EAU-ESMO Consensus Statements on the Management of Advanced and Variant Bladder Cancer-An International Collaborative Multistakeholder Effort: Under the Auspices of the EAU-ESMO Guidelines Committees

J Alfred Witjes* (Corresponding Author), Marek Babjuk, Joaquim Bellmunt, H Maxim Bruins, Theo M De Reijke, Maria De Santis, Silke Gillessen, Nicholas James, Steven Maclennan, Juan Palou, Tom Powles, Maria J Ribal, Shahrokh F Shariat, Theo Van Der Kwast, Evanguelos Xylinas, Neeraj Agarwal, Tom Arends, Aristotle Bamias, Alison Birtle, Peter C BlackBernard H Bochner, Michel Bolla, Joost L Boormans, Alberto Bossi, Alberto Briganti, Iris Brummelhuis, Max Burger, Daniel Castellano, Richard Cathomas, Arturo Chiti, Ananya Choudhury, Eva Compérat, Simon Crabb, Stephane Culine, Berardino De Bari, Willem De Blok, Pieter J L De Visschere, Karel Decaestecker, Konstantinos Dimitropoulos, Jose L Dominguez-Escrig, Stefano Fanti, Valerie Fonteyne, Mark Frydenberg, Jurgen J Futterer, Georgios Gakis, Bogdan Geavlete, Paolo Gontero, Bernhard Grubmüller, Shaista Hafeez, Donna E Hansel, Arndt Hartmann, Dickon Hayne, Ann M Henry, Virginia Hernandez, Harry Herr, Ken Herrmann, Peter Hoskin, Jorge Huguet, Barbara A Jereczek-Fossa, Rob Jones, Ashish M Kamat, Vincent Khoo, Anne E Kiltie, Susanne Krege, Sylvain Ladoire, Pedro C Lara, Annemarie Leliveld, Estefania Linares-Espinós, Vibeke Løgager, Anja Lorch, Yohann Loriot, Richard Meijer, M Carmen Mir, Marco Moschini, Hugh Mostafid, Arndt-Christian Müller, Christoph R Müller, James N'Dow, Andrea Necchi, Yann Neuzillet, Jorg R Oddens, Jan Oldenburg, Susanne Osanto, Wim J G Oyen, Luís Pacheco-Figueiredo, Helle Pappot, Manish I Patel, Bradley R Pieters, Karin Plass, Mesut Remzi, Margitta Retz, Jonathan Richenberg, Michael Rink, Florian Roghmann, Jonathan E Rosenberg, Morgan Rouprêt, Olivier Rouvière, Carl Salembier, Antti Salminen, Paul Sargos, Shomik Sengupta, Amir Sherif, Robert J Smeenk, Anita Smits, Arnulf Stenzl, George N Thalmann, Bertrand Tombal, Baris Turkbey, Susanne Vahr Lauridsen, Riccardo Valdagni, Antoine G Van Der Heijden, Hein Van Poppel, Mihai D Vartolomei, Erik Veskimäe, Antoni Vilaseca, Franklin A Vives Rivera, Thomas Wiegel, Peter Wiklund, Andrew Williams, Richard Zigeuner, Alan Horwich

*Corresponding author for this work

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish
Pages (from-to)223-250
Number of pages28
JournalEuropean Urology
Volume77
Issue number2
Early online date19 Nov 2019
DOIs
Publication statusPublished - Feb 2020

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Medical Oncology
Urology
Urinary Bladder Neoplasms
Guidelines
Politics
Disease Management
Histology
Urinary Bladder
Radiotherapy
Biomarkers
Delivery of Health Care
Surveys and Questionnaires
Therapeutics

Keywords

  • Bladder cancer
  • consenus
  • Delphi
  • diagnosis
  • treatment
  • follow-up

Cite this

EAU-ESMO Consensus Statements on the Management of Advanced and Variant Bladder Cancer-An International Collaborative Multistakeholder Effort : Under the Auspices of the EAU-ESMO Guidelines Committees. / Witjes, J Alfred (Corresponding Author); Babjuk, Marek; Bellmunt, Joaquim; Bruins, H Maxim; De Reijke, Theo M; De Santis, Maria; Gillessen, Silke; James, Nicholas; Maclennan, Steven; Palou, Juan; Powles, Tom; Ribal, Maria J; Shariat, Shahrokh F; Der Kwast, Theo Van; Xylinas, Evanguelos; Agarwal, Neeraj; Arends, Tom; Bamias, Aristotle; Birtle, Alison; Black, Peter C; Bochner, Bernard H; Bolla, Michel; Boormans, Joost L; Bossi, Alberto; Briganti, Alberto; Brummelhuis, Iris; Burger, Max; Castellano, Daniel; Cathomas, Richard; Chiti, Arturo; Choudhury, Ananya; Compérat, Eva; Crabb, Simon; Culine, Stephane; De Bari, Berardino; De Blok, Willem; J L De Visschere, Pieter; Decaestecker, Karel; Dimitropoulos, Konstantinos; Dominguez-Escrig, Jose L; Fanti, Stefano; Fonteyne, Valerie; Frydenberg, Mark; Futterer, Jurgen J; Gakis, Georgios; Geavlete, Bogdan; Gontero, Paolo; Grubmüller, Bernhard; Hafeez, Shaista; Hansel, Donna E; Hartmann, Arndt; Hayne, Dickon; Henry, Ann M; Hernandez, Virginia; Herr, Harry; Herrmann, Ken; Hoskin, Peter; Huguet, Jorge; Jereczek-Fossa, Barbara A; Jones, Rob; Kamat, Ashish M; Khoo, Vincent; Kiltie, Anne E; Krege, Susanne; Ladoire, Sylvain; Lara, Pedro C; Leliveld, Annemarie; Linares-Espinós, Estefania; Løgager, Vibeke; Lorch, Anja; Loriot, Yohann; Meijer, Richard; Mir, M Carmen; Moschini, Marco; Mostafid, Hugh; Müller, Arndt-Christian; Müller, Christoph R; N'Dow, James; Necchi, Andrea; Neuzillet, Yann; Oddens, Jorg R; Oldenburg, Jan; Osanto, Susanne; J G Oyen, Wim; Pacheco-Figueiredo, Luís; Pappot, Helle; Patel, Manish I; Pieters, Bradley R; Plass, Karin; Remzi, Mesut; Retz, Margitta; Richenberg, Jonathan; Rink, Michael; Roghmann, Florian; Rosenberg, Jonathan E; Rouprêt, Morgan; Rouvière, Olivier; Salembier, Carl; Salminen, Antti; Sargos, Paul; Sengupta, Shomik; Sherif, Amir; Smeenk, Robert J; Smits, Anita; Stenzl, Arnulf; Thalmann, George N; Tombal, Bertrand; Turkbey, Baris; Lauridsen, Susanne Vahr; Valdagni, Riccardo; Der Heijden, Antoine G Van; Van Poppel, Hein; Vartolomei, Mihai D; Veskimäe, Erik; Vilaseca, Antoni; Rivera, Franklin A Vives; Wiegel, Thomas; Wiklund, Peter; Williams, Andrew; Zigeuner, Richard; Horwich, Alan.

In: European Urology, Vol. 77, No. 2, 02.2020, p. 223-250.

Research output: Contribution to journalArticle

Witjes, JA, Babjuk, M, Bellmunt, J, Bruins, HM, De Reijke, TM, De Santis, M, Gillessen, S, James, N, Maclennan, S, Palou, J, Powles, T, Ribal, MJ, Shariat, SF, Der Kwast, TV, 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, J L De Visschere, P, 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, Mir, MC, Moschini, M, Mostafid, H, Müller, A-C, Müller, CR, N'Dow, J, Necchi, A, Neuzillet, Y, Oddens, JR, Oldenburg, J, Osanto, S, J G Oyen, W, 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, Der Heijden, AGV, Van Poppel, H, Vartolomei, MD, Veskimäe, E, Vilaseca, A, Rivera, FAV, 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: Under the Auspices of the EAU-ESMO Guidelines Committees', European Urology, vol. 77, no. 2, pp. 223-250. https://doi.org/10.1016/j.eururo.2019.09.035
Witjes, J Alfred ; Babjuk, Marek ; Bellmunt, Joaquim ; Bruins, H Maxim ; De Reijke, Theo M ; De Santis, Maria ; Gillessen, Silke ; James, Nicholas ; Maclennan, Steven ; Palou, Juan ; Powles, Tom ; Ribal, Maria J ; Shariat, Shahrokh F ; Der Kwast, Theo Van ; Xylinas, Evanguelos ; Agarwal, Neeraj ; Arends, Tom ; Bamias, Aristotle ; Birtle, Alison ; Black, Peter C ; Bochner, Bernard H ; Bolla, Michel ; Boormans, Joost L ; Bossi, Alberto ; Briganti, Alberto ; Brummelhuis, Iris ; Burger, Max ; Castellano, Daniel ; Cathomas, Richard ; Chiti, Arturo ; Choudhury, Ananya ; Compérat, Eva ; Crabb, Simon ; Culine, Stephane ; De Bari, Berardino ; De Blok, Willem ; J L De Visschere, Pieter ; Decaestecker, Karel ; Dimitropoulos, Konstantinos ; Dominguez-Escrig, Jose L ; Fanti, Stefano ; Fonteyne, Valerie ; Frydenberg, Mark ; Futterer, Jurgen J ; Gakis, Georgios ; Geavlete, Bogdan ; Gontero, Paolo ; Grubmüller, Bernhard ; Hafeez, Shaista ; Hansel, Donna E ; Hartmann, Arndt ; Hayne, Dickon ; Henry, Ann M ; Hernandez, Virginia ; Herr, Harry ; Herrmann, Ken ; Hoskin, Peter ; Huguet, Jorge ; Jereczek-Fossa, Barbara A ; Jones, Rob ; Kamat, Ashish M ; Khoo, Vincent ; Kiltie, Anne E ; Krege, Susanne ; Ladoire, Sylvain ; Lara, Pedro C ; Leliveld, Annemarie ; Linares-Espinós, Estefania ; Løgager, Vibeke ; Lorch, Anja ; Loriot, Yohann ; Meijer, Richard ; Mir, M Carmen ; Moschini, Marco ; Mostafid, Hugh ; Müller, Arndt-Christian ; Müller, Christoph R ; N'Dow, James ; Necchi, Andrea ; Neuzillet, Yann ; Oddens, Jorg R ; Oldenburg, Jan ; Osanto, Susanne ; J G Oyen, Wim ; Pacheco-Figueiredo, Luís ; Pappot, Helle ; Patel, Manish I ; Pieters, Bradley R ; Plass, Karin ; Remzi, Mesut ; Retz, Margitta ; Richenberg, Jonathan ; Rink, Michael ; Roghmann, Florian ; Rosenberg, Jonathan E ; Rouprêt, Morgan ; Rouvière, Olivier ; Salembier, Carl ; Salminen, Antti ; Sargos, Paul ; Sengupta, Shomik ; Sherif, Amir ; Smeenk, Robert J ; Smits, Anita ; Stenzl, Arnulf ; Thalmann, George N ; Tombal, Bertrand ; Turkbey, Baris ; Lauridsen, Susanne Vahr ; Valdagni, Riccardo ; Der Heijden, Antoine G Van ; Van Poppel, Hein ; Vartolomei, Mihai D ; Veskimäe, Erik ; Vilaseca, Antoni ; Rivera, Franklin A Vives ; Wiegel, Thomas ; Wiklund, Peter ; Williams, Andrew ; Zigeuner, Richard ; Horwich, Alan. / EAU-ESMO Consensus Statements on the Management of Advanced and Variant Bladder Cancer-An International Collaborative Multistakeholder Effort : Under the Auspices of the EAU-ESMO Guidelines Committees. In: European Urology. 2020 ; Vol. 77, No. 2. pp. 223-250.
@article{38dddbe886e14a24849d1b457d1ee4b5,
title = "EAU-ESMO Consensus Statements on the Management of Advanced and Variant Bladder Cancer-An International Collaborative Multistakeholder Effort: Under the Auspices of the EAU-ESMO Guidelines Committees",
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.",
keywords = "Bladder cancer, consenus, Delphi, diagnosis, treatment, follow-up",
author = "Witjes, {J Alfred} and Marek Babjuk and Joaquim Bellmunt and Bruins, {H Maxim} and {De Reijke}, {Theo M} and {De Santis}, Maria and Silke Gillessen and Nicholas James and Steven Maclennan and Juan Palou and Tom Powles and Ribal, {Maria J} and Shariat, {Shahrokh F} and {Der Kwast}, {Theo Van} and Evanguelos Xylinas and Neeraj Agarwal and Tom Arends and Aristotle Bamias and Alison Birtle and Black, {Peter C} and Bochner, {Bernard H} and Michel Bolla and Boormans, {Joost L} and Alberto Bossi and Alberto Briganti and Iris Brummelhuis and Max Burger and Daniel Castellano and Richard Cathomas and Arturo Chiti and Ananya Choudhury and Eva Comp{\'e}rat and Simon Crabb and Stephane Culine and {De Bari}, Berardino and {De Blok}, Willem and {J L De Visschere}, Pieter and Karel Decaestecker and Konstantinos Dimitropoulos and Dominguez-Escrig, {Jose L} and Stefano Fanti and Valerie Fonteyne and Mark Frydenberg and Futterer, {Jurgen J} and Georgios Gakis and Bogdan Geavlete and Paolo Gontero and Bernhard Grubm{\"u}ller and Shaista Hafeez and Hansel, {Donna E} and Arndt Hartmann and Dickon Hayne and Henry, {Ann M} and Virginia Hernandez and Harry Herr and Ken Herrmann and Peter Hoskin and Jorge Huguet and Jereczek-Fossa, {Barbara A} and Rob Jones and Kamat, {Ashish M} and Vincent Khoo and Kiltie, {Anne E} and Susanne Krege and Sylvain Ladoire and Lara, {Pedro C} and Annemarie Leliveld and Estefania Linares-Espin{\'o}s and Vibeke L{\o}gager and Anja Lorch and Yohann Loriot and Richard Meijer and Mir, {M Carmen} and Marco Moschini and Hugh Mostafid and Arndt-Christian M{\"u}ller and M{\"u}ller, {Christoph R} and James N'Dow and Andrea Necchi and Yann Neuzillet and Oddens, {Jorg R} and Jan Oldenburg and Susanne Osanto and {J G Oyen}, Wim and Lu{\'i}s Pacheco-Figueiredo and Helle Pappot and Patel, {Manish I} and Pieters, {Bradley R} and Karin Plass and Mesut Remzi and Margitta Retz and Jonathan Richenberg and Michael Rink and Florian Roghmann and Rosenberg, {Jonathan E} and Morgan Roupr{\^e}t and Olivier Rouvi{\`e}re and Carl Salembier and Antti Salminen and Paul Sargos and Shomik Sengupta and Amir Sherif and Smeenk, {Robert J} and Anita Smits and Arnulf Stenzl and Thalmann, {George N} and Bertrand Tombal and Baris Turkbey and Lauridsen, {Susanne Vahr} and Riccardo Valdagni and {Der Heijden}, {Antoine G Van} and {Van Poppel}, Hein and Vartolomei, {Mihai D} and Erik Veskim{\"a}e and Antoni Vilaseca and Rivera, {Franklin A Vives} and Thomas Wiegel and Peter Wiklund and Andrew Williams and Richard Zigeuner and Alan Horwich",
note = "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. FUNDING All costs relating to the consensus conference were covered jointly by the European Association of Urology and the European Society for Medical Oncology. There was no external funding of the event or manuscript production.",
year = "2020",
month = "2",
doi = "10.1016/j.eururo.2019.09.035",
language = "English",
volume = "77",
pages = "223--250",
journal = "European Urology",
issn = "0302-2838",
publisher = "Elsevier",
number = "2",

}

TY - JOUR

T1 - EAU-ESMO Consensus Statements on the Management of Advanced and Variant Bladder Cancer-An International Collaborative Multistakeholder Effort

T2 - Under the Auspices of the EAU-ESMO Guidelines Committees

AU - Witjes, J Alfred

AU - Babjuk, Marek

AU - Bellmunt, Joaquim

AU - Bruins, H Maxim

AU - De Reijke, Theo M

AU - De Santis, Maria

AU - Gillessen, Silke

AU - James, Nicholas

AU - Maclennan, Steven

AU - Palou, Juan

AU - Powles, Tom

AU - Ribal, Maria J

AU - Shariat, Shahrokh F

AU - Der Kwast, Theo Van

AU - Xylinas, Evanguelos

AU - Agarwal, Neeraj

AU - Arends, Tom

AU - Bamias, Aristotle

AU - Birtle, Alison

AU - Black, Peter C

AU - Bochner, Bernard H

AU - Bolla, Michel

AU - Boormans, Joost L

AU - Bossi, Alberto

AU - Briganti, Alberto

AU - Brummelhuis, Iris

AU - Burger, Max

AU - Castellano, Daniel

AU - Cathomas, Richard

AU - Chiti, Arturo

AU - Choudhury, Ananya

AU - Compérat, Eva

AU - Crabb, Simon

AU - Culine, Stephane

AU - De Bari, Berardino

AU - De Blok, Willem

AU - J L De Visschere, Pieter

AU - Decaestecker, Karel

AU - Dimitropoulos, Konstantinos

AU - Dominguez-Escrig, Jose L

AU - Fanti, Stefano

AU - Fonteyne, Valerie

AU - Frydenberg, Mark

AU - Futterer, Jurgen J

AU - Gakis, Georgios

AU - Geavlete, Bogdan

AU - Gontero, Paolo

AU - Grubmüller, Bernhard

AU - Hafeez, Shaista

AU - Hansel, Donna E

AU - Hartmann, Arndt

AU - Hayne, Dickon

AU - Henry, Ann M

AU - Hernandez, Virginia

AU - Herr, Harry

AU - Herrmann, Ken

AU - Hoskin, Peter

AU - Huguet, Jorge

AU - Jereczek-Fossa, Barbara A

AU - Jones, Rob

AU - Kamat, Ashish M

AU - Khoo, Vincent

AU - Kiltie, Anne E

AU - Krege, Susanne

AU - Ladoire, Sylvain

AU - Lara, Pedro C

AU - Leliveld, Annemarie

AU - Linares-Espinós, Estefania

AU - Løgager, Vibeke

AU - Lorch, Anja

AU - Loriot, Yohann

AU - Meijer, Richard

AU - Mir, M Carmen

AU - Moschini, Marco

AU - Mostafid, Hugh

AU - Müller, Arndt-Christian

AU - Müller, Christoph R

AU - N'Dow, James

AU - Necchi, Andrea

AU - Neuzillet, Yann

AU - Oddens, Jorg R

AU - Oldenburg, Jan

AU - Osanto, Susanne

AU - J G Oyen, Wim

AU - Pacheco-Figueiredo, Luís

AU - Pappot, Helle

AU - Patel, Manish I

AU - Pieters, Bradley R

AU - Plass, Karin

AU - Remzi, Mesut

AU - Retz, Margitta

AU - Richenberg, Jonathan

AU - Rink, Michael

AU - Roghmann, Florian

AU - Rosenberg, Jonathan E

AU - Rouprêt, Morgan

AU - Rouvière, Olivier

AU - Salembier, Carl

AU - Salminen, Antti

AU - Sargos, Paul

AU - Sengupta, Shomik

AU - Sherif, Amir

AU - Smeenk, Robert J

AU - Smits, Anita

AU - Stenzl, Arnulf

AU - Thalmann, George N

AU - Tombal, Bertrand

AU - Turkbey, Baris

AU - Lauridsen, Susanne Vahr

AU - Valdagni, Riccardo

AU - Der Heijden, Antoine G Van

AU - Van Poppel, Hein

AU - Vartolomei, Mihai D

AU - Veskimäe, Erik

AU - Vilaseca, Antoni

AU - Rivera, Franklin A Vives

AU - Wiegel, Thomas

AU - Wiklund, Peter

AU - Williams, Andrew

AU - Zigeuner, Richard

AU - Horwich, Alan

N1 - 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. FUNDING All costs relating to the consensus conference were covered jointly by the European Association of Urology and the European Society for Medical Oncology. There was no external funding of the event or manuscript production.

PY - 2020/2

Y1 - 2020/2

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.

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.

KW - Bladder cancer

KW - consenus

KW - Delphi

KW - diagnosis

KW - treatment

KW - follow-up

U2 - 10.1016/j.eururo.2019.09.035

DO - 10.1016/j.eururo.2019.09.035

M3 - Article

C2 - 31753752

VL - 77

SP - 223

EP - 250

JO - European Urology

JF - European Urology

SN - 0302-2838

IS - 2

ER -