First Brazilian consensus on the management of localized and locally advanced urothelial bladder cancer: a SBU-SBOC-SBRT-LACOG-GU panel review

ABSTRACT

Introduction: Urothelial carcinoma, especially localized bladder cancer, has a substantial prevalence in Brazil with 9,480 new cases each year and 3,903 deaths, therefore progress is required in its management in order to decrease its recurrence and progression, and improve survival. Material and Methods: Medical oncologists, radiation oncologists, and urologists from Brazil conducted a meeting to vote the best approaches available in this country in the diagnosis, staging, and treatment of localized and locally advanced urothelial bladder carcinoma. The panel drew up 73 questions and answers were chosen considering the feasibility according to the access to drugs and the procedures used in this country. Each answer reaching 75% of voters was considered a consensus. The results of this consensus were compared with evidence published in the medical literature and rated with a level of evidence and grade of recommendation using the Oxford classification. Results: Transurethral resection of bladder tumors confirms the diagnosis of and provides initial treatment for non-muscle-invasive bladder cancers. Repeated resection is necessary in selected cases and should not delay further treatment. The use of intravesical Bacillus Calmette-Guérin is performed according to risk stratification, showing a significant reduction in tumor recurrence and progression, and improved disease-specific survival in intermediate- and high-risk patients. Radical cystectomy should be considered for high-progression risk cases after Bacillus Calmette-Guérin treatment failure and for localized muscle-invasive bladder cancer. Conclusion:  Management of urothelial carcinoma often requires a multidisciplinary team with surgical and clinical approaches, based on the expertise of professionals and evidence from the literature.

RESUMO

Introdução: O carcinoma urotelial, principalmente o câncer localizado de bexiga, tem prevalência substancial no Brasil com 9.480 novos casos a cada ano e 3.903 óbitos, portanto, é necessário avançar no seu manejo para diminuir sua recorrência e progressão, e melhorar a sobrevida. Material e Métodos: Médicos oncologistas, oncologistas de radiação e urologistas do Brasil realizaram uma reunião para votar as melhores abordagens disponíveis no país no diagnóstico, estadiamento e tratamento do carcinoma de bexiga urotelial localizado e localmente avançado. O painel elaborou 73 perguntas e as respostas foram escolhidas considerando a viabilidade de acordo com o acesso aos medicamentos e os procedimentos utilizados no país. Cada resposta que atingiu 75% dos eleitores foi considerada um consenso. Os resultados desse consenso foram comparados com as evidências publicadas na literatura médica e avaliados com um nível de evidência e grau de recomendação usando a classificação de Oxford. Resultados: A ressecção transuretral de tumores de bexiga confirma o diagnóstico e fornece tratamento inicial para cânceres de bexiga não músculo-invasivo. A ressecção repetida é necessária em casos selecionados e não deve atrasar o posterior tratamento. O uso do Bacillus Calmette-Guérin intravesical é realizado de acordo com a estratificação de risco, mostrando redução significativa na recorrência e progressão tumoral e melhora na sobrevida específica da doença em pacientes de risco intermediário e alto. A cistectomia radical deve ser considerada para casos de alto risco de progressão após falha no tratamento com Bacillus Calmette-Guérin e para câncer de bexiga músculo-invasivo localizado. Conclusão: O manejo do carcinoma urotelial muitas vezes requer uma equipe multidisciplinar com abordagens cirúrgicas e clínicas, com base na experiência dos profissionais e evidências da literatura.

Keywords:

Urinary bladder neoplasms - Cystectomy - Consensus - Carcinoma - Transitional cell - Administration - Intravesical.

Descritores:

Neoplasias da bexiga urinária - Cistectomia - Consenso - Carcinoma de célula transicional - Administração intravesical.

AUTHORS' CONTRIBUTIONS

All authors participated in the conceptualization, review, and revision of this manuscript. In addition, all authors have read and approved the final version of this manuscript.

ABBREVIATIONS:

American Society of Anesthesiologists (ASA); Bacillus

Calmette-Guérin (BCG);

Bladder cancer (BCa);

Brazilian Society of Clinical Oncology (SBOC); Brazilian Society of Radiotherapy (SBRT); Brazilian Society of Urology (SBU);

Carcinoma in situ (CIS); Computed tomography (CT); Cutaneous ureterostomy (CU); Disease-free survival (DFS); Disease-specific survival (DSS);

Enhanced recovery after surgery (ERAS); Grade of recommendation (GR);

Intravesical chemotherapy (IVC); Intravesical therapy (IVT);

Latin American Cooperative Oncology Group (LACOG); Level of evidence (LE);

Magnetic resonance imaging (MRI); Muscle-invasive bladder cancer (MIBC);

Non-muscle-invasive bladder cancer (NMIBC); Overall survival (OS);

Radical Cystectomy (RC); Recurrence-free survival (RFS); Repeating TURBT (re-TURBT); Transurethral resection (TUR);

Transurethral resection of bladder tumor (TURBT); Tri-modality therapy (TMT);

Upper urinary tract (UUT); Urothelial carcinoma (UC); Urothelial bladder carcinoma (UBC); Urinary diversion (UD);

With white light cystoscopy (WLC).

Publication History

Received: 26 March 2021

Accepted: 28 May 2021

Article published online:
22 June 2021

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