Non-muscle-invasive Bladder Cancer 2020
Summary of changes
Additional data has been included throughout this document text. In particular in sections:
- 4.7 - Variants of urothelial carcinoma and lymphovascular invasion: this section has been expanded to include further information on variant histologies.
- 7.3 - Treatment of failure of intravesical therapy. This section has been considerably expanded, alongside a revision of Figure 7.2, Table 7.2 (Categories of unsuccessful treatment with intravesical BCG) and 7.7 Guidelines for the treatment of BCG failure.
Recommendations have been changed in sections:
7.5 Guidelines for adjuvant therapy in TaT1 tumours and for therapy of carcinoma in situ
| General recommendations | Strength rating |
| Offer a RC to patients with BCG unresponsive tumours (see Section 7.7). | Strong |
| Offer patients with BCG unresponsive tumours, who are not candidates for RC due to comorbidities, preservation strategies (intravesical chemotherapy, chemotherapy and microwave-induced hyperthermia, electromotive administration of chemotherapy, intravesical- or systemic immunotherapy; preferably within clinical trials). | Weak
|
7.7 Guidelines for the treatment of BCG failure
| Category | Treatment options | Strength rating |
| BCG-unresponsive | 1. Radical cystectomy (RC) | Strong |
| 2. Enrollment in clinical trials assessing new treatment strategies. | Weak | |
| 3. Bladder-preserving strategies in patients unsuitable or refusing RC. | Weak | |
Late BCG relapsing: T1Ta/HG recurrence > 6 months or CIS > 12 months of last BCG exposure | 1. Radical cystectomy or repeat BCG course according to individual situation.
| Strong |
| 2. Bladder-preserving strategies | Weak | |
| LG recurrence after BCG for primary | 1. Repeat BCG or intravesical chemotherapy | Weak |
| 2. Radical cystectomy | Weak |