{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T06:07:16Z","timestamp":1788847636718,"version":"build-2803163510"},"reference-count":25,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To review how response to neoadjuvant therapy (NAT) is assessed in clinical trials of muscle\u2010invasive bladder cancer (MIBC), and to determine whether trial\u2010derived evidence can inform response evaluation in contemporary practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Subjects\/Patients and Methods<\/jats:title>\n                    <jats:p>We searched PubMed, Embase and ClinicalTrials.gov through August 2025 for randomised controlled trials (RCTs) of neoadjuvant chemotherapy, chemo\u2010immunotherapy or immunotherapy in non\u2010metastatic MIBC (cT2\u2013T4a N0\u20131 M0), and for prospective single\u2010arm chemo\u2010immunotherapy or immunotherapy trials. We extracted data on imaging modality and coverage, endoscopic and biomarker\u2010based assessment, timing, correlation with final pathology and diagnostic accuracy. Given heterogeneity in definitions and reporting, no meta\u2010analysis was performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified 22 studies, including 14 RCTs. Most incorporated response evaluation, yet methods differed widely. Computed tomography (CT) was the most frequent modality in RCTs, whereas bladder magnetic resonance imaging (MRI) predominated in recent single\u2010arm immunotherapy trials. Timing was inconsistent and usually post\u2010treatment; only two trials performed interim assessment. Endoscopic evaluation was concentrated in bladder\u2010preservation trials, and circulating tumour DNA (ctDNA) was used selectively. Only five studies correlated restaging with final pathology; multiparametric MRI scored with nacVI\u2010RADS predicted pathological complete response with 72%\u201383% accuracy. No trial reported imaging accuracy for distant metastases after NAT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Response assessment after NAT in MIBC remains insufficiently standardised. Trial\u2010derived evidence supports cross\u2010sectional imaging before radical local treatment, with CT the most established modality, largely reflecting trial\u2010design conventions and availability rather than demonstrated diagnostic superiority; bladder MRI is more accurate for local restaging. Emerging biomarkers such as ctDNA require validation. Harmonising timing, modalities and response definitions is needed to enable evidence\u2010based treatment adaptation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bju.70403","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T02:36:11Z","timestamp":1785983771000},"page":"558-564","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Response evaluation of neoadjuvant therapy in\n                    <scp>MIBC<\/scp>\n                    : clinical trial\u2010derived evidence to guide practice"],"prefix":"10.1111","volume":"138","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7011-0537","authenticated-orcid":false,"given":"Roberto","family":"Contieri","sequence":"first","affiliation":[{"name":"Department of Urology Istituto Nazionale Tumori di Napoli, IRCCS \u2018G. Pascale\u2019  Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bas W.G.","family":"van Rhijn","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology (Urology) Netherlands Cancer Institute  Amsterdam The Netherlands"},{"name":"Department of Urology Leiden University Medical Centre  Leiden The Netherlands"},{"name":"Department of Urology Caritas St. Josef Medical Centre, University of Regensburg  Regensburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Cathomas","sequence":"additional","affiliation":[{"name":"Division of Oncology\/Hematology Kantonsspital Graub\u00fcnden  Chur Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anja","family":"Lorch","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology and Hematology University Hospital Z\u00fcrich  Z\u00fcrich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Oprea\u2010Lager","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging Radboud University Medical Centre  Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paramananthan","family":"Mariappan","sequence":"additional","affiliation":[{"name":"Edinburgh Bladder Cancer Surgery (EBCS), Department of Urology Western General Hospital  Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Sanguedolce","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Pharmacy Universit\u00e0 degli Studi di Sassari  Sassari Italy"},{"name":"Department of Urology Fundaci\u00f3 Puigvert  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoine G.","family":"van der Heijden","sequence":"additional","affiliation":[{"name":"Department of Urology 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