Update of the ICUD-SIU consultation on upper tract urothelial carcinoma 2016: treatment of localized high-risk disease
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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).
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.
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.
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.
KeywordsChemotherapy Lymph node dissection Nephroureterectomy Renal-sparing Salvage, upper tract urothelial carcinoma
G Gakis was involved in data collection and management, data analysis, data update and manuscript writing and editing; T Schubert was involved in data collection and management, data analysis, data update and manuscript writing; M Alemozaffar was involved in data collection and management and data analysis; J Bellmunt was involved in data collection and management and data analysis; BH Bochner was involved in data collection and management and data analysis; SA Boorjian was involved in data collection and management and data analysis; S Daneshmand was involved in data collection and management and data analysis; WC Huang was involved in data collection and management and data analysis; T Kondo was involved in data collection and management and data analysis; BR Konety was involved in data collection and management and data analysis; MP Laguna was involved in data collection and management and data analysis; SF Matin was involved in project development; AO Siefker-Radtke was involved in data collection and management and data analysis; SF Shariat was involved in project development; and A Stenzl was involved in project development, data collection and management, data analysis and manuscript editing.
No funding was obtained for this study.
Compliance with ethical standards
Conflict of interest
The authors declare that the have no conflicts of interest.
This study was conducted according to the Declaration of Helsinki.
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