The American Urological Association (AUA), in partnership with the Society of Urologic Oncology (SUO), released the 2023 clinical practice guidelines for the diagnosis and management of non-metastatic upper tract urothelial carcinoma (UTUC). Of key importance is the fact that the recommendation for kidney-sparing treatment in these guidelines is tumour ablation.
UTUC is a rare disease, posing unique challenges to clinical management and significant risks to patients—both from the disease and treatment forms. UTUC is a cancer in either the inner lining of the ureter, calyces, or renal pelvis. While it is not very common, the diagnosis of UTUC of the renal pelvis is associated with a five-year mortality rate of more than 50%, comparatively worse than the less than 25% rate for bladder cancer.
“UTUC requires a specialised approach, and there is a need for updated strategies to help this vulnerable patient population,” said Jonathan Coleman, chair of the guideline panel and surgeon at Memorial Sloan Kettering Cancer Center (New York, USA). “New information and guidelines like these can help improve cancer control and survival. Clinicians will not only learn how to evaluate patients, but they will get the most up-to-date information on treatment, surveillance, survivorship and more.”
This guideline has 38 recommendations and serves as a useful reference on the effective evidence-based diagnosis and management of non-metastatic UTUC.
The contents of the guidelines cover:
- Diagnosis and evaluation
- Risk stratification
- Kidney-sparing management
- Surgical management
- Lymph node dissection (LND)
- Neoadjuvant/adjuvant chemotherapy and immunotherapy
- Post-treatment surveillance
- Survivorship
Within the section on kidney-sparing management, the guidelines stipulate that “tumour ablation should be the initial management option for patients with low-risk favourable UTUC.
“Tumour ablation may be the initial management option offered to patients with low-risk unfavourable UTUC and select patients with high-risk favourable disease who have low-volume tumours or cannot undergo radical nephrouretectomy,” is a further recommendation included for managing kidney-sparing.
Furthermore, it states that “tumour ablation may be accomplished via a retrograde or antegrade percutaneous approach and repeat endoscopic evaluation should be performed within three months.”
“SUO has been honoured to work alongside the AUA to help develop numerous guidelines in urology,” said Jeffrey Holzbeierlein, president of SUO and vice president and physician-in-chief at the University of Kansas Cancer Center (Kansas City, USA). “We believe it is important to take difficult diagnosis like non-metastatic UTUC and disseminate the most up-to-date information possible.”
