Definitive tumor resection and percutaneous bacille Calmette-Guérin for management of renal pelvic transitional cell carcinoma in solitary kidneys

Zacharias²,

et al. 2009

Advances in Urology

Urothelial carcinoma of the upper urinary tract represents only 5% of all urothelial cancers. The 5-year cancer-specific survival in the United States is roughly 75% with grade and stage being the most powerful predictors of survival. Nephroureterectomy with excision of the ipsilateral ureteral orifice and bladder cuff en bloc remains the gold standard treatment of the upper urinary tract urothelial cancers, while endoscopic and laparoscopic approaches are rapidly evolving as reasonable alternatives of care depending on grade and stage of disease. Several controversies remain in their management, including a selection of endoscopic versus laparoscopic approaches, management strategies on the distal ureter, the role of lymphadenectomy, and the value of chemotherapy in upper tract disease. Aims of this paper are to critically review the management of such tumors, including endoscopic management, laparoscopic nephroureterectomy and management of the distal ureter, the role of lymphadenectomy, and the emerging role of chemotherapy in their treatment.

Section: Adjuvant Therapymentioning

confidence: 99%

Comprehensive Management of Upper Tract Urothelial Carcinoma

Zacharias²,

et al. 2009

Advances in Urology

“…Studies have demonstrated evidence of reduced recurrence rates with administration of topical BCG. [3738] In addition, in the only study to investigate the outcomes of individuals who received post-resection BCG and those who did not, a significantly lower recurrence rate was identified in grade I patients in the treatment arm. [35] This improvement, however, was not seen in patients with grade II or III disease.…”

Section: Adjuvant Therapymentioning

confidence: 99%

Conservative management of upper tract transitional cell carcinoma

Iwaszko¹,

Krambeck²

2008

Indian J Urol

AimOur aim was to review the current literature describing the endoscopic management of upper tract transitional cell carcinoma (TCC).Materials and MethodsReview of published, peer-reviewed articles relating the primary ureteroscopic or percutaneous management of upper tract TCC was performed using the MEDLINE database.ResultsHistorically, the gold-standard management for upper tract TCC consists of nephroureterectomy with excision of a bladder cuff. The employment of endoscopic management with these neoplasms was initially instituted in individuals with imperative indications, including bilateral disease, solitary kidney, and/or renal insufficiency. For individuals treated with ureteroscopy, recurrence rates range from 30 to 71% and cancer-specific survival rates from 50 to 93%. Results are dependent primarily on tumor grade and stage. In individuals with low-stage, low-grade tumors treated percutaneously, recurrence rates, and cancer-specific survival rates are 18-33% and 94-100%, respectively. Adjuvant therapy has been employed with thiotepa, mitomycin, and BCG, but none have been able to demonstrate a statistically significant difference in recurrence or cancer-specific survival rates.ConclusionsEndoscopic management is a safe and effective treatment alternative to nephroureterectomy in the management of upper tract TCC. Survival outcomes are comparable, but renal preservation therapy offers the advantage of reduced morbidity, complications, and the potential for better quality of life. Recurrence and disease progression are not uncommon and underscore the need for strict tumor surveillance.

“…[8] Contemporary success of adjuvant intravesical treatments for non-muscle invasive bladder transitional cell carcinoma in reducing recurrence and progression rates has encouraged urologists to adopt a similar approach for UUT-TCC using BCG or Mitomycin C (MMC). [9101112131415]…”

Section: Introductionmentioning

confidence: 99%

“…[16] Furthermore, various doses and delivery schedules for instillation have been tried with a variable recurrence rate. [91011121314151617]…”

Section: Introductionmentioning

confidence: 99%

Mitomycin C instillation following ureterorenoscopic laser ablation of upper urinary tract carcinoma

Aboumarzouk¹,

Somani²,

Ahmad

et al. 2013

Urol Ann

Introduction:Instillation of Mitomycin C (MMC) should prevent implantation of cancer cells released during endoscopic treatment and prevent recurrences as seen in carcinoma of the bladder.Aim:To develop and evaluate a protocol for a single dose MMC instillation following Holmium: YAG laser ablation of upper urinary tract transitional cell carcinoma (UUT-TCC).Setting and Design:A single institute prospective study.Materials and Methods:MMC instillations protocol was designed and offered to patients between August 2005 and April 2011. Following tumor ablation, MMC was instilled into upper urinary tract (UUT) over 40 minutes. All the patients were regularly followed up.Results:Twenty UUT units (19 patients) were managed for UUT-TCCs using our MMC protocol. Two UUT units had G1pTa tumors, 14 had G2pTa, 2 had G3pTa, and 2 had G3pT1. At a mean follow-up of 24 months (range 1-72 months), 13/20 (65%) of the UUT units remained cancer-free, 3 (15%) UUT units developed stricture and were treated with endoscopic dilatation, only 1 (5%) of these developed long-term complications. None of the patients developed postoperative renal impairment or systemic side-effects.Conclusions:Using a set standard protocol, MMC can safely be instilled into the UUT after TCC ablation with minimal complications or side effects, good preservation of renal function, and with a low recurrences rate comparable to the literature.