CONTENT: Data related to the treatment of muscleinvasive and metastatic bladder cancer (MiM-BC) continue to emerge, leading to an update of the EAU guidelines for the treatment of MiM-BC. OBJECTIVE: To review the treatment section of the new EAU guidelines specifically for MiM-BC.
EVIDENCE ACQUIRED: Articles published since the last update of the EAU guidelines in 2008 and their references were searched through Medline, the Cochrane Database of Systematic Reviews (CDSR), which were carefully screened by urologists, oncologists and a radiologist designated by the EAU guidelines office. Recommended treatments assigned based on previous literature were also taken into consideration. Levels of evidence (LEs) and grades of recommendation (GRs) were derived from the Oxford Center for Evidence-Based Medicine Evidence Grading.
Evidence Summary: The available data suggest that neoadjuvant chemotherapy combined with radical cystectomy (RC) is recommended for the treatment of a specific subset of patients with MiM-BC. For patients with locally invasive bladder cancer, RC remains the basic treatment, regardless of gender. The scope of the procedure is being standardized for patients of both genders in standard situations. In situ neo-bladder replacement should be performed in patients without contraindications (e.g., net urethrotomy margins), whether male or female. Unlike neoadjuvant chemotherapy, current treatment recommendations are for postoperative adjuvant chemotherapy in the context of clinical trials. Multiple bladder-preserving treatment modalities are only available as an option for a subset of patients who are unable to undergo cystectomy due to personal or medical factors, and these patients should be carefully selected, adequately informed, and well adhered to. For patients with metastatic bladder cancer who can tolerate cisplatin, first-line therapy is cisplatin-containing combination chemotherapy. Second-line therapy is made possible by the availability of periflunomide. CONCLUSION: For locally invasive bladder cancer, the standard treatment remains the standard scope of total bladder dissection, including regional lymph node (currently unspecified) dissection. However, preoperative combined neoadjuvant chemotherapy should also be considered for some specific populations. A new second-line treatment for metastatic bladder cancer (periflunomide) has been approved and recommended for use.