PDF(Pubmed)
Abstract：
Kidney-sparing surgery (KSS) for upper urinary tract urothelial carcinoma (UTUC) is a promising alternative to radical nephroureterectomy, especially for low-risk cases. However, due to the established risk of ipsilateral UTUC recurrence caused by the implantation of floating neoplastic cells after endoscopic resection, adjuvant endocavitary (endoureteral) instillations have been proposed. Instillation therapy may be also used as primary treatment for UTUC. The two most studied drugs that have been evaluated in both the adjuvant and primary setting of endocavitary instillation are mitomycin C and Bacillus Calmette-Guerin. The current paper provides an overview of the endocavitary treatments for UTUC, focusing on methods of administration, novel formulations, oncologic outcomes (in terms of endocavitary recurrence and progression), as well as on complications. In particular, the role of UGN-101 as a primary chemoablative treatment of primary noninvasive, endoscopically unresectable, low-grade, UTUC has been analysed. The drug achieved a complete response rate of 58% after the induction cycle, with a durable response independently of the maintenance cycle. The cumulative experience on the role of UUT instillation therapy appears encouraging; however, no definitive conclusions can be drawn about its therapeutic benefit. Given the current state of the art, any decision to administer adjuvant endoureteral therapy for UTUC should be carefully weighed against the potential adverse events. Nevertheless, newer investigations that improve visualization during ureteroscopy, genomic characterization, novel drugs and innovative strategies of improved drug delivery are under evaluation. The landscape of KSS for the treatment of the UTUC is evolving and seems promising.
摘要：
上尿路尿路上皮癌（UTUC）的保肾手术（KSS）是根治性肾输尿管切除术的有希望的替代方法。尤其是低风险病例。然而,由于内窥镜切除后植入漂浮的肿瘤细胞导致同侧UTUC复发的风险已确定，已经提出了辅助腔内（输尿管内）滴注。滴注疗法也可用作UTUC的主要治疗。在腔内滴注的佐剂和主要设置中评估最多的两种研究药物是丝裂霉素C和卡介苗。本文概述了UTUC的腔内治疗，注重管理方法，新颖的配方，肿瘤学结果（就腔内复发和进展而言），以及并发症。特别是,UGN-101作为原发性非侵入性，内窥镜无法切除，低档,对UTUC进行了分析。该药物在诱导周期后达到了58%的完全缓解率，一个持久的响应独立的维护周期。关于UUT滴注疗法的作用的累积经验似乎令人鼓舞；然而，关于其治疗益处,目前尚无明确结论.鉴于目前的技术水平，对于UTUC进行输尿管内辅助治疗的任何决定,应仔细权衡潜在的不良事件.然而，在输尿管镜检查期间改善可视化的新研究，基因组表征，新药和改进药物递送的创新策略正在评估中。KSS治疗UTUC的前景正在演变，似乎很有希望。
