What are the NCCN treatment guidelines for urothelial tumors of the renal pelvis and ureters?

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

The NCCN guidelines provide treatment recommendations based on grade and tumor location. For low-grade renal pelvic tumors, the guidelines recommend the following treatment [23] :

  • Nephroureterectomy with cuff of bladder with or without perioperative intravesical chemotherapy or
  • Endoscopic resection with or without postsurgical intrapelvic chemotherapy or bacillus Calmette-Guerin (BCG) 

For high-grade renal pelvic tumors and upper ureter tumors, NCCN treatment recommendations include the following [23] :

  • Nephroureterectomy with cuff of bladder and regional lymphadenectomy with or without perioperative intravesical chemotherapy
  • Neoadjuvant chemotherapy may be considered in selected patients
  • Endoscopic resection is also an option for upper ureter tumors

For low-grade mid-ureter tumors, NCCN recommended treatment options include the following [23] :

  • Endoscopic resection
  • Nephroureterectomy with cuff of bladder
  • Excision and ureteroureterostomy/ileal ureter in highly selected patients

For high-grade mid-ureter tumors, NCCN recommended treatment options include the following [23] :

  • Nephroureterectomy with cuff of bladder and regional lymphadenectomy
  • Consider neoadjuvant chemotherapy in selective patients

For distal ureter tumors, NCCN recommended treatment options include the following [23] :

  • Distal ureterectomy and regional lymphadenectomy (high grade) and reimplantation of ureter (preferred if clinically feasible) and consider neoadjuvant chemotherapy in selected patients
  • Endoscopic resection (low grade)
  • Nephroureterectomy with cuff of bladder and regional lymphadenectomy and consider neoadjuvant chemotherapy in selected patients

For metastatic disease in both renal pelvis and ureter tumors, systemic therapy is recommended. [23]


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