EAU-ESMO Consensus Statements on the Management of Advanced and Variant Bladder Cancer—An International Collaborative Multistakeholder Effort†[Formula presented]: Under the Auspices of the EAU-ESMO Guidelines Committees: European Urology

J.A. Witjes; M. Babjuk; J. Bellmunt; H. Maxim Bruins; T.M. De Reijke; M. De Santis; S. Gillessen; N. James; S. Maclennan; J. Palou; T. Powles; M.J. Ribal; S.F. Shariat; T. Van Der Kwast; E. Xylinas; N. Agarwal; T. Arends; A. Bamias; A. Birtle; P.C. Black; B.H. Bochner; M. Bolla; J.L. Boormans; A. Bossi; A. Briganti; I. Brummelhuis; M. Burger; D. Castellano; R. Cathomas; A. Chiti; A. Choudhury; E. Compérat; S. Crabb; S. Culine; B. De Bari; W. De Blok; P.J.L. De Visschere; K. Decaestecker; K. Dimitropoulos; J.L. Dominguez-Escrig; S. Fanti; V. Fonteyne; M. Frydenberg; J.J. Futterer; G. Gakis; B. Geavlete; P. Gontero; B. Grubmüller; S. Hafeez; D.E. Hansel; A. Hartmann; D. Hayne; A.M. Henry; V. Hernandez; H. Herr; K. Herrmann; P. Hoskin; J. Huguet; B.A. Jereczek-Fossa; R. Jones; A.M. Kamat; V. Khoo; A.E. Kiltie; S. Krege; S. Ladoire; P.C. Lara; A. Leliveld; E. Linares-Espinós; V. Løgager; A. Lorch; Y. Loriot; R. Meijer; M. Carmen Mir; M. Moschini; H. Mostafid; A.-C. Müller; C.R. Müller; J. N’dow; A. Necchi; Y. Neuzillet; J.R. Oddens; J. Oldenburg; S. Osanto; W.J.G. Oyen; L. Pacheco-Figueiredo; H. Pappot; M.I. Patel; B.R. Pieters; K. Plass; M. Remzi; M. Retz; J. Richenberg; M. Rink; F. Roghmann; J.E. Rosenberg; M. Rouprêt; O. Rouvière; C. Salembier; A. Salminen; P. Sargos; S. Sengupta; A. Sherif; R.J. Smeenk; A. Smits; A. Stenzl; G.N. Thalmann; B. Tombal; B. Turkbey; S.V. Lauridsen; R. Valdagni; A.G. Van Der Heijden; H. Van Poppel; M.D. Vartolomei; E. Veskimäe; A. Vilaseca; F.A. Vives Rivera; T. Wiegel; P. Wiklund; A. Williams; R. Zigeuner; A. Horwich

doi:10.1016/j.eururo.2019.09.035

EAU-ESMO Consensus Statements on the Management of Advanced and Variant Bladder Cancer—An International Collaborative Multistakeholder Effort†[Formula presented]: Under the Auspices of the EAU-ESMO Guidelines Committees: European Urology

J.A. Witjes, M. Babjuk, J. Bellmunt, H. Maxim Bruins, T.M. De Reijke, M. De Santis, S. Gillessen, N. James, S. Maclennan, J. Palou, T. Powles, M.J. Ribal, S.F. Shariat, T. Van Der Kwast, E. Xylinas, N. Agarwal, T. Arends, A. Bamias, A. Birtle, P.C. BlackB.H. Bochner, M. Bolla, J.L. Boormans, A. Bossi, A. Briganti, I. Brummelhuis, M. Burger, D. Castellano, R. Cathomas, A. Chiti, A. Choudhury, E. Compérat, S. Crabb, S. Culine, B. De Bari, W. De Blok, P.J.L. De Visschere, K. Decaestecker, K. Dimitropoulos, J.L. Dominguez-Escrig, S. Fanti, V. Fonteyne, M. Frydenberg, J.J. Futterer, G. Gakis, B. Geavlete, P. Gontero, B. Grubmüller, S. Hafeez, D.E. Hansel, A. Hartmann, D. Hayne, A.M. Henry, V. Hernandez, H. Herr, K. Herrmann, P. Hoskin, J. Huguet, B.A. Jereczek-Fossa, R. Jones, A.M. Kamat, V. Khoo, A.E. Kiltie, S. Krege, S. Ladoire, P.C. Lara, A. Leliveld, E. Linares-Espinós, V. Løgager, A. Lorch, Y. Loriot, R. Meijer, M. Carmen Mir, M. Moschini, H. Mostafid, A.-C. Müller, C.R. Müller, J. N’dow, A. Necchi, Y. Neuzillet, J.R. Oddens, J. Oldenburg, S. Osanto, W.J.G. Oyen, L. Pacheco-Figueiredo, H. Pappot, M.I. Patel, B.R. Pieters, K. Plass, M. Remzi, M. Retz, J. Richenberg, M. Rink, F. Roghmann, J.E. Rosenberg, M. Rouprêt, O. Rouvière, C. Salembier, A. Salminen, P. Sargos, S. Sengupta, A. Sherif, R.J. Smeenk, A. Smits, A. Stenzl, G.N. Thalmann, B. Tombal, B. Turkbey, S.V. Lauridsen, R. Valdagni, A.G. Van Der Heijden, H. Van Poppel, M.D. Vartolomei, E. Veskimäe, A. Vilaseca, F.A. Vives Rivera, T. Wiegel, P. Wiklund, A. Williams, R. Zigeuner, A. Horwich

Research output: Contribution to journal › Article › peer-review

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 prior to 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), and 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 statements, 33 (28%) achieved level 1 consensus and 49 (42%) 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 when further evidence is available to guide our approach. Patient summary: This report summarises findings from an international, multistakeholder project organised by the EAU and ESMO. In this project, a steering committee identified areas of bladder cancer management where there is currently no good-quality evidence to guide treatment decisions. From this, they developed a series of proposed statements, 71 of which achieved consensus by a large group of experts in the field of bladder cancer. It is anticipated that these statements will provide further guidance to health care professionals and could help improve patient outcomes until a time when good-quality evidence is available. © 2019 European Society of Medical Oncology and European Association of Urology

Original language	English
Pages (from-to)	223-250
Number of pages	28
Journal	Eur. Urol.
Volume	77
Issue number	2
DOIs	https://doi.org/10.1016/j.eururo.2019.09.035
Publication status	Published - 2020

Keywords

Bladder cancer
Consensus
Delphi
Diagnosis
Follow-up
Treatment
checkpoint kinase inhibitor
tumor marker
advanced cancer
Article
bladder cancer
cancer prognosis
clinical decision making
clinical outcome
consensus
Delphi study
health care personnel
histology
human
metastasis
priority journal

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10.1016/j.eururo.2019.09.035

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Witjes, J. A., Babjuk, M., Bellmunt, J., Maxim Bruins, H., De Reijke, T. M., De Santis, M., Gillessen, S., James, N., Maclennan, S., Palou, J., Powles, T., Ribal, M. J., Shariat, S. F., Van Der Kwast, T., Xylinas, E., Agarwal, N., Arends, T., Bamias, A., Birtle, A., ... Horwich, A. (2020). EAU-ESMO Consensus Statements on the Management of Advanced and Variant Bladder Cancer—An International Collaborative Multistakeholder Effort†[Formula presented]: Under the Auspices of the EAU-ESMO Guidelines Committees: European Urology. Eur. Urol., 77(2), 223-250. https://doi.org/10.1016/j.eururo.2019.09.035

EAU-ESMO Consensus Statements on the Management of Advanced and Variant Bladder Cancer—An International Collaborative Multistakeholder Effort†[Formula presented]: Under the Auspices of the EAU-ESMO Guidelines Committees : European Urology. / Witjes, J.A.; Babjuk, M.; Bellmunt, J.; Maxim Bruins, H.; De Reijke, T.M.; De Santis, M.; Gillessen, S.; James, N.; Maclennan, S.; Palou, J.; Powles, T.; Ribal, M.J.; Shariat, S.F.; Van Der Kwast, T.; 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.; Compérat, E.; Crabb, S.; Culine, S.; De Bari, B.; De Blok, W.; De Visschere, P.J.L.; Decaestecker, K.; Dimitropoulos, K.; Dominguez-Escrig, J.L.; Fanti, S.; Fonteyne, V.; Frydenberg, M.; Futterer, J.J.; Gakis, G.; Geavlete, B.; Gontero, P.; Grubmüller, 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-Espinós, E.; Løgager, V.; Lorch, A.; Loriot, Y.; Meijer, R.; Carmen Mir, M.; Moschini, M.; Mostafid, H.; Müller, A.-C.; Müller, 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.; Rouprêt, M.; Rouvière, 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.; Van Der Heijden, A.G.; Van Poppel, H.; Vartolomei, M.D.; Veskimäe, E.; Vilaseca, A.; Vives Rivera, F.A.; Wiegel, T.; Wiklund, P.; Williams, A.; Zigeuner, R.; Horwich, A.

In: Eur. Urol., Vol. 77, No. 2, 2020, p. 223-250.

Research output: Contribution to journal › Article › peer-review

Witjes, JA, Babjuk, M, Bellmunt, J, Maxim Bruins, H, De Reijke, TM, De Santis, M, Gillessen, S, James, N, Maclennan, S, Palou, J, Powles, T, Ribal, MJ, Shariat, SF, Van Der Kwast, T, Xylinas, E, Agarwal, N, Arends, T, Bamias, A, Birtle, A, Black, PC, Bochner, BH, Bolla, M, Boormans, JL, Bossi, A, Briganti, A, Brummelhuis, I, Burger, M, Castellano, D, Cathomas, R, Chiti, A, Choudhury, A, Compérat, E, Crabb, S, Culine, S, De Bari, B, De Blok, W, De Visschere, PJL, Decaestecker, K, Dimitropoulos, K, Dominguez-Escrig, JL, Fanti, S, Fonteyne, V, Frydenberg, M, Futterer, JJ, Gakis, G, Geavlete, B, Gontero, P, Grubmüller, B, Hafeez, S, Hansel, DE, Hartmann, A, Hayne, D, Henry, AM, Hernandez, V, Herr, H, Herrmann, K, Hoskin, P, Huguet, J, Jereczek-Fossa, BA, Jones, R, Kamat, AM, Khoo, V, Kiltie, AE, Krege, S, Ladoire, S, Lara, PC, Leliveld, A, Linares-Espinós, E, Løgager, V, Lorch, A, Loriot, Y, Meijer, R, Carmen Mir, M, Moschini, M, Mostafid, H, Müller, A-C, Müller, CR, N’dow, J, Necchi, A, Neuzillet, Y, Oddens, JR, Oldenburg, J, Osanto, S, Oyen, WJG, Pacheco-Figueiredo, L, Pappot, H, Patel, MI, Pieters, BR, Plass, K, Remzi, M, Retz, M, Richenberg, J, Rink, M, Roghmann, F, Rosenberg, JE, Rouprêt, M, Rouvière, O, Salembier, C, Salminen, A, Sargos, P, Sengupta, S, Sherif, A, Smeenk, RJ, Smits, A, Stenzl, A, Thalmann, GN, Tombal, B, Turkbey, B, Lauridsen, SV, Valdagni, R, Van Der Heijden, AG, Van Poppel, H, Vartolomei, MD, Veskimäe, E, Vilaseca, A, Vives Rivera, FA, Wiegel, T, Wiklund, P, Williams, A, Zigeuner, R & Horwich, A 2020, 'EAU-ESMO Consensus Statements on the Management of Advanced and Variant Bladder Cancer—An International Collaborative Multistakeholder Effort†[Formula presented]: Under the Auspices of the EAU-ESMO Guidelines Committees: European Urology', Eur. Urol., vol. 77, no. 2, pp. 223-250. https://doi.org/10.1016/j.eururo.2019.09.035

Witjes JA, Babjuk M, Bellmunt J, Maxim Bruins H, De Reijke TM, De Santis M et al. EAU-ESMO Consensus Statements on the Management of Advanced and Variant Bladder Cancer—An International Collaborative Multistakeholder Effort†[Formula presented]: Under the Auspices of the EAU-ESMO Guidelines Committees: European Urology. Eur. Urol. 2020;77(2):223-250. https://doi.org/10.1016/j.eururo.2019.09.035

Witjes, J.A. ; Babjuk, M. ; Bellmunt, J. ; Maxim Bruins, H. ; De Reijke, T.M. ; De Santis, M. ; Gillessen, S. ; James, N. ; Maclennan, S. ; Palou, J. ; Powles, T. ; Ribal, M.J. ; Shariat, S.F. ; Van Der Kwast, T. ; 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. ; Compérat, E. ; Crabb, S. ; Culine, S. ; De Bari, B. ; De Blok, W. ; De Visschere, P.J.L. ; Decaestecker, K. ; Dimitropoulos, K. ; Dominguez-Escrig, J.L. ; Fanti, S. ; Fonteyne, V. ; Frydenberg, M. ; Futterer, J.J. ; Gakis, G. ; Geavlete, B. ; Gontero, P. ; Grubmüller, 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-Espinós, E. ; Løgager, V. ; Lorch, A. ; Loriot, Y. ; Meijer, R. ; Carmen Mir, M. ; Moschini, M. ; Mostafid, H. ; Müller, A.-C. ; Müller, 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. ; Rouprêt, M. ; Rouvière, 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. ; Van Der Heijden, A.G. ; Van Poppel, H. ; Vartolomei, M.D. ; Veskimäe, E. ; Vilaseca, A. ; Vives Rivera, F.A. ; Wiegel, T. ; Wiklund, P. ; Williams, A. ; Zigeuner, R. ; Horwich, A. / EAU-ESMO Consensus Statements on the Management of Advanced and Variant Bladder Cancer—An International Collaborative Multistakeholder Effort†[Formula presented]: Under the Auspices of the EAU-ESMO Guidelines Committees : European Urology. In: Eur. Urol. 2020 ; Vol. 77, No. 2. pp. 223-250.

@article{93479f625d144b64a04864de833350ff,

title = "EAU-ESMO Consensus Statements on the Management of Advanced and Variant Bladder Cancer—An International Collaborative Multistakeholder Effort†[Formula presented]: Under the Auspices of the EAU-ESMO Guidelines Committees: European Urology",

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 prior to 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), and 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 statements, 33 (28%) achieved level 1 consensus and 49 (42%) 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 when further evidence is available to guide our approach. Patient summary: This report summarises findings from an international, multistakeholder project organised by the EAU and ESMO. In this project, a steering committee identified areas of bladder cancer management where there is currently no good-quality evidence to guide treatment decisions. From this, they developed a series of proposed statements, 71 of which achieved consensus by a large group of experts in the field of bladder cancer. It is anticipated that these statements will provide further guidance to health care professionals and could help improve patient outcomes until a time when good-quality evidence is available. {\textcopyright} 2019 European Society of Medical Oncology and European Association of Urology",

keywords = "Bladder cancer, Consensus, Delphi, Diagnosis, Follow-up, Treatment, checkpoint kinase inhibitor, tumor marker, advanced cancer, Article, bladder cancer, cancer prognosis, clinical decision making, clinical outcome, consensus, Delphi study, health care personnel, histology, human, metastasis, priority journal",

author = "J.A. Witjes and M. Babjuk and J. Bellmunt and {Maxim Bruins}, H. and {De Reijke}, T.M. and {De Santis}, M. and S. Gillessen and N. James and S. Maclennan and J. Palou and T. Powles and M.J. Ribal and S.F. Shariat and {Van Der Kwast}, T. and E. Xylinas and N. Agarwal and T. Arends and A. Bamias and A. Birtle and P.C. Black and B.H. Bochner and M. Bolla and J.L. Boormans and A. Bossi and A. Briganti and I. Brummelhuis and M. Burger and D. Castellano and R. Cathomas and A. Chiti and A. Choudhury and E. Comp{\'e}rat and S. Crabb and S. Culine and {De Bari}, B. and {De Blok}, W. and {De Visschere}, P.J.L. and K. Decaestecker and K. Dimitropoulos and J.L. Dominguez-Escrig and S. Fanti and V. Fonteyne and M. Frydenberg and J.J. Futterer and G. Gakis and B. Geavlete and P. Gontero and B. Grubm{\"u}ller and S. Hafeez and D.E. Hansel and A. Hartmann and D. Hayne and A.M. Henry and V. Hernandez and H. Herr and K. Herrmann and P. Hoskin and J. Huguet and B.A. Jereczek-Fossa and R. Jones and A.M. Kamat and V. Khoo and A.E. Kiltie and S. Krege and S. Ladoire and P.C. Lara and A. Leliveld and E. Linares-Espin{\'o}s and V. L{\o}gager and A. Lorch and Y. Loriot and R. Meijer and {Carmen Mir}, M. and M. Moschini and H. Mostafid and A.-C. M{\"u}ller and C.R. M{\"u}ller and J. N{\textquoteright}dow and A. Necchi and Y. Neuzillet and J.R. Oddens and J. Oldenburg and S. Osanto and W.J.G. Oyen and L. Pacheco-Figueiredo and H. Pappot and M.I. Patel and B.R. Pieters and K. Plass and M. Remzi and M. Retz and J. Richenberg and M. Rink and F. Roghmann and J.E. Rosenberg and M. Roupr{\^e}t and O. Rouvi{\`e}re and C. Salembier and A. Salminen and P. Sargos and S. Sengupta and A. Sherif and R.J. Smeenk and A. Smits and A. Stenzl and G.N. Thalmann and B. Tombal and B. Turkbey and S.V. Lauridsen and R. Valdagni and {Van Der Heijden}, A.G. and {Van Poppel}, H. and M.D. Vartolomei and E. Veskim{\"a}e and A. Vilaseca and {Vives Rivera}, F.A. and T. Wiegel and P. Wiklund and A. Williams and R. Zigeuner and A. Horwich",

note = "Cited By :28 Export Date: 11 March 2021 CODEN: EUURA Correspondence Address: Witjes, J.A.; Department of Urology, internal mail 659, PO Box 9101, Netherlands; email: Fred.Witjes@radboudumc.nl Funding details: Eau Claire Community Foundation, ECCF Funding details: European Society for Medical Oncology, ESMO Funding text 1: Acknowledgements: The authors would like to thank Peter E. Clark from Atrium Health, Levine Cancer Institute, Charlotte, NC, USA, for his contribution to the Delphi survey. Angela Corstorphine of Kstorfin Medical Communications Ltd provided medical writing support with the preparation of this manuscript; this support was funded jointly by EAU and ESMO.",

year = "2020",

doi = "10.1016/j.eururo.2019.09.035",

language = "English",

volume = "77",

pages = "223--250",

journal = "Eur. Urol.",

issn = "0302-2838",

publisher = "Elsevier B.V.",

number = "2",

}

TY - JOUR

T1 - EAU-ESMO Consensus Statements on the Management of Advanced and Variant Bladder Cancer—An International Collaborative Multistakeholder Effort†[Formula presented]: Under the Auspices of the EAU-ESMO Guidelines Committees

T2 - European Urology

AU - Witjes, J.A.

AU - Babjuk, M.

AU - Bellmunt, J.

AU - Maxim Bruins, H.

AU - De Reijke, T.M.

AU - De Santis, M.

AU - Gillessen, S.

AU - James, N.

AU - Maclennan, S.

AU - Palou, J.

AU - Powles, T.

AU - Ribal, M.J.

AU - Shariat, S.F.

AU - Van Der Kwast, T.

AU - Xylinas, E.

AU - Agarwal, N.

AU - Arends, T.

AU - Bamias, A.

AU - Birtle, A.

AU - Black, P.C.

AU - Bochner, B.H.

AU - Bolla, M.

AU - Boormans, J.L.

AU - Bossi, A.

AU - Briganti, A.

AU - Brummelhuis, I.

AU - Burger, M.

AU - Castellano, D.

AU - Cathomas, R.

AU - Chiti, A.

AU - Choudhury, A.

AU - Compérat, E.

AU - Crabb, S.

AU - Culine, S.

AU - De Bari, B.

AU - De Blok, W.

AU - De Visschere, P.J.L.

AU - Decaestecker, K.

AU - Dimitropoulos, K.

AU - Dominguez-Escrig, J.L.

AU - Fanti, S.

AU - Fonteyne, V.

AU - Frydenberg, M.

AU - Futterer, J.J.

AU - Gakis, G.

AU - Geavlete, B.

AU - Gontero, P.

AU - Grubmüller, B.

AU - Hafeez, S.

AU - Hansel, D.E.

AU - Hartmann, A.

AU - Hayne, D.

AU - Henry, A.M.

AU - Hernandez, V.

AU - Herr, H.

AU - Herrmann, K.

AU - Hoskin, P.

AU - Huguet, J.

AU - Jereczek-Fossa, B.A.

AU - Jones, R.

AU - Kamat, A.M.

AU - Khoo, V.

AU - Kiltie, A.E.

AU - Krege, S.

AU - Ladoire, S.

AU - Lara, P.C.

AU - Leliveld, A.

AU - Linares-Espinós, E.

AU - Løgager, V.

AU - Lorch, A.

AU - Loriot, Y.

AU - Meijer, R.

AU - Carmen Mir, M.

AU - Moschini, M.

AU - Mostafid, H.

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AU - Vilaseca, A.

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N1 - Cited By :28 Export Date: 11 March 2021 CODEN: EUURA Correspondence Address: Witjes, J.A.; Department of Urology, internal mail 659, PO Box 9101, Netherlands; email: Fred.Witjes@radboudumc.nl Funding details: Eau Claire Community Foundation, ECCF Funding details: European Society for Medical Oncology, ESMO Funding text 1: Acknowledgements: The authors would like to thank Peter E. Clark from Atrium Health, Levine Cancer Institute, Charlotte, NC, USA, for his contribution to the Delphi survey. Angela Corstorphine of Kstorfin Medical Communications Ltd provided medical writing support with the preparation of this manuscript; this support was funded jointly by EAU and ESMO.

PY - 2020

Y1 - 2020

N2 - 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 prior to 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), and 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 statements, 33 (28%) achieved level 1 consensus and 49 (42%) 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 when further evidence is available to guide our approach. Patient summary: This report summarises findings from an international, multistakeholder project organised by the EAU and ESMO. In this project, a steering committee identified areas of bladder cancer management where there is currently no good-quality evidence to guide treatment decisions. From this, they developed a series of proposed statements, 71 of which achieved consensus by a large group of experts in the field of bladder cancer. It is anticipated that these statements will provide further guidance to health care professionals and could help improve patient outcomes until a time when good-quality evidence is available. © 2019 European Society of Medical Oncology and European Association of Urology

AB - 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 prior to 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), and 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 statements, 33 (28%) achieved level 1 consensus and 49 (42%) 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 when further evidence is available to guide our approach. Patient summary: This report summarises findings from an international, multistakeholder project organised by the EAU and ESMO. In this project, a steering committee identified areas of bladder cancer management where there is currently no good-quality evidence to guide treatment decisions. From this, they developed a series of proposed statements, 71 of which achieved consensus by a large group of experts in the field of bladder cancer. It is anticipated that these statements will provide further guidance to health care professionals and could help improve patient outcomes until a time when good-quality evidence is available. © 2019 European Society of Medical Oncology and European Association of Urology

KW - Bladder cancer

KW - Consensus

KW - Delphi

KW - Diagnosis

KW - Follow-up

KW - Treatment

KW - checkpoint kinase inhibitor

KW - tumor marker

KW - advanced cancer

KW - Article

KW - bladder cancer

KW - cancer prognosis

KW - clinical decision making

KW - clinical outcome

KW - consensus

KW - Delphi study

KW - health care personnel

KW - histology

KW - human

KW - metastasis

KW - priority journal

U2 - 10.1016/j.eururo.2019.09.035

DO - 10.1016/j.eururo.2019.09.035

M3 - Article

VL - 77

SP - 223

EP - 250

JO - Eur. Urol.

JF - Eur. Urol.

SN - 0302-2838

IS - 2

ER -