Bladder Flashcards
Bladder staging: tumor invades lamina propria
T1
Bladder staging: Tumor invades superficial muscularis propria (inner half)
pT2a
Bladder staging: Tumor invades deep muscularis propria (outer half)
pT2b
Bladder staging: Tumor invades perivesical tissue, microscopically
pT3a
Bladder staging: Tumor invades perivesical tissue, macroscopically
pT3b
Bladder Staging: Tumor invades prostatic stroma, seminal vesicles, uterus, vagina
T4a
Bladder staging: Tumor invades pelvic wall, abdominal wall
T4b
Bladder staging: Single regional lymph node in true pelvis
N1
Bladder staging: Multiple regional lymph nodes in the true pelvis
N2
Bladder staging: Common iliac lymph node metastasis(es)
N3
Bladder staging: Distant metastasis limited to lymph nodes beyond common iliacs
M1a
Bladder staging: Distant non-lymph node metastases
M1b
Bladder staging: Stage I
T1 N0 M0
Bladder staging: Stage II
T2a/b N0 M0
Bladder staging: Stage IIIA
T3a/b/T4 N0 M0
T1-T4a N1 M0
Bladder staging: Stage IIIB
T1-T4a N2/3 M0
Bladder staging: Stage IVA
T4b or M1a
Bladder staging: Stage IVB
M1b
Bladder contouring
GTV = if able to visualize
CTV = whole bladder, prostatic urethra, draining nodes (presacral, obturator, internal iliac and external iliac - L5/S1)
PTV = CTV + 1 cm (5 mm on nodes)
Boost: cover tumor bed +1.5
Ideal bladder sparing candidate
cT2, maximal TURBT, unifocal, no extensive CIS, urothelial/papillary histology, no hydronephrosis, functional bladder, node negative
Bladder conventional dose
45-50.4 Gy to pelvis
Tumor boost to 60-65 Gy in 1.8 Gy
Bladder conventional constraints: Spinal cord
Dmax < 45
Bladder conventional constraints: Femoral heads
V45 < 20%
Bladder conventional constraints: Small bowel
V50 < 10cc, Dmax < 54 Gy
