TY - JOUR
T1 - Update of the ICUD-SIU consultation on upper tract urothelial carcinoma 2016
T2 - treatment of localized high-risk disease
AU - Gakis, Georgios
AU - Schubert, Tina
AU - Alemozaffar, Mehrdad
AU - Bellmunt, Joaquim
AU - Bochner, Bernard H.
AU - Boorjian, Steven A.
AU - Daneshmand, Siamak
AU - Huang, William C.
AU - Kondo, Tsunenori
AU - Konety, Badrinath R.
AU - Laguna, Maria Pilar
AU - Matin, Surena F.
AU - Siefker-Radtke, Arlene O.
AU - Shariat, Shahrokh F.
AU - Stenzl, Arnulf
N1 - Publisher Copyright:
© 2016, Springer-Verlag Berlin Heidelberg.
PY - 2017/3/1
Y1 - 2017/3/1
N2 - Purpose: To provide a comprehensive overview and update of the joint consultation of the International Consultation on Urological Diseases (ICUD) and Société Internationale d’Urologie for the treatment of localized high-risk upper tract urothelial carcinoma (UTUC). Methods: A detailed analysis of the literature was conducted reporting on treatment modalities and outcomes in localized high-risk UTUC. An international, multidisciplinary expert committee evaluated and graded the data according to the Oxford System of Evidence-based Medicine modified by the ICUD. Results: Radical nephroureterectomy (RNU) is the standard of treatment for high-grade or clinically infiltrating UTUC and includes the removal of the entire kidney, ureter and ipsilateral bladder cuff. The distal ureter can be managed either by extravesical or transvesical approach, whereas endoscopically assisted procedures are associated with decreased intravesical recurrence-free survival. Post-operative intravesical chemotherapy decreases the risk of subsequent bladder tumour recurrence. Regional lymph node dissection is of prognostic importance in infiltrative UTUC, but its extent has not been standardized. Renal-sparing surgery is an option for manageable, high-grade tumours of any part of the upper tract, especially of the distal ureter, as an alternative to RNU. Endoscopy-based renal-sparing procedures are associated with a higher risk of recurrence and progression. Conclusions: A multimodal approach should be considered in localized high-risk UTUC to improve outcomes. RNU is the standard of treatment in high-risk disease. Renal-sparing approaches may be oncologically equivalent alternatives to RNU in well-selected patients, especially in those with distal ureteric tumours.
AB - Purpose: To provide a comprehensive overview and update of the joint consultation of the International Consultation on Urological Diseases (ICUD) and Société Internationale d’Urologie for the treatment of localized high-risk upper tract urothelial carcinoma (UTUC). Methods: A detailed analysis of the literature was conducted reporting on treatment modalities and outcomes in localized high-risk UTUC. An international, multidisciplinary expert committee evaluated and graded the data according to the Oxford System of Evidence-based Medicine modified by the ICUD. Results: Radical nephroureterectomy (RNU) is the standard of treatment for high-grade or clinically infiltrating UTUC and includes the removal of the entire kidney, ureter and ipsilateral bladder cuff. The distal ureter can be managed either by extravesical or transvesical approach, whereas endoscopically assisted procedures are associated with decreased intravesical recurrence-free survival. Post-operative intravesical chemotherapy decreases the risk of subsequent bladder tumour recurrence. Regional lymph node dissection is of prognostic importance in infiltrative UTUC, but its extent has not been standardized. Renal-sparing surgery is an option for manageable, high-grade tumours of any part of the upper tract, especially of the distal ureter, as an alternative to RNU. Endoscopy-based renal-sparing procedures are associated with a higher risk of recurrence and progression. Conclusions: A multimodal approach should be considered in localized high-risk UTUC to improve outcomes. RNU is the standard of treatment in high-risk disease. Renal-sparing approaches may be oncologically equivalent alternatives to RNU in well-selected patients, especially in those with distal ureteric tumours.
KW - Chemotherapy
KW - Lymph node dissection
KW - Nephroureterectomy
KW - Renal-sparing
KW - Salvage, upper tract urothelial carcinoma
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U2 - 10.1007/s00345-016-1819-1
DO - 10.1007/s00345-016-1819-1
M3 - Article
C2 - 27043218
AN - SCOPUS:84962173594
SN - 0724-4983
VL - 35
SP - 327
EP - 335
JO - World Journal of Urology
JF - World Journal of Urology
IS - 3
ER -