To provide a comprehensive overview and update of the Joint Société Internationale d'Urologie-International Consultation on Urological Diseases (SIU-ICUD) Consultation on Bladder Cancer for muscle-invasive presumably node-negative bladder cancer (MIBC).
Contemporary literature was analyzed for the latest evidence in treatment options, outcomes, including radical surgery, neoadjuvant and adjuvant treatment modalities, and bladder-sparing approaches. An international multi-disciplinary expert panel evaluated and graded the data according to guidelines from the Oxford Centre for Evidence-Based Medicine.
Radical cystectomy (RC) is the standard of care for MIBC patients considered to be surgical candidates. While associated with substantial morbidity and mortality, this has been mitigated with improved technique, minimally invasive technology, and better perioperative care pathways (e.g., enhanced recovery after surgery). Neoadjuvant (NA) cisplatin-based combination chemotherapy improves overall survival and should be offered to eligible ≥ cT2N0 patients. Adjuvant (Adj) cisplatin-based combination chemotherapy may be considered, particularly for pT3-4 and/or pN+ disease without prior NA chemotherapy. Trimodal bladder-preserving treatment via maximum transurethral resection of bladder tumor followed by concurrent chemoradiation is safe and, when combined with early salvage RC for recurrence, offers long-term survival rates in selected patients comparable to RC. Immunotherapy is still experimental and is given either alone or in combination with chemotherapy and/or radiation.
A multi-disciplinary approach is paramount to achieving optimal outcomes for MIBC patients, irrespective of their age, performance and nutritional status, fitness/frailty, renal and other organ function, or disease severity.
World journal of urology. 2019 Jan 25 [Epub ahead of print]
Jeffrey J Leow, Jens Bedke, Karim Chamie, Justin W Collins, Siamak Daneshmand, Petros Grivas, Axel Heidenreich, Edward M Messing, Trevor J Royce, Alexander I Sankin, Mark P Schoenberg, William U Shipley, Arnauld Villers, Jason A Efstathiou, Joaquim Bellmunt, Arnulf Stenzl
Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore., Department of Urology, University of Tübingen, Tübingen, Germany., Department of Urology and Institute of Urologic Oncology, David Geffen School of Medicine at University of California, Los Angeles, CA, USA., Department of Molecular Medicine and Surgery (MMK), Karolinska Institutet, Solna, Sweden., USC Institute of Urology, University of Southern California, Los Angeles, CA, USA., Division of Oncology, Department of Medicine, University of Washington, Seattle, WA, USA., Department of Urology, University Hospital of Cologne, Cologne, Germany., Department of Urology, University of Rochester Medical Center, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA., Department of Radiation Oncology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA., Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA., Genitourinary Division, Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA., Department of Urology, University of Lille Nord de France, Lille, France., Genitourinary Division, Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. ., PSMAR-IMIM Hospital del Mar Medical Research Institute, Barcelona, Spain. ., Department of Urology, University of Tübingen, Tübingen, Germany. .