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The Role of Radiation Therapy for Upper Urinary Tract Malignancies

  • Alfredo I. Urdaneta
  • Mitchell S. Anscher
Chapter

Abstract

Historically, tumors arising from the upper urinary tract have been considered to be radioresistant, hence the primary management of these tumors is surgery. No study to date has shown improved survival for adjuvant radiation therapy in resectable renal cell carcinomas. This finding is most likely due to the fact that the vast majority of failures are distant, rather than local, and the anatomical location of the kidney has made it difficult to deliver high doses of radiation using older treatment techniques, due to the limitations in tolerance to radiation of surrounding organs. For tumors of the renal pelvis and the ureter, the local recurrence rate after surgery remains low, although there is retrospective evidence to suggest that postoperative radiation therapy with or without chemotherapy may improve locoregional control in selected patients. Radiotherapy plays an important and growing role in the management of metastatic renal cell carcinoma. Newer approaches to treatment delivery, combined with more sophisticated target localization, such as stereotactic radiation therapy, and the use of charged particles, may overcome limitations of older techniques, and permit the delivery of tumoricidal doses without exceeding normal tissue tolerance. Thus, radiotherapy, owing to its noninvasive nature, may be an attractive alternative for patients unsuitable for surgery. The use of radiotherapy as primary treatment for renal cell carcinoma is the subject of current investigation.

Keywords

Radiation therapy Adjuvant radiation therapy Ureteral cancer Cancer of the renal pelvis Intensity modulated radiation therapy Image-guided radiation therapy Stereotactic body radiation therapy Intraoperative radiation therapy 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Radiation OncologyVirginia Commonwealth University School of MedicineRichmondUSA

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