World Journal of Urology

, Volume 35, Issue 3, pp 327–335 | Cite as

Update of the ICUD-SIU consultation on upper tract urothelial carcinoma 2016: treatment of localized high-risk disease

  • Georgios Gakis
  • Tina Schubert
  • Mehrdad Alemozaffar
  • Joaquim Bellmunt
  • Bernard H. Bochner
  • Steven A. Boorjian
  • Siamak Daneshmand
  • William C. Huang
  • Tsunenori Kondo
  • Badrinath R. Konety
  • Maria Pilar Laguna
  • Surena F. Matin
  • Arlene O. Siefker-Radtke
  • Shahrokh F. Shariat
  • Arnulf Stenzl
Topic Paper

Abstract

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.

Keywords

Chemotherapy Lymph node dissection Nephroureterectomy Renal-sparing Salvage, upper tract urothelial carcinoma 

Notes

Authors’ contribution

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.

Funding

No funding was obtained for this study.

Compliance with ethical standards

Conflict of interest

The authors declare that the have no conflicts of interest.

Ethical standards

This study was conducted according to the Declaration of Helsinki.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Georgios Gakis
    • 1
  • Tina Schubert
    • 1
  • Mehrdad Alemozaffar
    • 2
  • Joaquim Bellmunt
    • 3
  • Bernard H. Bochner
    • 4
  • Steven A. Boorjian
    • 5
  • Siamak Daneshmand
    • 2
  • William C. Huang
    • 6
  • Tsunenori Kondo
    • 7
  • Badrinath R. Konety
    • 8
  • Maria Pilar Laguna
    • 9
  • Surena F. Matin
    • 10
  • Arlene O. Siefker-Radtke
    • 11
  • Shahrokh F. Shariat
    • 12
  • Arnulf Stenzl
    • 1
  1. 1.Department of UrologyUniversity Hospital TübingenTübingenGermany
  2. 2.USC/Norris Comprehensive Cancer CenterInstitute of UrologyLos AngelesUSA
  3. 3.Dana-Farber Cancer InstituteBostonUSA
  4. 4.Urology Service, Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkUSA
  5. 5.Department of UrologyMayo ClinicRochesterUSA
  6. 6.Department of UrologyNew York University Langone Medical CenterNew YorkUSA
  7. 7.Department of UrologyTokyo Women’s Medical UniversityTokyoJapan
  8. 8.Department of UrologyMasonic Cancer Center, University of MinnesotaMinneapolisUSA
  9. 9.Department of Urology, AMCUniversity of AmsterdamAmsterdamThe Netherlands
  10. 10.Department of UrologyThe University of Texas, MD Anderson Cancer CenterHoustonUSA
  11. 11.Department of Medical OncologyThe University of Texas, MD Anderson Cancer CenterHoustonUSA
  12. 12.Department of UrologyMedical University ViennaViennaAustria

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