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Intracavitary Topical Chemo and Immune Therapy of the Upper Tract

  • Joel Hillelsohn
  • Majid Eshghi
  • Arthur D. Smith
Chapter

Abstract

Endourologic management of upper tract urothelial carcinoma has become the preferred treatment in selected groups of patients. However, recurrence is high and there is a large interest in utilizing adjuvant topical agents as used in the lower tract. Many agents have been studied, but they are less efficacious than they are in the lower tract. This is likely due to incomplete staging, difficult delivery, and incomplete resection. There is evidence that primary BCG for isolated carcinoma in situ has some efficacy, but the evidence is not robust. There is mixed evidence for the use of adjuvant BCG, Mitomycin C, and Adriamycin. In our institution (ME), we utilize adjuvant Mitomycin C for a 6-week course in the office following resection. The future of adjuvant therapy likely lies in products such as MitoGel© that coat the upper tract.

Keywords

Topical chemotherapy BCG Mitomycin C Adjuvant treatment Intracavitary instillation Adriamycin Gemcitabine 

Abbreviations

Radical Nephroureterectomy

RNU

Upper Tract Urothelial Carcinoma

UTUC

Mitomycin C

MMC

Bacillus Calmette–Guérin

BCG

Percutaneous nephrostomy

PCN

Carcinoma in situ

CIS

Trans Urethral Resection Bladder Tumor

TURBT

Renal Units

RU

Interferon

IFN

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Joel Hillelsohn
    • 1
  • Majid Eshghi
    • 1
  • Arthur D. Smith
    • 2
  1. 1.Department of UrologyWestchester Medical Health Network/New York Medical CollegeValhallaUSA
  2. 2.Department of UrologyNorthwell Health and Hofstra UniversityLake SuccessUSA

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