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

Horwich, A.; Babjuk, M.; Bellmunt, J.; Bruins, H.M.; Reijke, T.M. de; Santis, M. de; ... ; Witjes, J.A. (2019)

Article / Letter to editor

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.

• bladder cancer
• consensus
• Delphi
• diagnosis
• treatment
• follow-up

• All authors: Horwich, A.; Babjuk, M.; Bellmunt, J.; Bruins, H.M.; Reijke, T.M. de; Santis, M. de; Gillessen, S.; James, N.; Maclennan, S.; Palou, J.; Powles, T.; Ribal, M.J.; Shariat, S.F.; Kwast, T. van der; Xylinas, E.; Agarwal, N.; Arends, T.; Bamias, A.; Birtle, A.; Black, P.C.; Bochner, B.H.; Bolla, M.; Boormans, J.L.; Bossi, A.; Briganti, A.; Brummelhuis, I.; Burger, M.; Castellano, D.; Cathomas, R.; Chiti, A.; Choudhury, A.; Comperat, E.; Crabb, S.; Culine, S.; Bari, B. de; Blok, W. de; Visschere, P.J.L. de; Decaestecker, K.; Dimitropoulos, K.; Dominguez-Escrig, J.L.; Fanti, S.; Fonteyne, V.; Frydenberg, M.; Futterer, J.J.; Gakis, G.; Geavlete, B.; Gontero, P.; Grubmuller, B.; Hafeez, S.; Hansel, D.E.; Hartmann, A.; Hayne, D.; Henry, A.M.; Hernandez, V.; Herr, H.; Herrmann, K.; Hoskin, P.; Huguet, J.; Jereczek-Fossa, B.A.; Jones, R.; Kamat, A.M.; Khoo, V.; Kiltie, A.E.; Krege, S.; Ladoire, S.; Lara, P.C.; Leliveld, A.; Linares-Espinos, E.; Logager, V.; Lorch, A.; Loriot, Y.; Meijer, R.; Mir, M.C.; Moschini, M.; Mostafid, H.; Muller, A.C.; Muller, C.R.; N'Dow, J.; Necchi, A.; Neuzillet, Y.; Oddens, J.R.; Oldenburg, J.; Osanto, S.; Oyen, W.J.G.; Pacheco-Figueiredo, L.; Pappot, H.; Patel, M.I.; Pieters, B.R.; Plass, K.; Remzi, M.; Retz, M.; Richenberg, J.; Rink, M.; Roghmann, F.; Rosenberg, J.E.; Roupret, M.; Rouviere, O.; Salembier, C.; Salminen, A.; Sargos, P.; Sengupta, S.; Sherif, A.; Smeenk, R.J.; Smits, A.; Stenzl, A.; Thalmann, G.N.; Tombal, B.; Turkbey, B.; Lauridsen, S.V.; Valdagni, R.; Heijden, A.G. van der; Poppel, H. van; Vartolomei, M.D.; Veskimae, E.; Vilaseca, A.; Rivera, F.A.V.; Wiegel, T.; Wiklund, P.; Williams, A.; Zigeuner, R.; Witjes, J.A.
• Date: 2019-11-01
• Journal: Annals of Oncology
• Volume: 30
• Issue: 11
• Pages: 1697 - 1727
• DOI: doi:10.1093/annonc/mdz296