title: Progression of disease despite good endoscopic local control of upper tract urothelial carcinoma.
abstract: OBJECTIVE
  Several series have demonstrated the effective management of low-grade upper tract urothelial carcinoma (UC) in select patients using endoscopic approaches. Despite rigorous surveillance, we have identified 3 patients with renal parenchymal recurrences and/or metastatic disease without progression of renal pelvis disease.
  
  
  METHODS
  Three patients with renal parenchymal and/or metastatic UC were identified through routine clinical care. Data on these 3 patients were obtained from medical records to identify possible explanations for this recurrence pattern.
  
  
  RESULTS
  Three men (mean age, 68 years) were initially managed endoscopically (1 ureteroscopy and 2 percutaneous) for upper tract UC. Indications were solitary kidney in 2 patients and renal insufficiency in 1 patient. Two patients had low-grade disease and 1 patient had high-grade disease. Despite apparently successful management for 9 to 50 months, with complete tumor resection on initial and subsequent treatments, and at least 1 tumor-free period was documented in 2 of the 3 patients, parenchymal recurrence, metastases, or both were confirmed in 1 patient each. One patient underwent nephroureterectomy and the other 2 patients received adjuvant chemotherapy.
  
  
  CONCLUSIONS
  Despite complete initial resection of upper tract disease and apparent successful surveillance, these 3 patients had renal parenchymal recurrence and/or metastatic disease without obvious progression of collecting system disease. Unless there is an imperative indication for organ preservation, nephroureterectomy should be considered as the primary option. Biopsy of subsequent lesions is recommended to evaluate for advancing grade, and periodic cross-sectional imaging should be used to evaluate for disease progression.
authors: Department of Urology, University of Michigan Hospital, Ann Arbor, Michigan 48109-0330, USA. aweizer@umich.edu
authors: Alon Z
authors: AZ
authors: Weizer
authors: Gary J
authors: GJ
authors: Faerber
authors: J Stuart
authors: JS
authors: Wolf
mesh_terms: D000368:Aged; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016190:Carboplatin / Q000008:administration & dosage; D002291:Carcinoma, Papillary / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D018450:Disease Progression; D000077143:Docetaxel; D004564:Electrocoagulation; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D007682:Kidney Pelvis / Q000473:pathology; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary*; D008175:Lung Neoplasms / Q000188:drug therapy / Q000556:secondary*; D008207:Lymphatic Metastasis; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009392:Nephrectomy / Q000379:methods; D017239:Paclitaxel / Q000008:administration & dosage; D043823:Taxoids / Q000627:therapeutic use; D018666:Ureteroscopy; D000093542:Gemcitabine
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D043823:Taxoids; D003841:Deoxycytidine; D000077143:Docetaxel; D016190:Carboplatin; D017239:Paclitaxel; D000093542:Gemcitabine