033IC - Trimodality Therapy for Management of Muscle Invasive Bladder Cancer

Saturday, April 29, 2023

10:00 AM – 12:00 PM CST

Location: S103C

Instructional Course Director(s)

AF

Adam Feldman, MD, MPH

Massachusetts General Hospital/Harvard Medical School

Instructional Course Faculty(s)

JE

Jason Efstathiou, MD, PHD

Professor
Massachusetts General Hospital, Harvard Medical School
Richard Lee, MD (he/him/his)

Assistant Professor of Medicine
Harvard Medical School
Matthew Wszolek, MD

Harvard Medical School

Course Description: This course is a comprehensive review of trimodal therapy for muscularis propria invasive urothelial carcinoma of the bladder with a multidisciplinary faculty including urology, radiation oncology and medical oncology. We will review results from prospective randomized trials and large institutional experiences in trimodality bladder-sparing therapy. The course will focus on the urologist’s critical role in patient selection for this approach versus radical cystectomy. We will discuss the technique and importance of aggressive transurethral resection and repeat resection prior to proceeding with chemotherapy and radiation, as well as the continued role of the urologist in repeat cystoscopic assessments of tumor response and ongoing surveillance of the bladder. We will review the coordinated multidisciplinary approach for bladder preservation, including radiation fields, role of concurrent chemotherapy and need for early salvage cystectomy when indicated, as well as management of non-muscle invasive recurrences. We will review potential toxicities and quality of life associated with bladder-sparing therapy versus cystectomy and will address emerging topics such as novel biomarkers and the potential role of combination with immunotherapy and other targeted therapies.

Learning Objectives:

Explain prospective randomized trials and large institutional experiences in trimodality therapy for muscularis propria invasive bladder cancer.
Describe which patients are candidates for trimodal bladder-sparing therapy, and which patients are not candidates and should instead undergo radical cystectomy.
Describe the technique and importance of aggressive initial transurethral resection, repeat transurethral resection and ongoing cystoscopic surveillance of the bladder.
Describe the coordinated multidisciplinary technique in trimodality therapy, including radiosensitizing chemotherapy agents, radiation fields and adjuvant chemotherapy.
Describe the indications for salvage cystectomy, discuss management of noninvasive recurrences, understand the quality of life and potential toxicities after trimodality therapy, and gain knowledge of novel biomarkers and the potential role of combining radiation with immunotherapy and other targeted therapies.
Examine novel biomarkers and the potential role of combining radiation with immunotherapy and other targeted therapies.