- Joined
- May 14, 2018
- Messages
- 19
- Reaction score
- 45
I have an 83-year-old patient with high grade urothelial ca sent from the VA. He had a TURBT and bilateral neph tubes placed there. Multiple co-morbidities. He was told he is not a candidate for surgery and sent to me. I ordered an MRI which showed extensive disease along the posterior wall, extra vesicular invasion of the prostate and bilateral ureters. There is also a 1.2 cm right external iliac lymph node.
My local urologist agreed with the VA in that he cannot do any more TURBT as its too vascular and he has to get to the base and he will "never get there". He recommended proceeding with RT+chemo. My initial plan was treating whole bladder and prostate to 64/32 but unsure of how to treat the elective and involved lymph nodes. I think doing 1.5Gy/day * 32 = 48 Gy elective may be too low of a daily dose. Maybe 1.8 Gy/day to 45 to the bladder, prostate, nodes, then sequential boost of the bladder, prostate, involved LN to 63 Gy? Any thoughts? Obviously not ideal to not have a max TURBT prior but I am backed into a corner.
My local urologist agreed with the VA in that he cannot do any more TURBT as its too vascular and he has to get to the base and he will "never get there". He recommended proceeding with RT+chemo. My initial plan was treating whole bladder and prostate to 64/32 but unsure of how to treat the elective and involved lymph nodes. I think doing 1.5Gy/day * 32 = 48 Gy elective may be too low of a daily dose. Maybe 1.8 Gy/day to 45 to the bladder, prostate, nodes, then sequential boost of the bladder, prostate, involved LN to 63 Gy? Any thoughts? Obviously not ideal to not have a max TURBT prior but I am backed into a corner.