EAU Guidelines on Non-Muscle-invasive Urothelial Carcinoma of the Bladder: Update 2013
Por:
Babjuk, M, Burger, M, Zigeuner, R, Shariat, SF, van Rhijn, BWG, Comperat, E, Sylvester, RJ, Kaasinen, E, Bohle, A, Redorta, JP, Roupret, M
Publicada:
1 oct 2013
Resumen:
Context: The first European Association of Urology (EAU) guidelines on bladder cancer were published in 2002 [1]. Since then, the guidelines have been continuously updated.
Objective: To present the 2013 EAU guidelines on non-muscle-invasive bladder cancer (NMIBC).
Evidence acquisition: Literature published between 2010 and 2012 on the diagnosis and treatment of NMIBC was systematically reviewed. Previous guidelines were updated, and the levels of evidence and grades of recommendation 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, where there is no muscle in the specimen, or where a high-grade or T1 tumour is detected, a second TUR should be performed within 2-6 wk. The risks of both recurrence and progression may be estimated for individual patients using the EORTC scoring system and risk tables. The stratification of patients into low-, intermediate-, and high-risk groups is pivotal to recommending adjuvant treatment. For patients with a low-risk tumour, one immediate instillation of chemotherapy is recommended. Patients with an intermediate-risk tumour should receive one immediate instillation of chemotherapy followed by 1 yr of full-dose bacillus Calmette-Guerin (BCG) intravesical immunotherapy or by further instillations of chemotherapy for a maximum of 1 yr. In patients with high-risk tumours, full-dose intravesical BCG for 1-3 yr is indicated. In patients at highest risk of tumour progression, immediate radical cystectomy should be considered. Cystectomy is recommended in BCG-refractory tumours. The long version of the guidelines is available from the EAU Web site: http://www.uroweb.org/guidelines/.
Conclusions: These abridged EAU guidelines present updated information on the diagnosis and treatment of NMIBC for incorporation into clinical practice.
Patient summary: The EAU Panel on Non-muscle Invasive Bladder Cancer released an updated version of their guidelines. Current clinical studies support patient selection into different risk groups; low, intermediate and high risk. These risk groups indicate the likelihood of the development of a new (recurrent) cancer after initial treatment (endoscopic resection) or progression to more aggressive (muscle-invasive) bladder cancer and are most important for the decision to provide chemo-or immunotherapy (bladder installations). Surgical removal of the bladder (radical cystectomy) should only be considered in patients who have failed chemo-or immunotherapy, or who are in the highest risk group for progression. (C) 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Filiaciones:
Babjuk, M:
Charles Univ Prague, Dept Urol, Hosp Motol, Fac Med 2, Prague 15006 5, Czech Republic
Burger, M:
Univ Wurzburg, Med Ctr, Dept Urol & Paediat Urol, D-97070 Wurzburg, Germany
Zigeuner, R:
Med Univ Graz, Dept Urol, Graz, Austria
Shariat, SF:
Med Univ Vienna, Vienna Gen Hosp, Dept Urol, Vienna, Austria
van Rhijn, BWG:
Antoni van Leeuwenhoek Hosp, Netherlands Canc Inst, Dept Surg Oncol Urol, Amsterdam, Netherlands
Comperat, E:
UPMC, Hop Pitie Salpetriere, Dept Pathol, Paris, France
Sylvester, RJ:
EORTC Headquarters, Dept Biostat, Brussels, Belgium
Kaasinen, E:
Hyvinkaa Hosp, Dept Surg, Hyvinkaa, Finland
Bohle, A:
HELIOS Agnes Karll Krankenhaus, Dept Urol, Bad Schwartau, Germany
Redorta, JP:
Univ Autonoma Barcelona, Dept Urol, Fundacio Puigvert, E-08193 Barcelona, Spain
Roupret, M:
Hop La Pitie Salpetriere, AP HP, Serv Urol, F-75013 Paris, France
Univ Paris 06, GRC5, ONCOTYPE Uro, Inst Univ Cancerol, F-75005 Paris, France
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