find your saved items on your dashboard, in the "saved" tab.
You've recommended your first item
Your recommendations help us improve our content suggestions for you and other PracticeUpdate members.
You've subscribed to your first topic alert
What does that mean?
Each day, we'll check to see if new items have been published to the topics you're subscribed to, and we'll send you one email with all of the new items from that day.
We'll keep all topic alert notifications available on your dashboard for 30 days, to make sure you don't miss anything.
Lastly, whenever you have unread items in the topics you've subscribed to, the "Alerts" icon will light up in the main menu. Just click on the bell to see your five most-recent, unread notifications.
Sign in to PracticeUpdate
Only registered members have full access to PracticeUpdate content.
No comments yet, be the first to start the discussion!
Guru Sonpavde
Apr 10, 2021
To summarize, this is a 75 year-old female with a solitary muscle-invasive urothelial carcinoma on the right trigone/right lateral wall with no carcinoma in-situ or hydronephrosis. Multiparametric (mp)MRI may help with staging of a bladder tumor, although further data are necessary. In the event a suspicious pelvic lymph node is seen, a PET scan can help with optimal staging (a metastatic lymph node would render upfront optimal systemic combination chemotherapy more important before considering local definitive therapy). The patient appears fit and eligible for cisplatin and radical cystectomy. The conventional and preferred option is neoadjuvant cisplatin-based combination chemotherapy followed by radical cystectomy since this approach is proven in phase III trials to extend survival (clinical trials combining neoadjuvant chemotherapy with immune checkpoint inhibitors may be offered if available). The alternative trimodality chemoradiation strategy following initial maximal TURBT as a bladder-sparing approach is reasonable in well selected patients who are unfit for or refuse radical cystectomy. This patient does have features associated with favorable outcomes with trimodality therapy, i.e. solitary tumor (not in a diverticulum), no CIS, no prior radiation to that region, absence of significant urinary symptoms and absence of hydronephrosis. While this specific patient can certainly choose to pursue trimodality therapy, it is important to discuss the fact that no randomized phase III trial data exist that compare neoadjuvant chemotherapy followed by radical cystectomy vs trimodality therapy. Notably, the UK MRC phase III trial (Griffiths et al, JCO 2011) that demonstrated improved survival with neoadjuvant cisplatin-based combination chemo did allow either radical cystectomy, radiation or chemoradiation as definitive local therapy. The optimal chemotherapy regimen to combine with radiation is unclear, although cisplatin, 5FU+mitomycin and gemcitabine alone are all considered reasonable. The patient may be offered trials combining chemoradiation with PD1/L1 inhibitors, which offers the promising potential to improve outcomes. Interestingly, improved disease-free survival was reported recently with adjuvant nivolumab following radical cystectomy for high-risk muscle-invasive urothelial carcinoma (CHECKMATE274 trial).
Ramesh Arya
Feb 20, 2022
Agree with the protocol suggested for management.
Nov 24, 2024
Pending Moderator approval.
Are you sure you want to delete this comment? This can't be undone.
Guru Sonpavde
Apr 10, 2021
Ramesh Arya
Feb 20, 2022
Nov 24, 2024
Pending Moderator approval.