EAU Guidelines on non–muscle–invasive urothelial carcinoma of the bladder – the 2011 Update
Authors:
M. Babjuk 1; W. Oosterlinck 2; R. Sylvester 3; E. Kaasinen 4; A. Böhle 5; J. Palou-Redorta 6; M. Roupręt 7
Authors‘ workplace:
Faculty of Medicine Pierre et Marie Curie, University Paris VI, Paris, France
; Department of Urology, Hospital Motol, nd Faculty of Medicine, Charles University, Praha
1; Department of Urology, Ghent University Hospital, Ghent, Belgium
2; European Organisation for Research and Treatment of Cancer Headquarters, Department of Biostatistics, Brussels, Belgium
3; Department of Urology, Hyvinkää Hospital, Hyvinkää, Finland
4; Department of Urology, HELIOS Agnes Karll Hospital, Bad Schwartau, Germany
5; Department of Urology, Fundació Puigvert, Universitat Autónoma de Barcelona, Barcelona, Spain
6; Department of Urology of Pitié-Salpétriére Hospital, GHU Est, Assistance-Publique Hôpitaux de Paris
7
Published in:
Urol List 2011; 9(3): 63-74
Overview
Context and objective:
To present the 2011 European Association of Urology (EAU) Guidelines on non–muscle-invasive bladder cancer (NMIBC).
Evidence acquisition:
Literature published between 2004 and 2010 on the diagnosis and treatment of NMIBC was systematically reviewed. Previous guidelines were updated, and the level of evidence (LE) and grade of recommendation (GR) were assigned.
Evidence synthesis:
Tumours staged as Ta, T1, or carcinoma in situ (CIS) are grouped as NMIBC. Diagnosis depends on cystoscopy and histologic evaluation of the tissue obtained by transurethral resection (TUR) in papillary tumours or by multiple bladder biopsies in CIS. In papillary lesions, a complete TUR is essential for the patient’s prognosis. Where the initial resection is incomplete or where a high-grade or T1 tumour is detected, a second TUR should be performed within 2–6 wk. In papillary tumours, the risks of both recurrence and progression may be estimated for individual patients using the scoring system and risk tables. The stratification of patients into low-, intermediate-, and high-risk groups – separately for recurrence and progression – is pivotal to recommending adjuvant treatment. For patients with a low risk of tumour recurrence and progression, one immediate instillation of chemotherapy is recommended. Patients with an intermediate or high risk of recurrence and an intermediate risk of progression should receive one immediate instillation of chemotherapy followed by a minimum of 1 yr of bacillus Calmette-Guérin (BCG) intravesical immunotherapy or further instillations of chemotherapy. Papillary tumours with a high risk of progression and CIS should receive intravesical BCG for 1 yr. Cystectomy may be offered to the highest risk patients, and it is at least recommended in BCG failure patients. The long version of the guidelines is available from the EAU Web site (www.uroweb.org).
Conclusions:
These abridged EAU guidelines present updated information on the diagnosis and treatment of NMIBC for incorporation into clinical practice.
Key words:
Bacillus Calmette-Guérin (BCG), bladder cancer, cystectomy, cystoscopy, diagnosis, EAU Guidelines, follow-up, intravesical chemotherapy, prognosis, transurethral resection (TUR), urothelial carcinoma
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