Salvage topical therapy for upper tract urothelial carcinoma

World J Urol. 2018 Dec;36(12):2027-2034. doi: 10.1007/s00345-018-2349-9. Epub 2018 May 26.


Purpose: Topical therapy (TT) for upper tract urothelial carcinoma (UTUC) has been explored as a kidney sparing approach to treat carcinoma in situ (CIS) and as adjuvant for endoscopically treated Ta/T1 tumors. In bladder cancer, data support use of salvage TT for repeat induction. We investigate the outcomes of salvage TT for UTUC in patients ineligible for or refusing nephroureterectomy.

Methods: A single-center retrospective review on patients receiving salvage TT via percutaneous nephrostomy tube or cystoscopically placed ureteral catheters was performed. Primary outcome was response to therapy based on International Bladder Cancer Group criteria.

Results: 51 patients with 58 renal units (RUs) received TT. Of these, 17 patients with 18 RUs received the second-line TT, with a median follow-up of 36.5 months (IQR 24.5-67 months). 44% (8/18) received salvage TT for refractory disease and 56% (10/18) as reinduction. 5 RUs with CIS were unresponsive to initial TT and went on to receive salvage TT, of which 20% (1/5) responded. 13 RUs recurred or relapsed following initial TT and received salvage TT for papillary tumors, with 62% (8/13) responding.

Conclusion: Our data provide preliminary clinical rationale for the second-line TT for refractory and recurrent, endoscopically managed papillary UTUC in patients ineligible for or refusing nephroureterectomy. However, refractory upper tract CIS appears to have poor response to salvage TT.

Keywords: Chemotherapy; Renal pelvis cancer; Topical therapy; Upper tract urothelial carcinoma; Ureteral cancer.

MeSH terms

  • Adjuvants, Immunologic / administration & dosage*
  • Administration, Topical
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / administration & dosage*
  • BCG Vaccine / administration & dosage
  • Carcinoma in Situ / drug therapy*
  • Carcinoma in Situ / pathology
  • Carcinoma, Transitional Cell / drug therapy*
  • Carcinoma, Transitional Cell / pathology
  • Deoxycytidine / administration & dosage
  • Deoxycytidine / analogs & derivatives
  • Female
  • Gemcitabine
  • Humans
  • Kidney Neoplasms / drug therapy*
  • Kidney Neoplasms / pathology
  • Kidney Pelvis / pathology
  • Male
  • Mitomycin / administration & dosage
  • Nephrostomy, Percutaneous
  • Retrospective Studies
  • Salvage Therapy*
  • Treatment Outcome
  • Ureteral Neoplasms / drug therapy*
  • Ureteral Neoplasms / pathology
  • Urinary Catheterization


  • Adjuvants, Immunologic
  • Antineoplastic Agents
  • BCG Vaccine
  • Deoxycytidine
  • Mitomycin
  • Gemcitabine