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Endoscopic Treatment of Upper Tract Urothelial Carcinoma

  • Published:2017-03-01 Issue:4 Volume:18 Page:
  • ISSN:1527-2737
  • Container-title:Current Urology Reports
  • language:en
  • Short-container-title:Curr Urol Rep

Author:

Verges Daniel P.,Lallas Costas D.,Hubosky Scott G.,Bagley Demetrius H.

Publisher

Springer Science and Business Media LLC

Subject

Urology,General Medicine

Reference76 articles.

1. •• Roupret M, Babjuk M, Shariat S, et al. European guidelines on upper tract urothelial carcinomas: 2013 update. Eur Urol. 2013;63:1059–71. doi: 10.1016/j.eururo.2013.03.032 . These guidelines update the 2011 EAU guidelines on UTUC and offer a broad survey of the disease based on 152 articles from the literature. Figures and tables concisely present evidence-based recommendations for UTUC management. Endoscopic management is suggested for unifocal tumors less than 1 cm in size with low-grade characteristics and no evidence of invasion on CT urography.

2. • Leow JJ et al. A contemporary review of management and prognostic factors of upper tract urothelial carcinoma. Cancer Treat Rev. 2015;41:310–9. doi: 10.1016/j.ctrv.2015.02.006 . This thoroughly indexed review (174 references) provides a whirlwind tour of the entire UTUC disease and treatment spectrum. The authors end their conclusion section by boldly endorsing adjuvant and neoadjuvant chemotherapy for UTUC.

3. • Azemar MD, Comperat E, Richard F, Cussenot O, Roupret M. Bladder recurrence after surgery for upper urinary tract urothelial carcinoma: frequency, risk factors and surveillance. Urol Oncol. 2011;29:130–6. doi: 10.1016/j.urolonc.2009.06.003 . In this review article, Azemar and Roupret examine bladder cancer after surgery for UTUC. The downstream tumor seeding and pan-urothelial defect theories for bladder recurrence are discussed. The authors remind the reader that the bladder is the most common site of recurrence after treatment for UTUC and that synchronous bladder tumors are present in 8-13% of patients with UTUC. This review found that 15-50% of patients with UTUC will subsequently develop a metachronous bladder lesion and that upper tract tumor multifocality and previous history of bladder cancer are the most significant risk factors for bladder recurrence after surgery for UTUC. Most bladder recurrences occur within 2 years of initial surgery for UTUC.

4. • Roupret M, Hupertan V, Traxer O, Cussenot O et al. Comparison of open nephroureterectomy and ureteroscopic and percutaneous management of upper urinary tract transitional cell carcinoma. Urol. 2006;67(6). DOI: 10.1016/j.urology.2005.12.034 . This retrospective study of 97 patients treated for UTUC compared outcomes for 54 patients undergoing nephroureterectomy (RNU), 27 patients undergoing ureteroscopic management (URS), and 16 patients undergoing percutaneous treatment (PNRT) of UTUC. For patients with low-grade tumors 5-year disease specific survival was 84%, 80.7%, 80% for patients undergoing NU, URS, and PNRT, respectively (p=0.89). Fifty percent of patients undergoing NU, 44.4% of patients undergoing URS, and 37.5% of patients undergoing PNRT experienced recurrence of disease. Complication rates were 14.8%, 11.1%, and 12.5% for NU, URS, and PNRT, respectively. Twenty percent of patients undergoing endoscopic management progressed to needing NU therapy.

5. Catto JW, Hartmann A, Stoehr R, et al. Multifocal urothelial cancers with the mutator phenotype are of monoclonal origin and require pan-urothelial treatment for tumor clearance. J Urol. 2006;175:2323–30. doi: 10.1016/S0022-5347(06)00256-4 .

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