A Horwich1, M Babjuk2, J Bellmunt3, H M Bruins4, T M De Reijke5, M De Santis6, S Gillessen7, N James8, S Maclennan9, J Palou10, T Powles11, M J Ribal12, S F Shariat13, T Van Der Kwast14, E Xylinas15, N Agarwal16, T Arends17, A Bamias18, A Birtle19, P C Black20, B H Bochner21, M Bolla22, J L Boormans23, A Bossi24, A Briganti25, I Brummelhuis4, M Burger26, D Castellano27, R Cathomas28, A Chiti29, A Choudhury30, E Compérat31, S Crabb32, S Culine33, B De Bari34, W DeBlok35, P J L De Visschere36, K Decaestecker37, K Dimitropoulos38, J L Dominguez-Escrig39, S Fanti40, V Fonteyne41, M Frydenberg42, J J Futterer43, G Gakis44, B Geavlete45, P Gontero46, B Grubmüller47, S Hafeez48, D E Hansel49, A Hartmann50, D Hayne51, A M Henry52, V Hernandez53, H Herr54, K Herrmann55, P Hoskin56, J Huguet10, B A Jereczek-Fossa57, R Jones58, A M Kamat59, V Khoo60, A E Kiltie61, S Krege62, S Ladoire63, P C Lara64, A Leliveld65, E Linares-Espinós66, V Løgager67, A Lorch68, Y Loriot69, R Meijer70, M Carmen Mir39, M Moschini71, H Mostafid72, A-C Müller73, C R Müller74, J N'Dow75, A Necchi76, Y Neuzillet77, J R Oddens5, J Oldenburg78, S Osanto79, W J G Oyen80, L Pacheco-Figueiredo81, H Pappot82, M I Patel83, B R Pieters84, K Plass85, M Remzi47, M Retz86, J Richenberg87, M Rink88, F Roghmann89, J E Rosenberg90, M Rouprêt91, O Rouvière92, C Salembier93, A Salminen94, P Sargos95, S Sengupta96, A Sherif97, R J Smeenk98, A Smits4, A Stenzl99, G N Thalmann100, B Tombal101, B Turkbey102, S Vahr Lauridsen103, R Valdagni104, A G Van Der Heijden4, H Van Poppel105, M D Vartolomei106, E Veskimäe107, A Vilaseca12, F A Vives Rivera108, T Wiegel109, P Wiklund110, A Williams111, R Zigeuner112, J A Witjes4. 1. Emeritus Professor, The Institute of Cancer Research, London, UK; Emeritus Professor, The Institute of Cancer Research, London, UK. Electronic address: clinicalguidelines@esmo.org. 2. Depatment of Urology, 2nd Faculty of Medicine, Hospital Motol, Charles University, Prague, Czech Republic; Department of Urology, Medical University of Vienna, Vienna, Austria. 3. IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Harvard Medical School, Boston, USA. 4. Department of Urology, Radboud University Medical Center, Nijmegen. 5. Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands. 6. Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Charité University Hospital, Berlin, Germany. 7. Division of Cancer Sciences, University of Manchester, Manchester; The Christie NHS Foundation Trust, Manchester, UK; Division of Oncology and Haematology, Kantonsspital St Gallen, St Gallen; University of Bern, Bern, Switzerland. 8. University Hospitals Birmingham NHS Foundation Trust, Birmingham; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham. 9. Academic Urology Unit, University of Aberdeen, Aberdeen, UK. 10. Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain. 11. The Royal Free NHS Trust, London; Barts Cancer Institute, Queen Mary University of London, London, UK. 12. Uro-Oncology Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain. 13. Depatment of Urology, 2nd Faculty of Medicine, Hospital Motol, Charles University, Prague, Czech Republic; Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York; Department of Urology, University of Texas Southwestern Medical Center, Dallas, USA; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia. 14. Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands. 15. Department of Urology, Bichat-Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, Paris; Paris Descartes University, Paris, France. 16. Huntsman Cancer Institute, University of Utah (NCI-CCC), Salt Lake City, USA. 17. Urology Department, Canisius-Wilhelmina Ziekenhuis Nijmegen, Nijmegen, The Netherlands. 18. 2nd Propaedeutic Dept of Internal Medicine, Medical School, National & Kapodistrian University of Athens, Athens, Greece. 19. Division of Cancer Sciences, University of Manchester, Manchester; Rosemere Cancer Centre, Lancashire Teaching Hospitals, Preston, UK. 20. Department of Urologic Sciences, Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada. 21. Department of Urology, Weill Cornell Medical College, New York; Urology Service, Department of Urology, Memorial Sloan Kettering Cancer Center, New York, USA. 22. Emeritus Professor of Radiation Oncology, Grenoble - Alpes University, Grenoble, France. 23. Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands. 24. Department of Radiation Oncology, Gustave Roussy Institute, Villejuif, France. 25. Department of Urology, Urological Research Institute, Milan; Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy. 26. Department of Urology, Caritas-St. Josef Medical Center, University of Regensburg, Regensburg, Germany. 27. Medical Oncology Department, 12 de Octubre University Hospital (CIBERONC), Madrid, Spain. 28. Department Innere Medizin, Abteilung Onkologie und Hämatologie, Kantonsspital Graubünden, Chur, Switzerland. 29. Department of Biomedical Sciences, Humanitas University, Milan; Humanitas Research Hospital, Milan, Italy. 30. Division of Cancer Sciences, University of Manchester, Manchester; The Christie NHS Foundation Trust, Manchester, UK. 31. Department of Pathology, Tenon Hospital, HUEP, Paris; Sorbonne University, Paris, France. 32. Cancer Sciences Unit, University of Southampton, Southampton, UK. 33. Department of Cancer Medicine, Hôpital Saint Louis, Paris. 34. Radiation Oncology Department, Centre Hospitalier Régional Universitaire "Jean Minjoz" of Besançon, INSERM UMR 1098, Besançon, France; Radiation Oncology Department, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Switzerland. 35. Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands. 36. Department of Radiology and Nuclear Medicine, Division of Genitourinary Radiology and Mammography, Ghent University Hospital, Ghent. 37. Department of Urology, Ghent University Hospital, Ghent, Belgium. 38. Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK. 39. Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain. 40. Department of Nuclear Medicine, Policlinico S Orsola, University of Bologna, Bologna, Italy. 41. Department of Radiotherapy Oncology, Ghent University Hospital, Ghent, Belgium. 42. Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia. 43. Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands. 44. Department of Urology and Paediatric Urology, University Hospital of Würzburg, Julius-Maximillians University, Würzburg, Germany. 45. Department of Urology, Saint John Emergency Clinical Hospital, Bucharest, Romania. 46. Division of Urology, Molinette Hospital, University of Studies of Torino, Torino, Italy. 47. Department of Urology, Medical University of Vienna, Vienna, Austria. 48. Division of Radiotherapy and Imaging, The Institute of Cancer Research, London; Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, London, UK. 49. Department of Urology, University of California, San Diego Pathology, La Jolla, USA. 50. Institute of Pathology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany. 51. Department of Urology, UWA Medical School, University of Western Australia, Perth, Australia. 52. Leeds Institute of Medical Research, University of Leeds, Leeds, UK. 53. Department of Urology, Hospital Universitario Fundación de Alcorcón, Madrid, Spain. 54. Urology Service, Department of Urology, Memorial Sloan Kettering Cancer Center, New York, USA. 55. Department of Nuclear Medicine, Universitätsklinikum Essen, Essen, Germany. 56. Division of Cancer Sciences, University of Manchester, Manchester; The Christie NHS Foundation Trust, Manchester, UK; Mount Vernon Centre for Cancer Treatment, London, UK. 57. Department of Oncology and Hemato-oncology, University of Milan, Milan; Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy. 58. Institute of Cancer Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK. 59. Department of Urology - Division of Surgery, The University of Texas, MD Anderson Cancer Center, Houston, USA. 60. Division of Radiotherapy and Imaging, The Institute of Cancer Research, London; Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, London, UK; Department of Medicine, University of Melbourne, Melbourne; Monash University, Melbourne, Australia. 61. CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK. 62. Department of Urology, Pediatric Urology and Urologic Oncology, Kliniken Essen-Mitte, Essen, Germany. 63. Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France. 64. Department of Oncology, Hospital Universitario San Roque, Canarias; Universidad Fernando Pessoa, Canarias, Spain. 65. Department of Urology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 66. Department of Urology, University Hospital La Paz, Madrid, Spain. 67. Department of Radiology, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark. 68. Department of Medical Oncology and Hematology, University Hospital Zürich, Zürich, Switzerland. 69. Département de Médecine Oncologique, Gustave Roussy, INSERM U981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France. 70. UMC Utrecht Cancer Center, MS Oncologic Urology, Utrecht, The Netherlands. 71. Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland. 72. Department of Urology, Royal Surrey County Hospital, Guildford, UK. 73. Department of Radiation Oncology, Eberhard Karls University, Tübingen, Germany. 74. Cancer Treatment Centre, Sorlandet Hospital, Kristiansand, Norway. 75. Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK. 76. Department of Medical Oncology, Istituto Nazionale Tumori of Milan, Milan, Italy. 77. Department of Urology, Hospital Foch, University of Versailles-Saint-Quentin-en-Yvelines, Suresnes, France. 78. Department of Oncology, Akershus University Hospital, Lørenskog; Faculty of Medicine, University of Oslo, Oslo, Norway. 79. Department of Clinical Oncology, Leiden University Medical Center, Leiden. 80. Department of Biomedical Sciences, Humanitas University, Milan; Humanitas Research Hospital, Milan, Italy; Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands. 81. Department of Urology, Centro Hospitalar São João, Porto; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal. 82. Department of Oncology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark. 83. Department of Urology, Westmead Hospital, University of Sydney, Sydney, Australia. 84. Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam. 85. EAU Guidelines Office, Arnhem, The Netherlands. 86. Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany. 87. Department of Imaging and Nuclear Medicine, Royal Sussex County Hospital, Brighton; Brighton and Sussex Medical School, Brighton, UK. 88. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg. 89. Department of Urology, Ruhr-University Bochum, Marien Hospital, Herne, Germany. 90. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York; Weill Cornell Medical College, New York, USA. 91. Department of Urology, Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, Paris. 92. Hospices Civils de Lyon, Service d'Imagerie Urinaire et Vasculaire, Hôpital Edouard Herriot, Lyon; Université de Lyon, Université Lyon 1, Faculté de Médecine Lyon Est, Lyon, France. 93. Department of Radiation Oncology, Europe Hospitals Brussels, Brussels, Belgium. 94. Department of Urology, University Hospital of Turku, Turku, Finland. 95. Department of Radiotherapy, Institut Bergonié, Bordeaux, France. 96. Department of Surgery, Austin Health, University of Melbourne, Melbourne; Eastern Health Clinical School, Monash University, Melbourne, Australia. 97. Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden. 98. Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands. 99. Department of Urology, Eberhard Karls University Tübingen, Tübingen, Germany. 100. Department of Urology, Inselspital, Bern University Hospital, Berne, Switzerland. 101. Division of Urology, IREC, Cliniques Universitaires Saint Luc, UCL, Brussels, Belgium. 102. Molecular Imaging Program, National Cancer Institute, Bethesda, USA. 103. Department of Urology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. 104. Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 105. Department of Urology, University Hospitals Leuven, Leuven, Belgium. 106. Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Cell and Molecular Biology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania. 107. Department of Urology, Tampere University Hospital, Tampere, Finland. 108. Clinica HematoOncologica Bonadona Prevenir, Universidad Metropolitana, Clinica Club de Leones, Barranquilla, Colombia. 109. Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany. 110. Icahn School of Medicine, Mount Sinai Health System, New York City, USA; Department of Urology, Karolinska Institutet, Stockholm, Sweden. 111. Department of Urology, Auckland City Hospital, Auckland, New Zealand. 112. Department of Urology, Medizinische Universität Graz, Graz, Austria.
Abstract
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.
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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Authors: E J van Gennep; K K H Aben; T J N Hermans; L M C van Hoogstraten; L A L M Kiemeney; J A Witjes; C S Voskuilen; M Deelen; L S Mertens; R P Meijer; J L Boormans; D G J Robbrecht; L V Beerepoot; R H A Verhoeven; T M Ripping; B W G van Rhijn Journal: World J Urol Date: 2021-09-28 Impact factor: 4.226
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