Updated 2016 EAU Guidelines on Muscle-invasive and Metastatic Bladder Cancer

Witjes, J. Alfred; Lebrét, Thierry; Compérat, Éva; Cowan, Nigel C.; Santis, Maria De; Bruins, H.M.; Hernández, Virginia; Espinós, Estefanía Linares; Dunn, James P.; Rouanne, Mathieu; Neuzillet, Y.; Veskimäe, Erik; Heijden, Antoine G. van der; Gakis, Georgios; Ribal, María J.

doi:10.1016/j.eururo.2016.06.020

Cited by 1,267 publications

(699 citation statements)

References 123 publications

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“…Although evidence supports the use of neoadjuvant chemotherapy (NAC) with an absolute improvement of survival rates of 5% at 5 years, utilization in clinical practice is generally low [6, 7]. In contrast, adjuvant chemotherapy (AC) has higher rates of utilization, although evidence is more limited than it is for NAC [2, 8]. In addition, there are no clear statements on the optimal number of cycles to be planned for both regimens.…”

Section: Introductionmentioning

confidence: 99%

“…Approximately 1/4 of patients are diagnosed with muscle-invasive bladder cancer (MIBC), which constitutes a very aggressive type of tumor [1]. For patients with localized MIBC, radical cystectomy (RC) is the treatment of choice [2, 3]. Despite radical therapy, 5-year overall survival for patients with nonmetastatic MIBC is around 50% [4, 5].…”

Section: Introductionmentioning

confidence: 99%

“…NAC should be offered to patients with clinical T2–4a stage tumors without clinically detectable lymph node and organ metastases. Both regimens should be cisplatin-based combination therapy [2]. …”

Section: Introductionmentioning

confidence: 99%

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Acceptance of Adjuvant and Neoadjuvant Chemotherapy in Muscle-Invasive Bladder Cancer in Germany: A Survey of Current Practice

et al. 2018

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Background: Guidelines support the use of neoadjuvant (NAC) and adjuvant (AC) chemotherapy in muscle-invasive bladder cancer. However, data from North America reported the underutilization of NAC in favor of AC despite the lower level of scientific evidence supporting AC. We aimed to assess current practice patterns of NAC and AC in Germany. Methods: A 15-question online survey was developed and sent via email newsletters to members of the German Association of Urology and of the German Society of Residents in Urology in October 2016 to analyze current practice patterns. Results: The survey yielded 141 individual responses from 61 different German urology departments. Eighty-nine (69.0%) and 119 (93.0%) participants were stated to regularly use NAC and AC respectively. The number of participants who were stated to use NAC and AC regularly was not associated with the type of institution (academic vs. nonacademic), number of hospital beds, and number of cystectomies performed annually. Gemcitabine/cisplatin combination chemotherapy was named as the primarily used NAC regimen by 80 (95%) respondents. The median number of administered cycles was 3 for NAC and 4 for AC. In the case of cisplatin ineligibility, combination chemotherapy with gemcitabine/carboplatin was the most common regimen. Respondents stated that chemotherapy was generally administered by urologists (81% for NAC and 85% for AC). Conclusions: Our survey of current practice shows a high acceptance rate of NAC in Germany, which was independent of the type of institution. Although the scientific level of evidence for AC is lower, it still seems to be more widely accepted than NAC. NAC and AC were generally administered by urologists.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Acceptance of Adjuvant and Neoadjuvant Chemotherapy in Muscle-Invasive Bladder Cancer in Germany: A Survey of Current Practice

et al. 2018

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“…Based on several guidelines [34,35] NAC was not recommended in the patients with CKD (= cisplatin-unfit) and carboplatin-based regimen was believed less effective than cisplatin. However, no clear evidence currently supports the superiority of cisplatinbased regimens over carboplatin-based regimens in the neoadjuvant setting [36].…”

Section: Risk-score-based Protocol Months After Rcmentioning

confidence: 99%

Risk-stratified surveillance and cost effectiveness of follow-up after radical cystectomy in patients with muscle-invasive bladder cancer.

Hatakeyama

Kusaka

Hosogoe

et al. 2018

JCO

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Background: The recurrence risk stratification and the cost effectiveness of oncological surveillance after radical cystectomy are not clear. We aimed to develop a risk stratification and a surveillance protocol with improved cost effectiveness after radical cystectomy.Results: Of 581 enrolled patients, 175 experienced disease recurrences. The pathology-based protocol presented significant differences in recurrence-free survival between normal-and high-risk patients, but the medical expense was high, especially in normal-risk (≤pT2pN0) patients. Cox regression analysis identified six factors associated with recurrence-free survival. Risk score-based 5-year follow-up was significantly more cost effective than the pathology-based protocol.Materials and Methods: We retrospectively evaluated 581 patients with radical cystectomy for muscle-invasive bladder cancer at 4 hospitals. Patients with routine oncological follow-up were stratified into normal-and high-risk groups by a pathologybased protocol utilizing pT, pN, lymphovascular invasion, and histology. Cost effectiveness of the pathology-based protocol was evaluated and a risk-score-based protocol was developed to optimize cost effectiveness. Risk-scores were calculated by summing risk factors independently associated with recurrence-free survival. Patients were stratified by low-, intermediate-, and high-risk score. Estimated cost per one recurrence detection by the pathology and by risk-scores were compared.Conclusions: Risk-score-stratified surveillance protocol has potential to reduce over-evaluation after radical cystectomy without adverse effects on medical cost.

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“…Extended and superextended dissection has been reported to be associated with superior survival outcome. The potential for meaningful bias, however, prohibits drawing definite conclusions [12][13][14].…”

mentioning

confidence: 99%

Lymphadenectomy in Muscle Invasive Bladder Cancer

Horsanalı¹,

Ozer²

2017

Bladder Cancer - Management of NMI and Muscle-Invasive Cancer

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Bladder cancer is the second most common genitourinary malignancy with urothelial cancer comprising nearly 90% of primary bladder tumors. Urothelial carcinoma of the urinary bladder is the fifth most common malignancy in the United States, with an estimated 76,960 new cases and 163,900 deaths in 2016. Radical cystectomy with lymph node dissection remains the standard treatment for patients with muscle-invasive urothelial carcinoma of the bladder, and also for nonmuscle-invasive disease, refractory to intravesical therapy. The current approaches to pelvic lymph node dissections are based on the removal of lymph nodes most commonly harboring metastatic disease, notably the external iliac, obturator, and hypogastric lymph nodes. The boundaries for a standard pelvic lymph node dissection generally include the bifurcation of the common iliac vessels superiorly and the genitofemoral nerve laterally. Extended pelvic lymph node includes the removal of lymph nodes between the bifurcation of the common iliac vessels and the level of the aortic bifurcation, sometimes including distal aortic and caval nodes up to the level of the inferior mesenteric artery, as well as presacral nodes. Extended and superextended dissection has been reported to be associated with superior survival outcome.

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Updated 2016 EAU Guidelines on Muscle-invasive and Metastatic Bladder Cancer

Cited by 1,267 publications

References 123 publications

Acceptance of Adjuvant and Neoadjuvant Chemotherapy in Muscle-Invasive Bladder Cancer in Germany: A Survey of Current Practice

Acceptance of Adjuvant and Neoadjuvant Chemotherapy in Muscle-Invasive Bladder Cancer in Germany: A Survey of Current Practice

Risk-stratified surveillance and cost effectiveness of follow-up after radical cystectomy in patients with muscle-invasive bladder cancer.

Lymphadenectomy in Muscle Invasive Bladder Cancer

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