Consultation on UTUC, Stockholm 2018: aspects of treatment

Abstract

PurposeTo provide an overview of treatment modalities for management of upper tract urothelial carcinoma (UTUC).MethodsIn accordance with the standards for a scoping review, data presentation and discussion at the Consultation on UTUC in Stockholm, 6–7 September 2018, consensus was reached on the latest and most important treatment recommendations for UTUC. Using Pubmed, Web of Science, and Embase, publications were selected based on quality, clinical relevance, and level of evidence.ResultsKidney-sparing surgery should be attempted for low-grade UTUC. Radical nephroureterectomy with bladder cuff excision is first option for high-grade disease. Post-operative bladder instillation of chemotherapy should be offered after RNU to reduce intravesical recurrence rate. Identification of tumor grade and stage is crucial when selecting treatment. Ureteroscopic management of low-grade and non-invasive UTUC achieves disease-free survival similar to that offered by radical nephroureterectomy but seems to be a risk factor for intravesical recurrence. Lymphadenectomy appears important for high-risk disease, although the therapeutic benefit needs further validation. There is little evidence supporting use of Bacillus Calmette–Guérin (BCG) and mitomycin C as monotherapy and adjuvant treatment in UTUC. A randomized clinical trial has indicated that platin-based chemotherapy for invasive UTUC improves disease-free survival, suggesting that adjuvant chemotherapy should be considered standard care for ≥ T2 N0–3M0 disease.ConclusionsRisk stratification assessment is feasible and mandatory in UTUC. Identification of tumor grade and stage is essential for optimal treatment selection. Kidney-sparing surgery should be offered in low-risk disease, whereas radical nephroureterectomy and adjuvant chemotherapy should be considered in high-risk disease.

Retroperitoneal laparoscopic partial resection of the renal pelvis for urothelial carcinoma: A case report

“…Kidney-sparing surgery for low-risk upper urinary tract urothelial cell carcinoma reduces the morbidity associated with the loss of renal function without affecting oncologic outcomes[ 12 ]. In low-risk cancers, kidney-sparing management is the preferred approach, as survival rates are similar to those after RNU[ 13 ]. Furthermore, kidney preservation is advantageous if adjuvant or salvage chemotherapy is required.…”

Assessment of a Coated Mitomycin-Releasing Biodegradable Ureteral Stent as an Adjuvant Therapy in Upper Urothelial Carcinoma: A Comparative In Vitro Study

“…Unfortunately, there is currently no suitable procedure for adjuvant chemotherapeutic intracavitary instillation after holmium laser fulguration of UTUC tumor lesions [ 5 ]. This is due to the difficulty of intracavitary chemotherapy instillation in the upper urinary tract, given the washout effect of urine production at the renal level and the low storage capacity of the upper urinary tract [ 6 ]. As a result, many patients do not benefit from an adjuvant chemotherapy instillation procedure, which leads to worse results in this group of patients.…”

Outcome of Non-Muscle Invasive Upper Tract Urothelial Carcinoma Receiving Endoscopic Ablation: An Inverse Probability of Treatment Weighting Analysis

“…Endoscopic management can be considered in those with low-grade and low-stage disease [ 5 , 6 , 7 ]. Adjuvant or salvage systemic chemotherapy should be considered for those with muscle-invasive, at least, or node-positive disease [ 8 ]. Nevertheless, some patients or urologists may hesitate in undergoing nephroureterectomy because of the higher incidence of subsequent deterioration of renal function following the loss of one renal unit, particularly for those with potential progression to end-stage renal diseases (i.e., diabetics, patients with chronic kidney disease, patients with Aristolochic acid exposure), or not benefit those scheduled for post-operative chemotherapy.…”