Bladder Palliation Case

[Haybrant]

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metastatic bladder case questions

 

[BobbyHeenan]

Half life of gem is pretty quick (like 19 hours for metabolite I think), so I'd probably consider starting him in 1 week and go ahead and do the palliative XRT. You're right to be worried about it though, concurrent gem is no joke. If he has a brisk bleed he'll be in trouble bc he may not see a Hg above 10 for the rest of his days, so I'd go ahead and treat how.

 

[ramsesthenice]

Was it full dose (1000 mms)? If so, a week should be fine.

I also hate concurrent Gem. One of our med oncs loves it for panc and starts everyone at 600 Weekly which is invariably too high. It’s honestly all or nothing. Many patients tolerate it fine but the ones that crash do it in spectacular fashion. Same for concurrent FOLFOX and esophageal. In the absence of compelling data these are necessary I prefer to stick to the tried and true regimens.

 

[baculum1]

Yes would wait about a week but if urgent would start right away. Would try to give something hypofractionated like 50/20 (BED of 60) and call it a day

 

[PhotonBomb]

Yes would wait about a week but if urgent would start right away. Would try to give something hypofractionated like 50/20 (BED of 60) and call it a day

No need to push the dose this high for this case.

 

[baculum1]

No need to push the dose this high for this case.

Obviously if patient looks terrible i would do any of the palliative regimens but if patient looks pretty good like some of my pts would push dose to give some better LC. its a terrible way to go

 

[RickyScott]

Was it full dose (1000 mms)? If so, a week should be fine.

I also hate concurrent Gem. One of our med oncs loves it for panc and starts everyone at 600 Weekly which is invariably too high. It’s honestly all or nothing. Many patients tolerate it fine but the ones that crash do it in spectacular fashion. Same for concurrent FOLFOX and esophageal. In the absence of compelling data these are necessary I prefer to stick to the tried and true regimens.

I have given xrt on full dose gem for pancreas on protocol in past. Is tolerable; just would keep dose 2-2.5 gy to around 30 Gy. (Been a while but think in pancreas at time 35 at 2-2.5 was what protocol found tolerable)

 

[Palex80]

15 x 2.66 Gy ?