Treatment Options for Localized Transitional Cell Cancer of the Renal Pelvis and Ureter

Nephroureterectomy with bladder cuff excision.

Segmental resection of ureter, only if the tumor is superficial and located in the distal third of the ureter.

Electroresection and fulguration or laser fulguration, if the tumor is superficial (under clinical evaluation).

Any parenchymal sparing procedure (segmental resection; ureteroscopic or percutaneous resection/fulguration/laser destruction), if the renal unit is solitary or renal function is depressed (under clinical evaluation).

Intrapelvic or intraureteral cytotoxic/immunotherapy (under clinical evaluation). The dramatic success reported with intravesical cytotoxic (thiotepa, mitomycin, doxorubicin) or immunologic/inflammatory (Bacillus Calmette Guerin [BCG], interferon) therapy for superficial transitional cell cancers in the bladder has led to the occasional use of these agents in the treatment of upper tract cancers. Long-term follow-up of the results of such treatments has generally not been reported. The efficacy of this approach cannot be assessed, largely because experience has been limited to patients whose compromised clinical status (solitary kidney, renal failure, medical risks for surgery) may have influenced clinical outcome. The use of this approach is limited by the following:

Intrapelvic or intraureteral cytotoxic/immunotherapy (under clinical evaluation). The dramatic success reported with intravesical cytotoxic (thiotepa, mitomycin, doxorubicin) or immunologic/inflammatory (Bacillus Calmette Guerin [BCG], interferon) therapy for superficial transitional cell cancers in the bladder has led to the occasional use of these agents in the treatment of upper tract cancers. Long-term follow-up of the results of such treatments has generally not been reported. The efficacy of this approach cannot be assessed, largely because experience has been limited to patients whose compromised clinical status (solitary kidney, renal failure, medical risks for surgery) may have influenced clinical outcome. The use of this approach is limited by the following:

The extent of disease in the renal pelvis.

Intrapelvic or intraureteral cytotoxic/immunotherapy (under clinical evaluation). The dramatic success reported with intravesical cytotoxic (thiotepa, mitomycin, doxorubicin) or immunologic/inflammatory (Bacillus Calmette Guerin [BCG], interferon) therapy for superficial transitional cell cancers in the bladder has led to the occasional use of these agents in the treatment of upper tract cancers. Long-term follow-up of the results of such treatments has generally not been reported. The efficacy of this approach cannot be assessed, largely because experience has been limited to patients whose compromised clinical status (solitary kidney, renal failure, medical risks for surgery) may have influenced clinical outcome. The use of this approach is limited by the following:

The access that these agents may have to the area of disease.

Intrapelvic or intraureteral cytotoxic/immunotherapy (under clinical evaluation). The dramatic success reported with intravesical cytotoxic (thiotepa, mitomycin, doxorubicin) or immunologic/inflammatory (Bacillus Calmette Guerin [BCG], interferon) therapy for superficial transitional cell cancers in the bladder has led to the occasional use of these agents in the treatment of upper tract cancers. Long-term follow-up of the results of such treatments has generally not been reported. The efficacy of this approach cannot be assessed, largely because experience has been limited to patients whose compromised clinical status (solitary kidney, renal failure, medical risks for surgery) may have influenced clinical outcome. The use of this approach is limited by the following:

The sensitivity of the cancer being treated.

Intrapelvic or intraureteral cytotoxic/immunotherapy (under clinical evaluation). The dramatic success reported with intravesical cytotoxic (thiotepa, mitomycin, doxorubicin) or immunologic/inflammatory (Bacillus Calmette Guerin [BCG], interferon) therapy for superficial transitional cell cancers in the bladder has led to the occasional use of these agents in the treatment of upper tract cancers. Long-term follow-up of the results of such treatments has generally not been reported. The efficacy of this approach cannot be assessed, largely because experience has been limited to patients whose compromised clinical status (solitary kidney, renal failure, medical risks for surgery) may have influenced clinical outcome. The use of this approach is limited by the following:

The adequacy and accuracy of initial tumor staging and continued monitoring.

Laser vaporization/coagulation (under clinical evaluation). Transurethral and percutaneous access to the upper tract have permitted the use of laser therapy in the control of superficial upper tract transitional cell cancers. This approach is dependent on accurate staging and adequate visualization of the lesions that need to be coagulated. Results of this approach are too preliminary to assess. Therapeutic efficacy, however, will depend on staging accuracy at initial treatment and the ease of monitoring such patients for disease recurrence and possible progression.