Intensity-modulated radiation therapy (IMRT) is a possible primary option for patients with localized upper tract urothelial carcinoma (UTUC) unsuitable for surgery, according to Hao-Wei Chen MD, of Kaohsiung Medical University in Taiwan, and colleagues.

In a study, the investigators used IMRT to treat 16 patients (6 male; age range 51 to 93 years) with localized, single-lesion UTUC. Thirteen patients had high-grade tumors. Nine patients had tumors in the renal pelvis, 7 had tumors in the ureter, and 5 patients had locally advanced tumors. Mean body mass index ranged from 16.2 to 34 kg/m2, and mean estimated glomerular filtration rate (eGFR) ranged from 12 to 56.3 mL/min/1.73 m2).

IMRT was administered 5 days each week, for a total dose of 70 Gy in 35 fractions within 2 months. IMRT was chosen to reduce radiation exposure to nearby organs. By design, no one received chemotherapy or immunotherapy. Eight patients experienced skin erythema following treatment. There were no cases of kidney failure or ureteral stricture.

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At 1 month follow-up, 6 patients displayed complete responses (including 2 with locally advanced tumors) and 10 had partial responses, according to results published in the International Journal of Urology. Only 1 patient experienced UTUC recurrence at a median 30 months.

“To date, the only treatment option for localized UTUC in patients unsuited for surgery has been conservative treatment or palliative care,” Dr Chen and his collaborators stated. “We believe the non-invasive radiotherapy procedure reported herein might be a welcome development in the care of these patients, as complications were modest and outcomes fair.”

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Chen H-W, Tang J-Y, Chen Y-C, et al. Intensity modulation radiation therapy as alternative primary non-surgical treatment of upper tract urothelial carcinoma [published online December 29, 2019]. Int J Urol. doi: 10.1111/iju.14166