Editing Upper Urinary Tract Urothelial Cancer (section)

====Distant metastatic disease (M+)====
* '''Systemic therapy and alternative approaches (i.e., radiotherapy with or without chemotherapy in selected cases) should be favored for inoperable or symptomatic patients with M+ UTUC'''
**RNU or ureterectomy should not be offered as initial therapy
***Oncologic outcomes in the metastatic setting are strongly determined by response to systemic therapy, and surgical treatment has no demonstrable therapeutic efficacy for cytoreduction or as a single modality in this setting.
**Limited data on the efficacy of chemotherapy in metastatic UTUC
*** Prospective randomized trials comparing chemotherapeutic regimens for UTUC are not feasible owing to the rarity of these patients.
** '''Regimen: MVAC (methotrexate, vinblastine, doxorubicin (Adriamycin), and cisplatin)'''
*** '''Continues to have the highest response rate'''
*** '''Carboplatin is frequently substituted instead of cisplatin because of either limitations of renal function or concerns over nephrotoxicity associated with cisplatin. Results with carboplatin are inferior than cisplatin.'''
* Complete responses are rare in the metastatic setting, and the duration of response is limited, with overall survival of 12-24 months