Endoscopy effective in some patients with upper-tract TCC

Patients with a relatively small volume of low-grade, upper-tract transitional cell carcinoma can be managed by purely endoscopic means over a long period of time, surgeons from Thomas Jefferson University, Philadelphia, reported here.

Demetrius H. Bagley, MD, and colleagues collected data from 55 patients followed for 2 or more years (mean follow-up, 53 months) that suggested that ureteroscopic treatment of upper-tract TCC is viable in a select population.

"Even patients with a low volume of higher-grade disease can be followed endoscopically, but it has to be done very diligently with very close surveillance, and that requires effort on the part of the physician and the patients themselves," Brent Yanke, MD, an endourology/laparoscopy fellow working with Dr. Bagley.

Investigators recorded ureteroscopic findings and pathologic results for each procedure. Surveillance was composed of pyelogram and ureteroscopy 3 months after a positive finding or 6 months after consecutive negative findings. Patients underwent an average of 10 procedures, ranging from five to 41 procedures each.

Three deaths occurred during the study, for an overall survival rate of 94.6%. One death was not connected with upper-tract TCC, making disease-specific survival 96.4%; the other two deaths occurred in patients with solitary kidneys.

Four patients were alive with metastatic disease, two of whom received chemotherapy and one who underwent radical cystoprostatectomy.

All but four patients in the study initially presented with upper-tract TCC without bladder involvement. However, bladder TCC developed in 34 of them during follow-up (67%). In addition, bilateral disease developed in seven of 44 patients with bilateral kidneys who initially presented with unilateral TCC.

Tune into www.urologytimes.com/radio for an interview with Dr. Yanke.