EMUC 2020: Organ Preservation in Bladder Cancer (Trimodal vs Cystectomy)

(UroToday.com) In an oral presentation in the session examining Organ Preservation in Challenging Cases at the 12th European Multidisciplinary Congress on Urological Cancers (EMUC), Dr. Moschini, Dr. Choudhury, and Dr. Roupret discussed a case of organ preservation in bladder cancer.

 

Dr. Moschini began by highlighting the case of a 70-year-old man without relevant medical history or smoking exposure. 6 months prior, he presented to a general practitioner with gross hematuria and was treated with antibiotics. In the absence of lower urinary tract symptoms, he had recurrent painless gross hematuria 2 months ago and was referred to a urologist. Cystoscopy demonstrated a solitary bladder tumor, measuring less than 3 centimeters. CT scan was consistent with muscle-invasive disease, without any evidence of hydronephrosis. Cytology was positive indicative of high-grade disease.

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A transurethral resection of the bladder tumor was performed. Following a macroscopically complete resection, histopathologic assessment demonstrated pT2a high-grade urothelial carcinoma without evidence of carcinoma in situ or lymphovascular invasion.

Dr. Moschini proposed treatment with neoadjuvant chemotherapy followed by radical cystectomy or trimodal therapy.

Dr. Choudhury described this patient as “perfect for bladder preservation” on the basis of his solitary pT2 tumor, complete resection, lack of hydronephrosis, normal renal function, and lack of CIS. She proposed a course of neoadjuvant chemotherapy followed by hypofractionated radiotherapy with concomitant radiosensitizing chemotherapy.

Dr. Roupret emphasized that this case was indeed particularly well suited to bladder preservation. He emphasized that among these ideal patients in whom oncologic outcomes are likely to be similar between trimodal therapy and radical cystectomy, we need to consider the burden of ongoing surveillance and quality of life considerations. Finally, in the case of recurrence, he may be a candidate for salvage cystectomy. Dr. Roupret suggested that a tumor board discussion and radiation oncology referral should be undertaken for patients such as this whole have disease characteristics particularly well suited to a trimodal treatment approach.

Presented by: Marco Moschini, MD, Ph.D., Urology resident, Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland, Ananya Choudhury, MA (Cantab), Ph.D., MRCP, FRCR, Chair, and Honorary Consultant in Clinical Oncology, Co-Group Leader Translational Radiobiology, Radiation Oncologist, The Univerity of Manchester, Manchester, England, and Morgan Roupret, MD, Ph.D.,  Academic Professor of Urology, Sorbonne University, Hospital Pitié-Salpétrière, Paris, France

Written by: Christopher J.D. Wallis, Urologic Oncology Fellow, Vanderbilt University Medical Center, Contact: @WallisCJD on Twitter at the 12th European Multidisciplinary Congress on Urological Cancers (EMUC) (#EMUC20 ), November 13th - 14th, 2020

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