title: Update of the ICUD-SIU consultation on upper tract urothelial carcinoma 2016: treatment of localized high-risk disease.
abstract: OBJECTIVE
  To provide a comprehensive overview and update of the joint consultation of the International Consultation on Urological Diseases (ICUD) and Société Internationale d'Urologie for the treatment of localized high-risk upper tract urothelial carcinoma (UTUC).
  
  
  METHODS
  A detailed analysis of the literature was conducted reporting on treatment modalities and outcomes in localized high-risk UTUC. An international, multidisciplinary expert committee evaluated and graded the data according to the Oxford System of Evidence-based Medicine modified by the ICUD.
  
  
  RESULTS
  Radical nephroureterectomy (RNU) is the standard of treatment for high-grade or clinically infiltrating UTUC and includes the removal of the entire kidney, ureter and ipsilateral bladder cuff. The distal ureter can be managed either by extravesical or transvesical approach, whereas endoscopically assisted procedures are associated with decreased intravesical recurrence-free survival. Post-operative intravesical chemotherapy decreases the risk of subsequent bladder tumour recurrence. Regional lymph node dissection is of prognostic importance in infiltrative UTUC, but its extent has not been standardized. Renal-sparing surgery is an option for manageable, high-grade tumours of any part of the upper tract, especially of the distal ureter, as an alternative to RNU. Endoscopy-based renal-sparing procedures are associated with a higher risk of recurrence and progression.
  
  
  CONCLUSIONS
  A multimodal approach should be considered in localized high-risk UTUC to improve outcomes. RNU is the standard of treatment in high-risk disease. Renal-sparing approaches may be oncologically equivalent alternatives to RNU in well-selected patients, especially in those with distal ureteric tumours.
authors.affiliation: Department of Urology, University Hospital Tübingen, Hoppe-Seyler Street 3, 72076, Tübingen, Germany. georgios.gakis@web.de.
authors.forename: Georgios
authors.initials: G
authors.lastname: Gakis
authors.affiliation: Department of Urology, University Hospital Tübingen, Hoppe-Seyler Street 3, 72076, Tübingen, Germany.
authors.forename: Tina
authors.initials: T
authors.lastname: Schubert
authors.affiliation: USC/Norris Comprehensive Cancer Center, Institute of Urology, Los Angeles, CA, USA.
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Alemozaffar
authors.affiliation: Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Bellmunt
authors.affiliation: Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Bernard H
authors.initials: BH
authors.lastname: Bochner
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Boorjian
authors.affiliation: USC/Norris Comprehensive Cancer Center, Institute of Urology, Los Angeles, CA, USA.
authors.forename: Siamak
authors.initials: S
authors.lastname: Daneshmand
authors.affiliation: Department of Urology, New York University Langone Medical Center, New York, NY, USA.
authors.forename: William C
authors.initials: WC
authors.lastname: Huang
authors.affiliation: Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Tsunenori
authors.initials: T
authors.lastname: Kondo
authors.affiliation: Department of Urology, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Badrinath R
authors.initials: BR
authors.lastname: Konety
authors.affiliation: Department of Urology, AMC, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Maria Pilar
authors.initials: MP
authors.lastname: Laguna
authors.affiliation: Department of Urology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Surena F
authors.initials: SF
authors.lastname: Matin
authors.affiliation: Department of Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Arlene O
authors.initials: AO
authors.lastname: Siefker-Radtke
authors.affiliation: Department of Urology, Medical University Vienna, Vienna, Austria.
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.affiliation: Department of Urology, University Hospital Tübingen, Hoppe-Seyler Street 3, 72076, Tübingen, Germany.
authors.forename: Arnulf
authors.initials: A
authors.lastname: Stenzl
mesh_terms: D000283:Administration, Intravesical; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000628:therapy*; D007682:Kidney Pelvis / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision; D009392:Nephrectomy; D059351:Organ Sparing Treatments; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012955:Societies, Medical; D014513:Ureter / Q000601:surgery; D014516:Ureteral Neoplasms / Q000473:pathology / Q000628:therapy*; D018666:Ureteroscopy; D013520:Urologic Surgical Procedures; D014572:Urology
chemical_list: D000970:Antineoplastic Agents
keywords: Chemotherapy; Lymph node dissection; Nephroureterectomy; Renal-sparing; Salvage, upper tract urothelial carcinoma