BACKGROUND: In contrast to other cancers, the concept of oligometastatic disease (OMD) has not been investigated in bladder cancer (BC). OBJECTIVE: To develop an acceptable definition, classification, and staging recommendations for oligometastatic BC (OMBC) spanning the issues of patient selection and the roles of systemic therapy and ablative local therapy. DESIGN, SETTING, AND PARTICIPANTS: A European consensus group of 29 experts, led by the European Association of Urology (EAU), the European Society for Radiotherapy and Oncology (ESTRO), and the European Society of Medical Oncology (ESMO), and including members from all other relevant European societies, was established. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: A modified Delphi method was used. A systematic review was used to build consensus questions. Consensus statements were extracted from two consecutive surveys. The statements were formulated during two consensus meetings. Agreement levels were measured to determine if consensus was achieved (≥75% agreement). RESULTS AND LIMITATIONS: The first survey included 14 questions and the second survey had 12. Owing to a considerable lack of evidence, which was the major limitation, definition was limited in the context of de novo OMBC, which was further classified as synchronous OMD, oligorecurrence, and oligoprogression. A maximum of three metastatic sites, all resectable or amenable to stereotactic therapy, was proposed as the definition of OMBC. Pelvic lymph nodes represented the only "organ" not included in the definition of OMBC. For staging, no consensus on the role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography was reached. A favourable response to systemic treatment was proposed as the criterion for selection of patients for metastasis-directed therapy. CONCLUSIONS: A consensus statement on the definition and staging of OMBC has been formulated. This statement will help to standardise inclusion criteria in future trials, potentiate research on aspects of OMBC for which consensus was not achieved, and hopefully will lead to the development of guidelines on optimal management of OMBC. PATIENT SUMMARY: As an intermediate state between localised cancer and disease with extensive metastasis, oligometastatic bladder cancer (OMBC) might benefit from a combination of systemic treatment and local therapy. We report the first consensus statements on OMBC drawn up by an international expert group. These statements can provide a basis for standardisation of future research, which will lead to high-quality evidence in the field.

2nd Faculty of Medicine Hospital Motol Charles University Praha Czechia

Addenbrookes Hospital Cambridge UK

Akershus University Hospital Ahus Denmark

Clinica di Radio Oncologia Istituto Oncologico della Svizzera Italiana Ente Ospedaliero Cantonale Bellinzona Switzerland

Department of Clinical Oncology The Christie NHS Foundation Trust and University of Manchester Manchester UK

Department of Maternal Child and Urological Sciences Sapienza Rome University Policlinico Umberto 1 Hospital Rome Italy

Department of Radiation Oncology Ghent University Hospital Ghent Belgium

Department of Radiation Oncology Iridium Network Wilrijk Belgium; Department of Human Structure and Repair Ghent University Ghent Belgium

Department of Radiation Oncology MediClin Robert Janker Klinik Bonn Germany

Department of Radiology HFR Fribourg Hôpital Cantonal University of Fribourg Villars sur Glâne Switzerland

Department of Urology Caritas St Josef Medical Centre University of Regensburg Regensburg Germany

Department of Urology Charité University Hospital Berlin Germany

Department of Urology Division of Experimental Oncology Urological Research Institute IRCCS San Raffaele Scientific Institute Milan Italy

Department of Urology Hospital Clinico San Carlos Madrid Spain

Department of Urology University Hospital Schleswig Holstein Campus Luebeck Luebeck Germany

Division of Nuclear Medicine IRCCS Azienda Ospedaliero Universitaria di Bologna Bologna Italy

Goustave Roussy Institute Villejuif France

Kantonsspital Aarau AG Aarau Switzerland

Klinik für Urologie und Kinderurologie Abteilung für Klinisch Experimentelle Forschung Homburg Germany

Molecular Medicine and Cell Therapy Foundation Polytechnic University of the Marche Region Ancona Italy

Mount Vernon Cancer Centre Northwood UK

National and Kapodistrian University of Athens Attikon University Hospital Chaidari Greece

Rosemere Cancer Centre Lancashire Teaching Hospitals NHS Foundation Trust Preston UK

Royal Marsden Hospital Foundation Trust London UK

Sorbonne University GRC 5 Predictive Onco Uro AP HP Pitie Salpetriere Hospital Paris France

Translational and Clinical Research Institute Centre for Cancer Newcastle University Newcastle upon Tyne UK

University of Tübingen Medical Center Tübingen Germany

Uro Oncology Unit Hospital Clinic University of Barcelona Barcelona Spain

Vita Salute San Raffaele University IRCCS San Raffaele Hospital and Scientific Institute Milan Italy

Eur Urol. 2023 Oct;84(4):390-392. doi: 10.1016/j.eururo.2023.06.003. PubMed

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