urothelial Flashcards
adjuvant GC after cystectomy?
improvement in PFS significant, OS difference didn’t meet significance. possible benefit
tri-modality therapy for bladder conservation
can achieve CR in 2/3, 5-year survival 50% (similar to surgical), and 30-40% can keep bladder and survive 5-yr (1/3 of pts).
criteria for tri-modality
no urethrel disease, complete TUR, small solitary tumor, no obstruction, normal exam under anesthesia
CG standard
cystectomy/PLNDx with neoadjuvant GC, not carbo
standard for first line bladder metastatic
GC is best (adding taxol doesn’t reach significance)
alternative to GC
MVAC
prognosis in metastatic bladder
bad risk factor
residual disease after metastatic first line GC
can resect residual disease, 33% longer term survival (not cure)
bladder pts unfit for GC
can give carbo-based but worse
second line bladder
non FDA approved, can give pemetrexed, taxmen
mutations in bladder
CCND1, CCNE1, Rb, E2F3, CDKN2A, PIK3CA, FGFR
PET/CT for bladder cancer
may be helpful for patients to look for LN positive.
triplet disease?
if you have loco regional disease with LN’s and need response for surgery, can add taxol to GC
micropapillary bladder ca
high risk, cannot give BCG, need cystectomy
bladder preservation regimen
neoadjuvant GC–>if pCR on biopsy–>TURBT then chemoRT with RT+5-FU+mitomycin.
