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 HM, 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 , Burger M, Castellano D, Cathomas R, Chiti A, Choudhury A, Comperat E, Crabb S, Culine S, De Bari B, De Blok W, De Visschere PJL, Decaestecker K, Dimitropoulos K, Dominguez-Escrig JL, Fanti S, Fonteyne , Frydenberg M, Futterer JJ, Gakis G, Geavlete B, Gontero P, Grubmueller B, Hafeez S, Hansel DE, Hartmann A, Hayne D, Henry AM, Hernandez , Herr H, Herrmann K, Hoskin P, Huguet J, Jereczek-Fossa BA, Jones R, Kamat AM, Khoo , Kiltie AE, Krege S, Ladoire S, Lara PC, Leliveld A, Linares-Espinos E, Logager , Lorch A, Loriot Y, Meijer R, Carmen Mir M, Moschini M, Mostafid H, Mueller AC, Mueller CR, N'Dow J, Necchi A, Neuzillet Y, Oddens JR, Oldenburg J, Osanto S, Oyen WJG, Pacheco-Figueiredo L, Pappot H, Patel M, Pieters BR, Plass K, Remzi M, Retz M, Richenberg J, Rink M, Roghmann F, Rosenberg JE, Roupret M, Rouviere 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, Veskimae E, Vilaseca A, Vives Rivera FA, Wiegel T, Wiklund P, Williams A, Zigeuner R, Witjes JA (2019)

Publication Type: Journal article

Publication year: 2019


Book Volume: 30

Pages Range: 1697-1727

Journal Issue: 11

DOI: 10.1093/annonc/mdz296


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.

Authors with CRIS profile

Involved external institutions

University of Glasgow GB United Kingdom (GB) NHS Royal Surrey NHS Foundation Trust GB United Kingdom (GB) Kliniken Essen-Mitte DE Germany (DE) University of Texas MD Anderson Cancer Center US United States (USA) (US) Centre Georges François Leclerc (UNICANCER) FR France (FR) Kantonsspital Graubünden CH Switzerland (CH) Herlev Hospital DK Denmark (DK) Hospital Universitario La Paz ES Spain (ES) Universitat de Barcelona (UB) / University of Barcelona ES Spain (ES) Istituto Clinico Humanitas IT Italy (IT) Univerzita Karlova v Praze / Charles University in Prague CZ Czech Republic (CZ) Autonomous University of Barcelona (UAB) / Universitat Autònoma de Barcelona ES Spain (ES) University of Utah US United States (USA) (US) University of Manchester GB United Kingdom (GB) University of British Columbia CA Canada (CA) Medizinische Universität Wien AT Austria (AT) University of Amsterdam NL Netherlands (NL) National and Kapodistrian University of Athens GR Greece (GR) The Institute of Cancer Research (ICR) GB United Kingdom (GB) IMIM: Institut Hospital del Mar d'Investigacions Mèdiques ES Spain (ES) Royal Free Hospital GB United Kingdom (GB) University Hospitals Birmingham NHS Foundation Trust GB United Kingdom (GB) University of Grenoble Alpes (UGA) / Université de Grenoble FR France (FR) University of California, San Diego US United States (USA) (US) Julius-Maximilians-Universität Würzburg DE Germany (DE) Universität Regensburg DE Germany (DE) Radboud University Nijmegen NL Netherlands (NL) University Hospital Ghent BE Belgium (BE) Valencia Oncology Institute Foundation / Fundación Instituto Valenciano de Oncología / Fundació Institut Valencià d’Oncologia (IVO) ES Spain (ES) University of Southampton GB United Kingdom (GB) University Medical Centre Utrecht (UMC Utrecht) NL Netherlands (NL) University of Western Australia (UWA) AU Australia (AU) Universitätsklinikum Essen DE Germany (DE) Assistance Publique-Hôpitaux de Paris (AP-HP) FR France (FR) Hôpital Tenon FR France (FR) Erasmus University Medical Center (MC) NL Netherlands (NL) Hospital Universitario 12 de Octubre ES Spain (ES) Umeå University SE Sweden (SE) Fondazione IRCCS: Istituto Nazionale dei Tumori IT Italy (IT) Akershus University Hospital / Akershus universitetssykehus (Ahus) NO Norway (NO) Luzerner Kantonsspital (LUKS) CH Switzerland (CH) Universitätsspital Zürich (USZ) CH Switzerland (CH) Eberhard Karls Universität Tübingen DE Germany (DE) Leiden University NL Netherlands (NL) Technische Universität München (TUM) DE Germany (DE) Università degli studi di Milano IT Italy (IT) Hospices Civils de Lyon (CHU) FR France (FR) University of Sydney (USYD) AU Australia (AU) Hospital de São João / Saint John Hospital PT Portugal (PT) Inselspital, Universitätsspital Bern CH Switzerland (CH) Universitätsklinikum Hamburg-Eppendorf (UKE) DE Germany (DE) Ruhr-Universität Bochum (RUB) DE Germany (DE) Turku University Hospital / Turun yliopistollinen keskussairaala (TYKS) FI Finland (FI) University Hospital Leuven (UZ) / Universitaire ziekenhuizen Leuven BE Belgium (BE) University of Paris 4 - Paris-Sorbonne / Université paris IV Paris-Sorbonne FR France (FR) Royal Sussex County Hospital GB United Kingdom (GB) University of Oxford GB United Kingdom (GB) Memorial Sloan Kettering Cancer Center US United States (USA) (US) University of Aberdeen GB United Kingdom (GB) Tampere University Hospital / Tampereen yliopistollinen sairaala (TAYS) FI Finland (FI) Copenhagen University Hospital DK Denmark (DK) National Cancer Institute (NCI) US United States (USA) (US) Hôpital Bichat-Claude-Bernard (CHU, APHP) FR France (FR) European Association of Urology NL Netherlands (NL) Canisius-Wilhelmina Ziekenhuis NL Netherlands (NL) University of Turin / Università degli Studi di Torino (UNITO) IT Italy (IT) Auckland City Hospital NZ New Zealand (NZ) Cornell University US United States (USA) (US) University of Paris 11 - Paris-Sud / Université Paris XI Paris-Sud FR France (FR) University College London (UCL) GB United Kingdom (GB) Versailles Saint-Quentin-en-Yvelines University / Université de Versailles Saint-Quentin-en-Yvelines (UVSQ) FR France (FR) Institut Bergonié FR France (FR) Aberdeen Royal Infirmary (ARI) GB United Kingdom (GB) Icahn School of Medicine at Mount Sinai US United States (USA) (US) The University of Melbourne AU Australia (AU) Centre hospitalier régional et universitaire de Besançon (CHRU Besancon) FR France (FR) Universitätsklinikum Ulm DE Germany (DE) Monash University AU Australia (AU) University of Bologna / Università di Bologna IT Italy (IT) University of Leeds GB United Kingdom (GB) "Saint John" Emergency Clinical Hospital RO Romania (RO) Hospital Universitario Fundación Alcorcón (HUFA) ES Spain (ES) Institut Gustave-Roussy FR France (FR) University of Groningen / Rijksuniversiteit Groningen NL Netherlands (NL) Sørlandet Hospital Kristiansand NO Norway (NO)

How to cite


Horwich, A., Babjuk, M., Bellmunt, J., Bruins, H.M., De Reijke, T.M., De Santis, M.,... Witjes, J.A. (2019). 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†. Annals of Oncology, 30(11), 1697-1727. https://doi.org/10.1093/annonc/mdz296


Horwich, A., et al. "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†." Annals of Oncology 30.11 (2019): 1697-1727.

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