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Practice Guidelines in Oncology™ Bladder Cancer Including Upper Tracttumors and Urothelial Carcinoma of the Prostate

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Practice Guidelines in Oncology™ Bladder Cancer Including Upper Tracttumors and Urothelial Carcinoma of the Prostate NCCN Clinical Practice Guidelines in Oncology™ Bladder Cancer Including Upper TractTumors and Urothelial Carcinoma of the Prostate V.2.2010 Continue www.nccn.org Guidelines Index ® Practice Guidelines Bladder Cancer Table of Contents NCCN in Oncology – v.2.2010 Bladder Cancer Staging, Discussion, References NCCN Bladder Cancer Panel Members * James E. Montie, MD/Chair w * Timothy M. Kuzel, MD ‡ Jerome P. Richie, MD w University of Michigan Comprehensive Robert H. Lurie Comprehensive Cancer Dana-Farber/Brigham and Women’s Cancer Cancer Center Center of Northwestern University Center w Peter E. Clark, MD w Paul H. Lange, MD Wade J. Sexton, MD w Vanderbilt-Ingram Cancer Center Fred Hutchinson Cancer Research H. Lee Moffitt Cancer Center & Research Center/Seattle Cancer Care Alliance Institute Mario A. Eisenberger, MD † w ¹ The Sidney Kimmel Comprehensive Subodh M. Lele * William U. Shipley, MD § w Cancer Center at Johns Hopkins UNMC Eppley Cancer Center at The Massachusetts General Hospital Cancer Nebraska Medical Center Center Rizk El-Galley, MD w Jeffrey Michalski, MD, MBA § University of Alabama at Birmingham Eric J. Small, MD † w Siteman Cancer Center at Barnes-Jewish Comprehensive Cancer Center UCSF Helen Diller Comprehensive Cancer Hospital and Washington University Center Richard E. Greenberg, MD w School of Medicine Fox Chase Cancer Center w Donald L. Trump, MD † Anthony Patterson, MD Roswell Park Cancer Institute St. Jude Children’s Research Harry W. Herr, MD w Hospital/University of Tennessee Cancer Memorial Sloan-Kettering Cancer Center Phillip J. Walther, MD, PhD w Institute Duke Comprehensive Cancer Center Gary R. Hudes, MD † ‡ Kamal S. Pohar, MD w w Fox Chase Cancer Center Timothy G. Wilson, MD Authur G. James Cancer Hospital & City of Hope Comprehensive Cancer Center Deborah A. Kuban, MD § Richard J. Solove Research Institute at The University of Texas M.D. Anderson The Ohio State University Cancer Center w Urology † Medical oncology ‡ Hematology/Hematology oncology NCCN Guidelines Panel Disclosures § Radiotherapy/Radiation oncology ¹ Pathology Continue * Writing committee member Version 2.2010, 03/30/10 © 2010 National Comprehensive Cancer Network, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN. Guidelines Index ® Practice Guidelines Bladder Cancer Table of Contents NCCN in Oncology – v.2.2010 Bladder Cancer Staging, Discussion, References Table of Contents For help using these NCCN Bladder Cancer Panel Members documents, please click here Summary of Guidelines Updates Staging Bladder Cancer: · Clinical Presentation and Initial Evaluation (BL-1) Discussion · Noninvasive Disease or Tis, Workup, Primary Evaluation/Surgical Treatment (BL-1) > Secondary Surgical Treatment, Adjuvant Intravesical Treatment,Follow-up (BL-2) References > Posttreament cTa, cT1, Tis Recurrent or Persistent Disease (BL-3) · Muscle Invasive or Metastatic, Workup, Primary Evaluation/Surgical Treatment (BL-1) Guidelines Index > cT2 Primary and Adjuvant Treatment (BL-4) Print the Bladder Cancer Guideline > cT3 Primary and Adjuvant Treatment (BL-5) > cT4a, cT4b and Metastatic Disease, Additional Workup, Primary and Adjuvant Clinical Trials: The NCCN Treatment (BL-6) believes that the best management > Follow-up, Recurrent or Persistent Disease (BL-7) for any cancer patient is in a clinical · Principles of Surgical Management (BL-A) trial. Participation in clinical trials is · Principles of Pathology Management (BL-B) especially encouraged. · Probability of Recurrence and Progression (BL-C) To find clinical trials online at NCCN · Non-Urothelial Cell Carcinoma of the Bladder (BL-D) member institutions, click here: · Follow-Up After Cystectomy (BL-E) nccn.org/clinical_trials/physician.html · Principles of Intravesical Treatment (BL-F) · NCCN Categories of Evidence and Principles of Chemotherapy Management (BL-G) Consensus: All recommendations · Principles of Radiation Management of Invasive Disease (BL-H) are Category 2A unless otherwise Upper GU Tract Tumors: specified. · Renal Pelvis (UTT-1) See NCCN Categories of Evidence and Consensus · Urothelial Carcinoma of the Ureter (UTT-2) Urothelial Carcinoma of the Prostate (UCP-1) These guidelines are a statement of evidence and consensus of the authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult these guidelines is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient's care or treatment. The National Comprehensive Cancer Network makes no representations nor warranties of any kind whatsoever regarding their content, use, or application and disclaims any responsibility for their application or use in any way. These guidelines are copyrighted by National Comprehensive Cancer Network. All rights reserved. These guidelines and the illustrations herein may not be reproduced in any form without the express written permission of NCCN. ©2010. Version 2.2010, 03/30/10 © 2010 National Comprehensive Cancer Network, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN. Guidelines Index ® Practice Guidelines Bladder Cancer Table of Contents NCCN in Oncology – v.2.2010 Bladder Cancer Staging, Discussion, References Summary of the Guidelines updates The 2.2010 version of the Bladder Cancer guidelines represents the addition of the updated Discussion and the addition of the 2010 American Joint Committee on Cancer (AJCC) TNM Staging System for Bladder (ST-1 ), Renal Pelvis, and Ureter Cancers (ST-3 ). Summary of the changes in the v.1.2010 version of the Bladder Cancer guidelines from the v.1.2009 version include: BL-2: commonly used with squamous cell carcinoma of other sites such as · cTa, high grade, “If lymphovascular invasion” was removed as a qualifier 5-FU, taxanes, methotrexate, etc.” for adjuvant intravesical treatment. · Adenocarcinoma, management was clarified by adding “Conventional · Ta high grade and T1, low and high grade, follow-up with cystoscopy and chemotherapy (eg, MVAC) for urothelial carcinoma is not effective urine cytology was changed to every 3 -6 mo. however, the use of chemotherapy or RT should be individualized and BL-4: maybe of potential benefit in select patients.” and “Consider alternative · For primary treatment, radical cystectomy, “consider” was removed from therapy or clinical trial”. “neoadjuvant cisplatin-based combination” and was changed from a · Urachal carcinoma, “Treat per NCCN Colon Cancer guidelines” was category 2B to a category 2A designation. replaced with “Conventional chemotherapy for urothelial carcinoma is · For primary treatment with segmental cystectomy, for “highly selected not effective, however, the use of chemotherapy or RT should be patients with” was added to “solitary lesion in a suitable location; no individualized and maybe of potential benefit in select patients.” Tis”. BL-E · For patients with cT2 tumors that received selective bladder sparing · Follow-up after radical cystectomy, second bullet was modified, “Imaging following maximal TURBT or treatment for extensive comorbid disease of thechest, abdomen, and pelvis every 3 to 12 months for 2 years based or poor performance status: on risk of recurrence and then as clinically indicated.” > “Prior tumor site rebiopsy” was added to the evaluation after 40-50 Gy, BL-G at completion of RT, or at 3 mo (Also for BL-5) · First line chemotherapy (neoadjuvant, adjuvant and metastatic), a "Completion of RT up to 65 Gy" was added as an adjuvant treatment category 2B designation was added to “split dose administration of option. cisplatin may be considered”. · For adjuvant treatment of stage cT2 tumors, a category 2B designation · Second-line chemotherapy (metastatic), a statement regarding palliative was added to adjuvant chemotherapy (Also for BL-5 for cT3). options was added “Depending on first line therapies, palliative options BL-6 include single agent therapy bleomycin, 5-fluorouracil, cisplatin, · For primary and adjuvant treatment, “cystectomy” replaced “surgery” carboplatin, docetaxel, doxorubicin, gemcitabine, ifosfamide, paclitaxel, for clarification. pemetrexed, methotrexate, and vinblastine.” · “TURBT” was added to “Evaluate with cystoscopy and imaging of BL-H abdomen/pelvis”. · Principles of radiation therapy management of invasive disease, 7th BL-7 principle was modified by changing the dose of RT from 40-55 Gy to 40- · Footnote ‘a’ was added to the page. Also added as footnote ‘c’ on UTT-2. 45 Gy for treating the whole bladder, with or with pelvic lymph nodes. · Follow-up for bladder sparing was modified as “cystoscopy + urine · “External RT can also be used for medically inoperable patients or for selected mapping - 6 mo for 2 y cytology ± biopsy every 3 , then palliation” was added as a new principle. increasing intervals” UTT-2 BL-D · Workup, “IVP” was changed to “Upper tract imaging”. · Mixed histology, first bullet was modified by adding, “because of · Primary treatment of mid, low grade, for a nephroureterectomy with cuff potential to have a more aggressive natural history”. of bladder, “and consider regional lymphadenectomy” was added as an · Pure squamous, management was modified by adding “or other agents option. Note: All recommendations are category 2A unless otherwise indicated. Clinical Trials: NCCN believes that the best management of any cancer patient is
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