Editing Upper Urinary Tract Urothelial Cancer (section)

====== Adjuvant therapy ======
*'''Pelvicalyceal or intravesical chemotherapy following ablation of UTUC tumors[https://pubmed.ncbi.nlm.nih.gov/37096584/]'''
**Principle of an immediate instillation of intravesical or pyelocaliceal (upper tract) chemotherapy at the time of endoscopic tumor ablation for UTUC is undertaken by extrapolation of the data supporting immediate instillation of intravesical chemotherapy at the time of transurethral resection of a bladder tumor
**Options: thiotepa, mitomycin
**'''Indications'''
*** '''Considered optional'''
** Technique
***Prior to administration, must confirm that there is no perforation of the bladder or upper tract
***Approaches (3)
***#Antegrade perfusion by nephrostomy tube
***#Retrograde perfusion via ureteral catheter
***#Bladder instillation by transurethral catheter with reflux via a double J ureteral stent.
***#*In the third scenario, a cystogram and demonstration of adequate reflux of contrast into the pyelocaliceal system is recommended.
*'''Immunotherapy'''
**'''Pelvicalyceal BCG[https://pubmed.ncbi.nlm.nih.gov/37096584/]'''
***'''Indications'''
****'''May be offered to patients with HR favorable UTUC after complete tumor ablation or patients with upper tract carcinoma in situ (CIS).'''
****'''Imperative indications'''
****#'''Solitary kidney status'''
****# '''Bilateral UTUC'''
****#'''Risk of progression to end-stage renal disease'''
***Consists of a 6-week induction course of BCG
* '''Outcomes'''
**'''<span style="color:#ff00ff">Systematic review and meta-analysis (2019)</span>'''
*** Inclusion criteria: studies evaluating patients with upper tract urothelial carcinoma receiving instillation treatment as adjuvant/curative therapy for pTa/pT1 and CIS, respectively.
*** Studies with ≥10 participants included in quantitative analyses
*** Results
**** Included 212 patients from 12 studies of patients that underwent endoscopic laser ablation and instillation therapy for Ta/T1 UTUC
**** Recurrence-free survival: 40%
***** Similar to recurrence-free survival with observation after nephron-sparing surgery
**** Cancer-specific survival: 94%
**** Overall survival: 71%
**** No difference in survival based on approach (antegrade, retrograde, or combined) or drug (MMC vs. BCG)
*** [https://pubmed.ncbi.nlm.nih.gov/30846387/ Foerster, Beat, et al. "Endocavitary treatment for upper tract urothelial carcinoma: a meta-analysis of the current literature." ''Urologic Oncology: Seminars and Original Investigations''. Vol. 37. No. 7. Elsevier, 2019.]
* '''Adverse events'''
**'''Most common complication of intraluminal/instillation therapy is bacterial sepsis'''