Urothelial Carcinoma of the Upper Urinary Tract: What Changed?
A special issue of Cancers (ISSN 2072-6694).
Deadline for manuscript submissions: closed (30 April 2023) | Viewed by 10163
Special Issue Editor
Interests: non-muscle invasive bladder cancer; muscle invasive bladder cancer; robotic surgery
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Dear Colleagues,
Upper tract urothelial carcinoma (UTUC) is rare, accounting for just 5–10% of all urothelial tumours, with an incidence of just 1–2:100,000 in the Western population; therefore, high-quality RCT’s are rare and significant changes that are slow in comparison to other uro-oncologic entities. With this Special Issue on UTUC, we would like to focus on some changes and or novelties, which occurred in the last years in uncommon disease.
The tendency to opt for kidney-sparing treatment for UTUC is increasing. Nephro-ureterectomy (RNU) is no longer regarded as the only possible treatment for UTUC, especially in low-grade cancer. Accepted conservative treatments are segmental ureteral resection and endourological approaches, which include distal ureterectomy and retrograde ureteroscopy/percutaneous access with different laser systems.
Adjuvant treatment is gaining popularity after any type of treatment for UTUC in order to reduce the risk of recurrence and progression. Several topic agents have been applied after radical or conservative therapy for UTUC via irrigation through indwelling catheter and or percutaneous drainage.
Last but not least, adjuvant gemcitabine–platinum combination chemotherapy is now standard after RNU having improved disease-free survival in patients with pT2–pT4, N (any) or LN-positive (pT any, N1–3) M0 UTUC. The intrinsic limit is given by the fact that after RNU, more than 50% of patients treated for UTUC develop a chronic kidney failure, limiting the possibility of an adjuvant treatment. Additionally, histologic variants have alternating results after adjuvant gemcitabine–platinum combination chemotherapy.
More research and randomized clinical trials are needed to define which adjuvant systemic therapy could be applied in chronic kidney failure and in histologic variants.
Prof. Dr. Lukas Lusuardi
Guest Editor
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Keywords
- upper tract urothelial carcinoma
- adjuvant intracavitary therapy
- transitional cell carcinoma
- laser
- mitomcycin
- PD-L1
- PD-1
- chemotherapy
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