|
Localized Transitional Cell Cancer of the Renal Pelvis and Ureter
Current Clinical Trials
Standard treatment options:
- Nephroureterectomy with cuff of bladder.
- Segmental resection of ureter, only if the tumor is superficial and located
in the distal third of the ureter.
Treatment options under clinical evaluation:
The development of new instrumentation for endourological treatment of upper
tract transitional cell cancer has provided new options for regional management
of these cancers. Introduction of electrofulguration and resection instruments
or laser probes either transureterally or percutaneously may permit destruction
of a primary cancer. Introduction of cytotoxic agents has also been employed.
Although a biopsy can be taken for staging purposes, the accuracy of this
remains to be determined. The efficacy of treatment by these maneuvers has not
been established.
- Electroresection and fulguration or laser fulguration, if the tumor is
superficial.
- Any parenchymal sparing procedure (segmental resection; ureteroscopic or
percutaneous resection/fulguration/laser destruction) if the renal unit is
solitary or renal function is depressed.
- Intrapelvic or intraureteral cytotoxic/immunotherapy. The dramatic
successes that have been reported with intravesical cytotoxic (thiotepa,
mitomycin, doxorubicin) or immunologic/inflammatory (BCG, interferon) therapy
for superficial transitional cell cancers in the bladder have led to the
occasional use of these agents in the treatment of upper tract cancers.
Long-term follow-up of the results of such treatments has generally not been
reported, and the efficacy of this approach cannot be assessed, largely because
experience has been limited to those patients whose compromised clinical status
(solitary kidney, renal failure, medical risks for surgery) may have influenced
clinical outcome. The use of this approach will be limited by the extent of
disease in the renal pelvis, the access that these agents may have to the area
of disease, the sensitivity of the cancer being treated, and the adequacy and
accuracy of initial tumor staging and continued monitoring.
- Laser vaporization/coagulation. Transurethral and percutaneous access to
the upper tract have permitted the use of laser therapy in the control of
superficial upper tract transitional cell cancers. This approach is dependent
on accurate staging and adequate visualization of the lesions that need to be
coagulated. Results of this approach are at present too preliminary to assess.
Therapeutic efficacy, however, will depend on staging accuracy on initial
treatment and ease of monitoring such patients for disease recurrence and
possible progression.
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with localized transitional cell cancer of the renal pelvis and ureter. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Back to Top
< Previous Section | Next Section > |
