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.

中文翻译：

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抢救局部治疗上尿路尿路上皮癌。

目的探讨上尿路尿路上皮癌（UTUC）的局部治疗（TT）作为一种保留肾脏的方法来治疗原位癌（CIS）和作为经内镜治疗的Ta / T1肿瘤的佐剂。在膀胱癌中，数据支持使用打捞TT进行重复诱导。我们调查不适合或拒绝肾结直肠切除术的患者对UTUC进行TT抢救的结果。方法对通过经皮肾造瘘管或膀胱镜置入输尿管导管接受挽救性TT的患者进行单中心回顾性研究。主要结果是根据国际膀胱癌小组的标准对治疗的反应。结果51例具有58个肾单位（RUs）的患者接受了TT。其中17例18 RU的患者接受了二线TT，中位随访36.5个月（IQR 24.5-67个月）。44％（8/18）的患者因难治性疾病接受了TT挽救，而56％（10/18）的患者因缓解而接受了挽救TT。5例具有CIS的RU对初始TT无反应，并继续接受挽救性TT，其中20％（1/5）有反应。初始TT后复发或复发的13 RUs接受了乳头状肿瘤的TT抢救，其中62％（8/13）有反应。结论我们的数据为不适合或拒绝肾结直肠切除术的患者难治性和复发性内镜治疗乳头状UTUC的二线TT提供了初步的临床理论依据。但是，难治性上风道CIS对TT挽救的反应似乎较差。初始TT后复发或复发的13 RUs接受了乳头状肿瘤的TT抢救，其中62％（8/13）有反应。结论我们的数据为不适合或拒绝行肾结直肠切除术的患者难治性和复发性内镜治疗乳头状UTUC的二线TT提供了初步的临床依据。但是，难治性上风道CIS对TT挽救的反应似乎较差。初始TT后复发或复发的13 RUs接受了乳头状肿瘤的TT抢救，其中62％（8/13）有反应。结论我们的数据为不适合或拒绝行肾结直肠切除术的患者难治性和复发性内镜治疗乳头状UTUC的二线TT提供了初步的临床依据。但是，难治性上风道CIS对挽救TT的反应似乎较差。