Intracavitary Topical Chemo and Immune Therapy of the Upper Tract

  • Joel HillelsohnEmail author
  • Majid Eshghi
  • Arthur D. Smith


Endourologic management of upper tract urothelial carcinoma has become the preferred treatment in selected groups of patients. However, recurrence is high and there is a large interest in utilizing adjuvant topical agents as used in the lower tract. Many agents have been studied, but they are less efficacious than they are in the lower tract. This is likely due to incomplete staging, difficult delivery, and incomplete resection. There is evidence that primary BCG for isolated carcinoma in situ has some efficacy, but the evidence is not robust. There is mixed evidence for the use of adjuvant BCG, Mitomycin C, and Adriamycin. In our institution (ME), we utilize adjuvant Mitomycin C for a 6-week course in the office following resection. The future of adjuvant therapy likely lies in products such as MitoGel© that coat the upper tract.


Topical chemotherapy BCG Mitomycin C Adjuvant treatment Intracavitary instillation Adriamycin Gemcitabine 


Radical Nephroureterectomy


Upper Tract Urothelial Carcinoma


Mitomycin C


Bacillus Calmette–Guérin


Percutaneous nephrostomy


Carcinoma in situ


Trans Urethral Resection Bladder Tumor


Renal Units





  1. 1.
    Roupret M, Zigeuner R, Palou J, et al. European guidelines for the diagnosis and management of upper urinary tract urothelial cell carcinomas: 2011 update. Eur Urol. 2011;59:584.CrossRefPubMedGoogle Scholar
  2. 2.
    Green DA, Rink M, Xylinas E, et al. Urothelial carcinoma of the bladder and the upper tract: disparate twins. J Urol. 2013;189:1214.CrossRefPubMedGoogle Scholar
  3. 3.
    Giannarini G, Kessler TM, Birkhauser FD, et al. Antegrade perfusion with bacillus Calmette-Guérin in patients with non-muscle-invasive urothelial carcinoma of the upper urinary tract: who may benefit? Eur Urol. 2011;60:955.CrossRefPubMedGoogle Scholar
  4. 4.
    Rastinehad AR, Ost MC, Vanderbrink BA, et al. A 20-year experience with percutaneous resection of upper tract transitional carcinoma: is there an oncologic benefit with adjuvant bacillus Calmette Guérin therapy? Urology. 2009;73:27.CrossRefPubMedGoogle Scholar
  5. 5.
    Motamedinia P, Keheila M, Leavitt DA, et al. The expanded use of percutaneous resection for upper tract urothelial carcinoma: a 30-year comprehensive experience. J Endourol. 2015;30:262–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Smith AK, Stephenson AJ, Lane BR, et al. Inadequacy of biopsy for diagnosis of upper tract urothelial carcinoma: implications for conservative management. Urology. 2011;78:82.CrossRefPubMedGoogle Scholar
  7. 7.
    Wein AJ, Kavoussi LR, Campbell MF. Campbell-Walsh urology/editor-in-chief, Alan J. Wein; [editors, Louis R. Kavoussi … et al.]. 10th ed. Philadelphia, PA: Elsevier Saunders; 2012.Google Scholar
  8. 8.
    Jarrett TW, Sweetser PM, Weiss GH, et al. Percutaneous management of transitional cell carcinoma of the renal collecting system: 9-year experience. J Urol. 1995;154:1629.CrossRefPubMedGoogle Scholar
  9. 9.
    Nishino Y, Yamamoto N, Komeda H, et al. Bacillus Calmette-Guérin instillation treatment for carcinoma in situ of the upper urinary tract. BJU Int. 2000;85:799.CrossRefPubMedGoogle Scholar
  10. 10.
    Nonomura N, Ono Y, Nozawa M, et al. Bacillus Calmette-Guérin perfusion therapy for the treatment of transitional cell carcinoma in situ of the upper urinary tract. Eur Urol. 2000;38:701.CrossRefPubMedGoogle Scholar
  11. 11.
    Patel A, Fuchs GJ. New techniques for the administration of topical adjuvant therapy after endoscopic ablation of upper urinary tract transitional cell carcinoma. J Urol. 1998;159:71.CrossRefPubMedGoogle Scholar
  12. 12.
    Herr HW. Durable response of a carcinoma in situ of the renal pelvis to topical bacillus Calmette-Guérin. J Urol. 1985;134:531.CrossRefPubMedGoogle Scholar
  13. 13.
    Studer UE, Casanova G, Kraft R, et al. Percutaneous BCG perfusion of the upper urinary tract for carcinoma in situ. Prog Clin Biol Res. 1989;310:207.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Sharpe JR, Duffy G, Chin JL. Intrarenal bacillus Calmette-Guérin therapy for upper urinary tract carcinoma in situ. J Urol. 1993;149:457.CrossRefPubMedGoogle Scholar
  15. 15.
    Yokogi H, Wada Y, Mizutani M, et al. Bacillus Calmette-Guérin perfusion therapy for carcinoma in situ of the upper urinary tract. Br J Urol. 1996;77:676.CrossRefPubMedGoogle Scholar
  16. 16.
    Okubo K, Ichioka K, Terada N, et al. Intrarenal bacillus Calmette-Guérin therapy for carcinoma in situ of the upper urinary tract: long-term follow-up and natural course in cases of failure. BJU Int. 2001;88:343.CrossRefPubMedGoogle Scholar
  17. 17.
    Miyake H, Eto H, Hara S, et al. Clinical outcome of bacillus Calmette-Guérin perfusion therapy for carcinoma in situ of the upper urinary tract. Int J Urol. 2002;9:677.CrossRefPubMedGoogle Scholar
  18. 18.
    Irie A, Iwamura M, Kadowaki K, et al. Intravesical instillation of bacille Calmette-Guérin for carcinoma in situ of the urothelium involving the upper urinary tract using vesicoureteral reflux created by a double-pigtail catheter. Urology. 2002;59:53.CrossRefPubMedGoogle Scholar
  19. 19.
    Hayashida Y, Nomata K, Noguchi M, et al. Long-term effects of bacille Calmette-Guérin perfusion therapy for treatment of transitional cell carcinoma in situ of upper urinary tract. Urology. 2004;63:1084.CrossRefPubMedGoogle Scholar
  20. 20.
    Kojima Y, Tozawa K, Kawai N, et al. Long-term outcome of upper urinary tract carcinoma in situ: effectiveness of nephroureterectomy versus bacillus Calmette-Guérin therapy. Int J Urol. 2006;13:340.CrossRefPubMedGoogle Scholar
  21. 21.
    Bachir BG, Kassouf W. Efficacy of instillations with chemotherapy or immunotherapy following endoscopic resection for upper tract urothelial carcinoma. Expert Rev Anticancer Ther. 2012;12:63.CrossRefPubMedGoogle Scholar
  22. 22.
    Schoenberg MP, Van Arsdalen KN, Wein AJ. The management of transitional cell carcinoma in solitary renal units. J Urol. 1991;146:700.CrossRefPubMedGoogle Scholar
  23. 23.
    Clark PE, Streem SB, Geisinger MA. 13-year experience with percutaneous management of upper tract transitional cell carcinoma. J Urol. 1999;161:772.CrossRefPubMedGoogle Scholar
  24. 24.
    Elliott DS, Blute ML, Patterson DE, et al. Long-term follow-up of endoscopically treated upper urinary tract transitional cell carcinoma. Urology. 1996;47:819.CrossRefPubMedGoogle Scholar
  25. 25.
    Martínez-Piñeiro JA, García Matres MJ, Martínez-Piñeiro L. Endourological treatment of upper tract urothelial carcinomas: analysis of a series of 59 tumors. J Urol. 1996;156:377.CrossRefPubMedGoogle Scholar
  26. 26.
    Keeley FX, Bagley DH. Adjuvant mitomycin C following endoscopic treatment of upper tract transitional cell carcinoma. J Urol. 1997;158:2074.CrossRefPubMedGoogle Scholar
  27. 27.
    Goel MC, Mahendra V, Roberts JG. Percutaneous management of renal pelvic urothelial tumors: long-term followup. J Urol. 2003;169:925.CrossRefPubMedGoogle Scholar
  28. 28.
    Palou J, Piovesan LF, Huguet J, et al. Percutaneous nephroscopic management of upper urinary tract transitional cell carcinoma: recurrence and long-term followup. J Urol. 2004;172:66.CrossRefPubMedGoogle Scholar
  29. 29.
    See WA. Continuous antegrade infusion of adriamycin as adjuvant therapy for upper tract urothelial malignancies. Urology. 2000;56:216.CrossRefPubMedGoogle Scholar
  30. 30.
    Burns JA, WR, Hedican SP, O’Donnell MA. The treatment of upper tract transitional cell carcinoma with BCG plus interferon-alpha. In: American urological association annual meeting, 2001.Google Scholar
  31. 31.
    Katz MH, Lee MW, Gupta M. Setting a new standard for topical therapy of upper-tract transitional-cell carcinoma: BCG and interferon-alpha2B. J Endourol. 2007;21:374.CrossRefPubMedGoogle Scholar
  32. 32.
    Liatsikos EN, Dinlenc CZ, Kapoor R, et al. Transitional-cell carcinoma of the renal pelvis: ureteroscopic and percutaneous approach. J Endourol. 2001;15:377.CrossRefPubMedGoogle Scholar
  33. 33.
    Donin, NicholasStrauss-Ayali, DalitPantuck, Allan et al. PD13–10 Preclinical trial of serial mitogel® instillations into the pelvicalyceal system of the yorkshire swine. J Urology. 195(4):e301CrossRefGoogle Scholar
  34. 34.
    Mitogel OLYMPUS Trial, vol. 2016
  35. 35.
    Dalbagni G, Russo P, Bochner B, et al. Phase II trial of intravesical gemcitabine in bacille Calmette-Guérin-refractory transitional cell carcinoma of the bladder. J Clin Oncol. 2006;24:2729.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Joel Hillelsohn
    • 1
    Email author
  • Majid Eshghi
    • 1
  • Arthur D. Smith
    • 2
  1. 1.Department of UrologyWestchester Medical Health Network/New York Medical CollegeValhallaUSA
  2. 2.Department of UrologyNorthwell Health and Hofstra UniversityLake SuccessUSA

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