WPRT or whole bladder

[probiotic]

Bladder TCC T4bN0M0 with rectovesical fistula + RT kidney hydronephrosis
my plan is CRT with weeky cisplatin
what is the optimal field design?
WPRT to 45 Gy and then 20 Gy boost to whole bladder or treat the whole bladder up to 45 Gy and 20 Gy boost to GTV.

---

Members don't see this ad.

 

[Gfunk6]

Is this palliative? If so, why go to such high doses with chemo? Rates of bladder preservation with T4 disease AND hydronephrosis are very low, probably in the single digits. I would consider XRT alone per Horwich.

If you are going to do this anyway, I would stick with the the 2nd dose scheme. No sense expandIng the field and treating elective nodal regions when you are doing palliation.

 

[Palex80]

Is this palliative? If so, why go to such high doses with chemo? Rates of bladder preservation with T4 disease AND hydronephrosis are very low, probably in the single digits. I would consider XRT alone per Horwich.

If you are going to do this anyway, I would stick with the the 2nd dose scheme. No sense expandIng the field and treating elective nodal regions when you are doing palliation.

I fully agree.

Either you decide to go for a very "brave" curative treatment concept or you call it palliative.
Going to 65 Gy CRT with chemo and a rectovesical fistula probably means that you have a higher rate of °III-IV late toxicity than you have a cure rate. That fistula is not going to disappear from itself.

So I would either call it palliative and do something like 39 Gy in 3 Gy fractions to the tumor only without chemo or talk with the surgeons again. If they say yes, then I'd give 45 Gy WPRT as neoadjuvant treatment followed by resection of rectum, bladder (+prostate?).

 

[probiotic]

Thanks guys for help
Urologists refused to do anything because of uncontrolled IHD.
So I go for the palliative approach.

 

[probiotic]

Bladder TCC T4bN0M0 with rectovesical fistula + RT kidney hydronephrosis
my plan is CRT with weeky cisplatin
what is the optimal field design?
WPRT to 45 Gy and then 20 Gy boost to whole bladder or treat the whole bladder up to 45 Gy and 20 Gy boost to GTV.

The scans

 

[seper]

Without chemo, probability of long term control would be close to zero. I'd treat lymph nodes too.

 

[SneakyBooger]

Hydronephrosis is contraindication to chemo/rt...

Bladder TCC T4bN0M0 with rectovesical fistula + RT kidney hydronephrosis
my plan is CRT with weeky cisplatin
what is the optimal field design?
WPRT to 45 Gy and then 20 Gy boost to whole bladder or treat the whole bladder up to 45 Gy and 20 Gy boost to GTV.

 

[deleted4401]

Sort of ... it's a contraindication in terms of having a good outcome. If the patient is just not a surgical candidate, you don't really have any other choices, even if they have hydronephrosis.

 

[Palex80]

Hydronephrosis is contraindication to chemo/rt...

You could always give Mitomycin C, if you are concerned about Cisplatin-associated nephrotoxicity.