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For non-metastatic MIBC patients with incomplete debulking TURBT, who are not surgical candidates for cystectomy or repeat TURBT, would you try chemoRT or proceed directly to systemic treatment?
Can chemoradiation be curative without maximal debulking TURBT?
Answer from: Radiation Oncologist at Academic Institution
Definitely chemoRT. I believe around 1/3 of patients on BC2001 had biopsy only or incomplete TURBT. No doubt maximal TURBT is preferred, but when it is not possible, that is not a contraindication to definitive treatment. If not a chemo candidate (though there are several options), I would reco...
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Answer from: Medical Oncologist at Academic Institution
Although maximal TURBT has been an essential component of trimodality therapy, it is not uncommon to see this scenario in clinical practice. Inability to maximally resect the tumor has been associated with significantly lower rates or cure, likely due to higher tumor volume and higher T stage (T3/4 ...
Comments
Medical Oncologist at NMMC - Cancer Care Starkville
With this group of patients, especially more frail...
With this group of patients, especially more frail...
Medical Oncologist at Memorial Sloan Kettering Cancer Center
Weekly cisplatin is not unreasonable but may not b...
Weekly cisplatin is not unreasonable but may not b...
Medical Oncologist at City of Hope
For frail patients, we have used twice weekly gemc...
For frail patients, we have used twice weekly gemc...
Radiation Oncologist at Radiant Oncology
What would you estimate the LR rate of incomplete ...
What would you estimate the LR rate of incomplete ...
Radiation Oncologist at National Institutes of Health Clinical Center
In a retrospective publication from MRG, the hazar...
In a retrospective publication from MRG, the hazar...
Answer from: Medical Oncologist at Academic Institution
Would still try chemo RT in this specific scenario to give the patient the benefit of doubt. As it is non-metastatic, systemic therapy is a road to nowhere in and of itself. Need RT to give the patient a chance. Of course, need to fully discuss beforehand.