Consensus treatment pathway for patients with limited pelvic lymph node involvement in otherwise localised bladder cancer

There was a very practical debate between Prof. Jürgen Gschwend (Technical University München, Germany) and Prof. Sergio Bracarda (Ospedale San Donato, Italy) about how to treat patients with limited pelvic lymph node involvement in otherwise localised bladder cancer. The discussion was multidisciplinary, and a consensus treatment pathway was agreed upon (see Figure).

Figure: Consensus treatment pathway



In cisplatin-eligible patients, induction chemotherapy is advocated. Subsequently, patients are then stratified according to their response, choosing additional surgery (radical cystectomy with extended pelvic lymph node dissection) or second-line systemic treatment. In cisplatin-ineligible patients, Prof. Bracarda urged that it is essential to enrol as many of these patients as possible into clinical trials (e.g. immunotherapy) to facilitate the implementation of new approaches for these patients; the current data for carboplatin have been disappointing.



Posted on 21 May, 201917 March, 2021