SIU–ICUD consultation on bladder cancer: treatment of muscle-invasive bladder cancer

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

Research output: Contribution to journalArticlepeer-review

29 Scopus citations


Purpose: 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). Methods: 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. Results: 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)61-83
Number of pages23
JournalWorld Journal of Urology
Issue number1
StatePublished - Jan 23 2019


  • Adjuvant chemotherapy
  • Bladder-sparing
  • Chemoradiation
  • Enhanced recovery after surgery
  • Muscle-invasive bladder cancer
  • Neoadjuvant chemotherapy
  • Radical cystectomy
  • Transurethral resection of bladder tumor
  • Trimodal
  • Urothelial carcinoma of bladder
  • Variant histology

ASJC Scopus subject areas

  • Urology


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