Article open access publication

EAU–ESMO consensus statements on the management of advanced and variant bladder cancer—an international collaborative multi-stakeholder effort: under the auspices of the EAU and ESMO Guidelines Committees

Annals of Oncology, Elsevier, ISSN 1569-8041

Volume 30, 11, 2019

DOI:10.1093/annonc/mdz296, Dimensions: pub.1120729032, PMC: PMC7360152, PMID: 31740927,

Authors

Babjuk, M (2) (3)
Bellmunt, J (4) (5)
De Santis, M (3) (8)
Gillessen, S (9) (10) (11) (12)
James, N (13) (14)
Palou, J (16)
Powles, T (17) (18)
Ribal, M J (19)
Shariat, S F (2) (3) (20) (21) (22)
Xylinas, E (24) (25)
Agarwal, N (26)
Arends, T (27)
Bamias, A (28)
Birtle, A (11) (29)
Black, P C (30)
Bochner, B H (22) (31)
Bolla, M (32)
Bossi, A (33)
Briganti, A (34) (35)
Burger, M (36)
Chiti, A (39) (40)
Choudhury, A (11) (12)
Compérat, E (41) (42)
Crabb, S (43)
Culine, S (44)
De Bari, B (45) (46)
De Blok, W (47)
Fanti, S (51)
Gakis, G (53)
Gontero, P (55)
Hafeez, S (1) (56)
Hayne, D (59)
Henry, A M (60)
Herr, H (31)
Hoskin, P (11) (12) (63)
Huguet, J (16)
Jones, R (66)
Kamat, A M (67)
Khoo, V (1) (52) (56) (68)
Krege, S (70)
Ladoire, S (71)
Lara, P C (72) (73)
Lorch, A (77)
Loriot, Y (33)
Meijer, R (47)
N’Dow, J (15) (49)
Necchi, A (82)
Oldenburg, J (84) (85)
Osanto, S (86)
Oyen, W J G (6) (39) (40) (87)
Pappot, H (90)
Patel, M I (91)
Plass, K (92)
Remzi, M (3)
Retz, M (93)
Richenberg, J (94) (95)
Rink, M (96)
Rosenberg, J E (22) (31)
Rouvière, O (99) (100)
Salembier, C (101)
Salminen, A (102)
Sargos, P (103)
Sengupta, S (52) (68)
Sherif, A (104)
Smits, A (6)
Stenzl, A (80)
Tombal, B (106)
Turkbey, B (107)
Valdagni, R (109)
Vartolomei, M D (3) (111)
Veskimäe, E (112)
Wiegel, T (114)
Wiklund, P (115) (116)
Williams, A (117)
Zigeuner, R (118)

Affiliations

Organisations

  1. (1) Institute of Cancer Research, grid.18886.3f
  2. (2) Charles University, grid.4491.8
  3. (3) Medical University of Vienna, grid.22937.3d
  4. (4) Harvard University, grid.38142.3c
  5. (5) Hospital del Mar Medical Research Institute, grid.20522.37
  6. (6) Radboud University Nijmegen Medical Centre, grid.10417.33
  7. (7) University of Amsterdam, grid.7177.6
  8. (8) Charité, grid.6363.0
  9. (9) Division of Oncology and Haematology, Kantonsspital St Gallen, St Gallen
  10. (10) University of Bern, grid.5734.5
  11. (11) University of Manchester, grid.5379.8
  12. (12) Christie Hospital NHS Foundation Trust, grid.412917.8
  13. (13) Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham
  14. (14) University Hospitals Birmingham NHS Foundation Trust, grid.412563.7
  15. (15) University of Aberdeen, grid.7107.1
  16. (16) Puigvert Foundation, grid.418813.7
  17. (17) Queen Mary University of London, grid.4868.2
  18. (18) Royal Free Hospital, grid.426108.9
  19. (19) Uro-Oncology Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
  20. (20) Sechenov University, grid.448878.f
  21. (21) The University of Texas Southwestern Medical Center, grid.267313.2
  22. (22) Cornell University, grid.5386.8
  23. (23) Erasmus University Medical Center, grid.5645.2
  24. (24) Department of Urology, Bichat-Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, Paris
  25. (25) Paris Descartes University, grid.10992.33
  26. (26) University of Utah Health Care, grid.412722.0
  27. (27) Urology Department, Canisius-Wilhelmina Ziekenhuis Nijmegen, Nijmegen, The Netherlands
  28. (28) National and Kapodistrian University of Athens, grid.5216.0
  29. (29) Rosemere Cancer Centre, Lancashire Teaching Hospitals, Preston, UK
  30. (30) University of British Columbia, grid.17091.3e
  31. (31) Memorial Sloan Kettering Cancer Center, grid.51462.34
  32. (32) Grenoble Alpes University, grid.450307.5
  33. (33) Institut Gustave Roussy, grid.14925.3b
  34. (34) Department of Urology, Urological Research Institute, Milan
  35. (35) Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
  36. (36) University of Regensburg, grid.7727.5
  37. (37) Hospital Universitario 12 De Octubre, grid.144756.5
  38. (38) Kantonsspital Graubünden, grid.452286.f
  39. (39) Department of Biomedical Sciences, Humanitas University, Milan
  40. (40) Humanitas Research Hospital, grid.417728.f
  41. (41) Sorbonne University, grid.462844.8
  42. (42) Tenon Hospital, grid.413483.9
  43. (43) University of Southampton, grid.5491.9
  44. (44) Hôpital Saint-Louis, grid.413328.f
  45. (45) Radiation Oncology Department, Centre Hospitalier Régional Universitaire “Jean Minjoz” of Besançon, INSERM UMR 1098, Besançon, France
  46. (46) Radiation Oncology Department, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Switzerland
  47. (47) University Medical Center Utrecht, grid.7692.a
  48. (48) Ghent University Hospital, grid.410566.0
  49. (49) Aberdeen Royal Infirmary, grid.417581.e
  50. (50) Fundación Instituto Valenciano de Oncología, grid.418082.7
  51. (51) Department of Nuclear Medicine, Policlinico S Orsola, University of Bologna, Bologna, Italy
  52. (52) Monash University, grid.1002.3
  53. (53) University Hospital Würzburg, grid.411760.5
  54. (54) Spitalul Clinic de Urgenta Sfantul Ioan, grid.416503.5
  55. (55) Azienda Ospedaliero Universitaria San Giovanni Battista, grid.413005.3
  56. (56) Royal Marsden NHS Foundation Trust, grid.5072.0
  57. (57) Department of Urology, University of California, San Diego Pathology, La Jolla, USA
  58. (58) University of Erlangen-Nuremberg, grid.5330.5
  59. (59) University of Western Australia, grid.1012.2
  60. (60) University of Leeds, grid.9909.9
  61. (61) Hospital Universitario Fundación Alcorcón, grid.411316.0
  62. (62) Essen University Hospital, grid.410718.b
  63. (63) Mount Vernon Cancer Centre, grid.477623.3
  64. (64) Istituti di Ricovero e Cura a Carattere Scientifico, grid.414603.4
  65. (65) University of Milan, grid.4708.b
  66. (66) University of Glasgow, grid.8756.c
  67. (67) Department of Urology – Division of Surgery, The University of Texas, MD Anderson Cancer Center, Houston, USA
  68. (68) University of Melbourne, grid.1008.9
  69. (69) University of Oxford, grid.4991.5
  70. (70) Kliniken Essen-Mitte, grid.461714.1
  71. (71) Centre Georges François Leclerc, grid.418037.9
  72. (72) Department of Oncology, Hospital Universitario San Roque, Canarias
  73. (73) Universidad Fernando Pessoa, Canarias, Spain
  74. (74) Department of Urology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
  75. (75) Hospital Universitario La Paz, grid.81821.32
  76. (76) Department of Radiology, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark
  77. (77) University Hospital of Zurich, grid.412004.3
  78. (78) Luzerner Kantonsspital, grid.413354.4
  79. (79) Royal Surrey County Hospital, grid.416224.7
  80. (80) University of Tübingen, grid.10392.39
  81. (81) Sørlandet Sykehus, grid.417290.9
  82. (82) Department of Medical Oncology, Istituto Nazionale Tumori of Milan, Milan, Italy
  83. (83) Department of Urology, Hospital Foch, University of Versailles-Saint-Quentin-en-Yvelines, Suresnes, France
  84. (84) Department of Oncology, Akershus University Hospital, Lørenskog
  85. (85) University of Oslo, grid.5510.1
  86. (86) Leiden University Medical Center, grid.10419.3d
  87. (87) Rijnstate Hospital, grid.415930.a
  88. (88) Hospital de São João, grid.414556.7
  89. (89) University of Minho, grid.10328.38
  90. (90) Rigshospitalet, grid.475435.4, Capital Region
  91. (91) Department of Urology, Westmead Hospital, University of Sydney, Sydney, Australia
  92. (92) European Association of Urology, grid.466642.4
  93. (93) Technical University of Munich, grid.6936.a
  94. (94) Brighton and Sussex Medical School, grid.414601.6
  95. (95) Royal Sussex County Hospital, grid.416225.6
  96. (96) University Medical Center Hamburg-Eppendorf, grid.13648.38
  97. (97) Ruhr University Bochum, grid.5570.7
  98. (98) Department of Urology, Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, Paris
  99. (99) Hôpital Édouard-Herriot, grid.412180.e
  100. (100) University of Lyon System, grid.25697.3f
  101. (101) Department of Radiation Oncology, Europe Hospitals Brussels, Brussels, Belgium
  102. (102) Turku University Hospital, grid.410552.7
  103. (103) Institut Bergonié, grid.476460.7
  104. (104) Umeå University, grid.12650.30
  105. (105) University Hospital of Bern, grid.411656.1
  106. (106) Cliniques Universitaires Saint-Luc, grid.48769.34
  107. (107) National Cancer Institute, grid.48336.3a
  108. (108) Department of Urology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
  109. (109) Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
  110. (110) Universitair Ziekenhuis Leuven, grid.410569.f
  111. (111) Department of Cell and Molecular Biology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
  112. (112) Tampere University Hospital, grid.412330.7
  113. (113) Universidad Metropolitana, grid.441872.c
  114. (114) University Hospital Ulm, grid.410712.1
  115. (115) Icahn School of Medicine at Mount Sinai, grid.59734.3c
  116. (116) Karolinska Institute, grid.4714.6
  117. (117) Auckland City Hospital, grid.414055.1
  118. (118) Medical University of Graz, grid.11598.34

Description

BACKGROUND: Although guidelines exist for advanced and variant bladder cancer management, evidence is limited/conflicting in some areas and the optimal approach remains controversial. OBJECTIVE: To bring together a large multidisciplinary group of experts to develop consensus statements on controversial topics in bladder cancer management. DESIGN: A steering committee compiled proposed statements regarding advanced and variant bladder cancer management which were assessed by 113 experts in a Delphi survey. Statements not reaching consensus were reviewed; those prioritised were revised by a panel of 45 experts before voting during a consensus conference. SETTING: Online Delphi survey and consensus conference. PARTICIPANTS: The European Association of Urology (EAU), the European Society for Medical Oncology (ESMO), experts in bladder cancer management. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Statements were ranked by experts according to their level of agreement: 1-3 (disagree), 4-6 (equivocal), 7-9 (agree). A priori (level 1) consensus was defined as ≥70% agreement and ≤15% disagreement, or vice versa. In the Delphi survey, a second analysis was restricted to stakeholder group(s) considered to have adequate expertise relating to each statement (to achieve level 2 consensus). RESULTS AND LIMITATIONS: Overall, 116 statements were included in the Delphi survey. Of these, 33 (28%) statements achieved level 1 consensus and 49 (42%) statements achieved level 1 or 2 consensus. At the consensus conference, 22 of 27 (81%) statements achieved consensus. These consensus statements provide further guidance across a broad range of topics, including the management of variant histologies, the role/limitations of prognostic biomarkers in clinical decision making, bladder preservation strategies, modern radiotherapy techniques, the management of oligometastatic disease and the evolving role of checkpoint inhibitor therapy in metastatic disease. CONCLUSIONS: These consensus statements provide further guidance on controversial topics in advanced and variant bladder cancer management until a time where further evidence is available to guide our approach.

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