Table 7.

Delphi results regarding proposed statements for bladder preservation strategies

Proposed statements	Level of agreement												Relevant stakeholder groups	Consensus level (see Table 2)
	Urologists (n = 45)				Oncologists (n = 32)				Others (n = 20)
	D (%)	E (%)	A (%)	U (n)	D (%)	E (%)	A (%)	U (n)	D (%)	E (%)	A (%)	U (n)
1. Patients should be counselled on all treatment options by a neutral health care professional (e.g. a nurse specialist)	42	24	33	0	19	19	63	0	6	13	81	4	Ur+On+O	3
2. All patients diagnosed with MIBC should be seen by an Oncologist as well as a Urologist	23	18	59	1	0	3	97	0	0	0	100	1	Ur+On+O	3
3. All patients over 75 years of age should be evaluated preoperatively by a geriatrician	13	24	62	0	16	16	69	0	11	11	78	2	Ur+On+O	3
4. An important determinant for patient eligibility in case of bladder preserving treatment is absence of carcinoma in situ	4	7	89	0	3	13	84	1	7	7	86	6	Ur+On	1
5. An important determinant for patient eligibility in case of bladder preserving treatment is absence or presence of hydronephrosis	0	7	93	0	10	6	84	1	7	7	87	5	Ur+On	1
6. When assessing patient eligibility for bladder preservation, the likelihood of successful debulking surgery should be taken into consideration (optimal debulking)	0	7	93	0	9	6	84	0	6	6	88	4	Ur+On	1
7. In patients with clinical T4 or clinical N+ disease (regional), radical chemoradiation can be offered accepting that this may be palliative rather than curative in outcome	9	20	71	0	3	3	94	0	0	6	94	4	Ur+On	1
8. The preferred radiotherapeutic schedule is radiotherapy alone (single block)	100	0	0	3	93	0	7	2	90	0	10	10	On	1
9. The preferred radiotherapeutic schedule is radiotherapy given concurrently with BCON	87	11	3	7	60	23	17	2	71	29	0	13	On	3
10. The preferred radiotherapeutic schedule is radiotherapy alone, split course with interval cystoscopy and immediate cystectomy for non-responders	58	19	23	2	74	13	13	1	50	38	13	12	On	2
11. The preferred radiosensitiser is 5-fluorouracil + mitomycin C	26	39	34	7	19	13	69	0	17	17	67	14	On	3
12. The preferred radiosensitiser is cisplatin	5	13	82	6	10	13	77	1	33	17	50	14	On	2
13. The preferred radiosensitiser is gemcitabine	42	37	21	7	42	26	32	1	0	50	50	14	On	3
14. The preferred radiosensitiser is BCON	67	31	3	9	58	26	16	1	50	50	0	14	On	3
15. Brachytherapy has a role in the treatment of MIBC	87	4	9	0	59	24	17	3	44	22	33	11	Ur+On	3
16. PLND should be an integral part of bladder preservation strategies in patients with MIBC	38	16	47	0	69	6	25	0	0	17	83	8	Ur+On	3
17. When adjuvant chemotherapy is offered, patients should be selected based on the result of PLND (if done)	11	4	84	0	13	16	71	1	0	17	83	8	Ur+On	1
18. When adjuvant chemotherapy is offered, patients should be selected based on response to trimodality therapy	35	26	40	2	33	37	30	2	33	44	22	11	Ur+On	3
19. When adjuvant chemotherapy is offered, patients should be selected based on pT3 or pT4 at cystectomy	7	4	89	0	3	10	87	1	17	17	67	8	Ur+On	2
20. Irradiation of the lymph nodes should be standard during trimodality treatment	7	24	68	4	33	10	57	2	25	13	63	12	Ur+On+O	3

Statements highlighted in green achieved level 1 consensus, those in blue achieved level 2 consensus and those in yellow failed to reach consensus (level 3) as part of the Delphi survey; numbers highlighted in red indicate where the level of agreement among individual stakeholder groups reached ≥70% (see Table 2 for details of consensus level criteria). Statements indicated in bold were subsequently reviewed at the consensus conference with revised statements and voting shown in Table 8.

A, agree; BCON, carbogen/nicotinamide; D, disagree; E, equivocal; i.v., intravenous; MIBC, muscle-invasive bladder cancer; N, node; O, others (includes specialities in Nuclear Medicine, Pathology, Radiology, Specialist Nurse, Clinical Oncology); On, Oncologists; PLND, pelvic lymph node dissection; pT, pathological tumour stage; T, tumour; U, unable to respond; Ur, Urologists.