Purpose

Urothelial carcinomas (UCs), also known as transitional cell carcinomas, account for the majority of upper urinary tract tumors. The gold-standard therapy for operable patients with localized disease is radical nephroureterectomy. However, some patients are not surgical candidates. Data on the use of modern radiation therapy for upper urinary tract UC (UTUC) are scarce. The purpose of this study was to assess the safety and efficacy of SABR in UTUC.

Methods and Materials

This retrospective study included all patients with UTUC treated with SABR at one institution. Charts were reviewed to evaluate renal function and the development of toxicity using Common Terminology Criteria for Adverse Events, version 3.0. Tumor response on follow-up imaging with computed tomography or magnetic resonance imaging scans was assessed using the Response Evaluation Criteria in Solid Tumors, version 1.1.

Results

A total of 16 patients (7 patients with UC at the ureter and 9 at the renal pelvis) were identified as treated with SABR. Of the 9 patients with renal pelvis UC, 4 had a previous history of bladder cancer. At the time of treatment, the median age was 85 years (range, 67-95 years). Most patients received 40 Gy in 8 fractions every second day. The median followup was 21 months (range, 3-110 months). Most patients maintained stable renal function, and only 2 patients developed worsening chronic kidney disease, but none required dialysis. Acutely, 4 patients developed grade 1 diarrhea, and 1 patient had new grade 1 hematuria. No chronic side effects were observed. One patient did not have follow-up imaging and was excluded from the tumor-response analysis. Two patients had a complete response of the treated lesion, 9 had a partial response, 2 had stable disease, and 2 had disease progression within the treatment field.

Conclusions

This small case series suggests that SABR for UTUC is safe and well-tolerated, with good radiographic tumor response to ablative doses of radiation therapy.

中文翻译：

---

立体定向消融放射治疗上尿路尿路上皮癌

目的

尿路上皮癌 (UCs)，也称为移行细胞癌，占上尿路肿瘤的大部分。可手术的局限性疾病患者的金标准疗法是根治性肾输尿管切除术。然而，有些患者不适合手术。关于上尿路 UC (UTUC) 使用现代放射治疗的数据很少。本研究的目的是评估 SABR 在 UTUC 中的安全性和有效性。

方法和材料

这项回顾性研究包括在一个机构接受 SABR 治疗的所有 UTUC 患者。使用不良事件通用术语标准 3.0 版审查图表以评估肾功能和毒性发展。使用实体瘤反应评估标准 1.1 版评估对计算机断层扫描或磁共振成像扫描的后续成像的肿瘤反应。

结果

共有 16 名患者（7 名输尿管 UC 患者和 9 名肾盂 UC 患者）被确定为接受 SABR 治疗。9 名肾盂 UC 患者中，4 名既往有膀胱癌病史。治疗时，中位年龄为 85 岁（范围为 67-95 岁）。大多数患者每天接受 8 次 40 Gy 的照射。中位随访时间为 21 个月（范围 3-110 个月）。大多数患者维持稳定的肾功能，仅有2名患者出现恶化的慢性肾病，但没有人需要透析。急性期4例出现1级腹泻，1例出现新的1级血尿。没有观察到慢性副作用。一名患者没有进行后续成像，因此被排除在肿瘤反应分析之外。2名患者对治疗的病灶有完全反应，9名有部分反应，

结论

这个小型病例系列表明，用于 UTUC 的 SABR 是安全且耐受性良好的，对放射治疗的消融剂量具有良好的放射影像学肿瘤反应。