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Cases from the Multidisciplinary Tumor Board
Cases from the Multidisciplinary Tumor Board
Nicholas James, Professor Professor of Clinical OncologyInstitute of Cancer and Genomic SciencesUniversity of Birmingham
Mike Leveridge, Associate ProfessorDepartment of UrologyQueen’s University
Girish Kulkarni, Associate Professor Department of Surgical Oncology Princess Margaret Cancer Centre University Health Network.
Chris French, Clinical Assistant Professorof SurgeryMemorial University of Newfoundland
Conflicts of Interest
Learning Objectives
Assess important contraindications to bladder-sparing therapy for MIBC
Understand the role of cytoreductive nephrectomy in 2019
Review role of a multi-disciplinary approach to upper tract UC
S.B.51 yo male, healthy, ECOG 0
Presentation: left flank pain, microscopic hematuria
PMHx: Stage 1 GCTT
Renal Function: 114 (0 - 110) umol/L (eGFR 75)
TURBT: ~2.5 cm, cT2, CISCystoscopically complete resection
Cysview-solitary lesion
Q
NACTMid-course Gem/Cis
Q
Radical Cystectomy, Orthotopic Diversion, PLND
pT3b, N1 Positive LV invasionNegative Margins1 of 18 nodes positive
Q
~9 months post-op
Q
~9 months post-op
Q
2 months on durvalumab
Q
~5 months on durvalumab
DB55 yo male, ECOG 1
2019 ER presentation with gross hematuria
Past history HTN, ex-smoker
Cysto normal
VJ50 year old, ECOG 1
Hematuria with Plavix-2015
Investigations/management for angina (thrombectomy)
PMHX
JAK2V617F mutation-Polycythemia
Factor 5 Leiden deficiency
L pneumonectomy (gun shot)
R Nephroureterectomy
pT3 with necrosis and scaring associated with regression
N0 (necrotic)
May 2018
October 2018
Re-resection negative
Gets BCG but at first cysto after (prior to maintenance) another mass
T1HG
Q
J.I.63 yo male, ECOG 1
Presentation 2009: hematuria and increasingly bad LUTS
PMHx: dyslipidemia, HTN, PTCA with drug eluting stent 9 months ago, (?/remote) inflammatory bowel disease
Renal Function: 129 (0 - 110) umol/L (eGFR 53)
TURBT
T1, High GradeNo CIS“Nested” variantNo muscularis propria seen
Q
Aborted CystectomyT4B, N3
Q
TURBT-2013T1 high grade
Q
TURBT-2014
Q
Cystectomy and Ileal ConduitpT3a, N0
Nicholas James, Professor Professor of Clinical OncologyInstitute of Cancer and Genomic SciencesUniversity of Birmingham
Mike Leveridge, Associate ProfessorDepartment of UrologyQueen’s University
Girish Kulkarni, Associate Professor Department of Surgical Oncology Princess Margaret Cancer Centre University Health Network.
Chris French, Clinical Assistant Professorof Surgery
Memorial University of Newfoundland
Take Away Messages
Ideal candidate for bladder-sparing
NACT prior to bladder-sparing TMT
Switch direction (Bail) NACT
Role of cytoreductive nephrectomy in 2019
Take Away Messages
Early cystectomy for higher risk NMIBC
Salvage therapies for BCG unresponsive
Local therapy in metastatic UC
