How are superficial (Ta, T1) and carcinoma in situ urothelial tumors of the renal pelvis and ureters treated?

Updated: Aug 07, 2020
  • Author: Kyle A Richards, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Primary therapy

Primary treatment is with BCG, which can be used for carcinoma in situ and can be curative, but it is reserved for those who are not surgical candidates. Recurrence rates are high (50%). [27]

Adjuvant therapy

Adjuvant topical treatments include retrograde or percutaneous instillation of mitomycin C. There is no demonstrable benefit of BCG in these settings. [28] The efficacy of these agents in treating upper tract urothelial carcinoma is not well established because of the small retrospective studies with heterogeneous patients and tumor characteristics.

Keeley and Bagley reported on the use of mitomycin administered via a retrograde catheter in 19 patients. [29] They noted a 54% recurrence rate at a mean follow-up of 30 months. No patient had disease progression. With a single postoperative intravesical dose of mitomycin C administered after nephroureterectomy for TCC, the risk of a bladder tumor was reduced by 40% in the first year following surgery. [30]

The efficacy and safety of doxorubicin as adjuvant therapy has been explored in a limited number of patients. Of 10 patients evaluated, 50% had disease-free upper tracts at 4-53 months. In this series, doxorubicin was given via continuous infusion to improve dwell time and efficacy. No treatment-related toxicities were observed. [31]

Prospective randomized studies are needed to determine the efficacy and optimal use of these agents as adjuvant therapy for superficial upper tract TCC, especially in the setting of endoscopic surgery.


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