In contrast to other cancers, the concept of oligometastatic disease (OMD) has not been investigated in bladder cancer (BC).
To develop an acceptable definition, classification, and staging recommendations for oligometastatic BC (OMBC) spanning the issues of patient selection and the roles of systemic therapy and ablative local therapy.
A European consensus group of 29 experts, led by the European Association of Urology (EAU), the European Society for Radiotherapy and Oncology (ESTRO), and the European Society of Medical Oncology (ESMO), and including members from all other relevant European societies, was established.
A modified Delphi method was used. A systematic review was used to build consensus questions. Consensus statements were extracted from two consecutive surveys. The statements were formulated during two consensus meetings. Agreement levels were measured to determine if consensus was achieved (≥75% agreement).
The first survey included 14 questions and the second survey had 12. Owing to a considerable lack of evidence, which was the major limitation, definition was limited in the context of de novo OMBC, which was further classified as synchronous OMD, oligorecurrence, and oligoprogression. A maximum of three metastatic sites, all resectable or amenable to stereotactic therapy, was proposed as the definition of OMBC. Pelvic lymph nodes represented the only "organ" not included in the definition of OMBC. For staging, no consensus on the role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography was reached. A favourable response to systemic treatment was proposed as the criterion for selection of patients for metastasis-directed therapy.
A consensus statement on the definition and staging of OMBC has been formulated. This statement will help to standardise inclusion criteria in future trials, potentiate research on aspects of OMBC for which consensus was not achieved, and hopefully will lead to the development of guidelines on optimal management of OMBC.
As an intermediate state between localised cancer and disease with extensive metastasis, oligometastatic bladder cancer (OMBC) might benefit from a combination of systemic treatment and local therapy. We report the first consensus statements on OMBC drawn up by an international expert group. These statements can provide a basis for standardisation of future research, which will lead to high-quality evidence in the field.
European urology. 2023 May 20 [Epub ahead of print]
Aristotelis Bamias, Arnulf Stenzl, Stephanie L Brown, Laurence Albiges, Marko Babjuk, Alison Birtle, Alberto Briganti, Maximilian Burger, Ananya Choudhury, Maurizio Colecchia, Maria De Santis, Stefano Fanti, Valérie Fonteyne, Michele Gallucci, Juan Gómez Rivas, Robert Huddart, Kerstin Junker, Stephanie Kroeze, Yohann Loriot, Axel Merseburger, Rodolfo Montironi, Andrea Necchi, Christoph Oing, Jan Oldenburg, Piet Ost, Michael Pinkawa, Maria J Ribal, Morgan Rouprêt, Harriet Thoeny, Thomas Zilli, Peter Hoskin
National & Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Greece. Electronic address: ., University of Tübingen Medical Center, Tübingen, Germany., Addenbrookes Hospital, Cambridge, UK., Goustave Roussy Institute, Villejuif, France., 2nd Faculty of Medicine, Hospital Motol, Charles University, Praha, Czechia., Rosemere Cancer Centre, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK., Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy., Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany., Department of Clinical Oncology, The Christie NHS Foundation Trust and University of Manchester, Manchester, UK., Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital and Scientific Institute, Milan, Italy., Department of Urology, Charité University Hospital, Berlin, Germany., Division of Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy., Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium., Department of Maternal-Child and Urological Sciences, Sapienza Rome University, Policlinico Umberto I Hospital, Rome, Italy., Department of Urology. Hospital Clinico San Carlos. Madrid, Spain., Royal Marsden Hospital Foundation Trust, London, UK., Klinik für Urologie und Kinderurologie, Abteilung für Klinisch-Experimentelle Forschung, Homburg, Germany., Kantonsspital Aarau AG, Aarau, Switzerland., Department of Urology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany., Molecular Medicine and Cell Therapy Foundation, Polytechnic University of the Marche Region, Ancona, Italy., Translational and Clinical Research Institute, Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK., Akershus University Hospital, Ahus, Denmark., Department of Radiation Oncology, Iridium Network, Wilrijk, Belgium; Department of Human Structure and Repair, Ghent University, Ghent, Belgium., Department of Radiation Oncology, MediClin Robert Janker Klinik, Bonn, Germany., Uro-Oncology Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain., Sorbonne University GRC 5 Predictive Onco-Uro, AP-HP, Pitie-Salpetriere Hospital, Paris, France., Department of Radiology, HFR Fribourg-Hôpital Cantonal, University of Fribourg, Villars-sur-Glâne, Switzerland., Clinica di Radio-Oncologia, Istituto Oncologico della Svizzera Italiana, Ente Ospedaliero Cantonale, Bellinzona, Switzerland., Mount Vernon Cancer Centre, Northwood, UK.