Managing upper tract urothelial carcinoma in the real world

In conjunction with the 2023 release of “Diagnosis and Management of Non-Metastatic Upper Tract Urothelial Carcinoma: AUA/SUO Guideline,” Surena F. Matin, MD, the Monteleone Family Foundation Distinguished Professor in the department of urology at MD Anderson Cancer Center in Houston, led a distinguished panel of urologists whose clinical practice focuses on the treatment of upper tract urologic cancers (UTUC) in Friday’s session, “Management of Upper Tract Urothelial Carcinoma.” The discussion featured select topics on managing UTUC, which coincides with the release of the new guidelines.     Surena F. Matin, MD         

Using patient case vignettes to integrate the new treatment guidelines into real-world scenarios, panelists discussed their treatment recommendations for cases of low-grade UTUC, and high-grade, high-risk UTUC with good glomerular filtration rate. Panelists included Jay D. Raman, MD, FACS, professor and chair of the department of urology at Penn State Health Milton S. Hershey Medical Center; Sima P. Porten, MD, FASC, MPH, an associate professor in the department of urology at University of California, San Francisco; and Tomonori Habuchi, MD, an associate professor in the department of urology at Akita University in Japan.

The panelists debated the use of endoscopic therapy, neoadjuvant chemotherapy, bladder cuff dissection, laser selection for endoscopic UTUC management and lymphadenectomy. Summarizing the general recommendations for managing UTUC that emerged from the presented case studies, Dr. Matin offered these take-home tips:

• Consider mitomycin hydrogel for low-grade recurrent UTUC disease
• Intravesicular chemotherapy with nephroureterectomy (NU) is supported by level 1 data
• Intravesicular chemotherapy after ureteroscopic biopsy is supported by a preponderance of circumstantial data

For high-risk UTUC disease:

• Use risk stratification of upper tract tumor
• Estimate post-NU kidney function to counsel between initial NU or neoadjuvant chemotherapy
• Consider lymphadenectomy.

Panelists also discussed the appropriate use of Lynch syndrome testing. UTUC is the third most common Lynch syndrome cancer, affecting 9% to 10% of patients with UTUC.               

Strong, moderate or conditional recommendations were made where sufficient evidence existed. For more information, click here.