Treatment of Upper Urinary Tract Urothelial Carcinoma with High-Risk Features and No Distant Metastases

This protocol addresses renal pelvis cancer presenting as upper urinary tract urothelial carcinoma (UTUC) in which at least one established high-risk feature is present and no distant metastases are identified.

Clinical Scenario

High-risk UTUC is defined by the presence of any one of the following criteria:

High-grade urine cytology
High-grade ureteroscopy biopsy
Local invasion on CT imaging
Histological urothelial carcinoma subtype

No distant metastases are present.

Treatment Approach (Partial Overview)

For eligible patients following surgical management, adjuvant systemic therapy is the primary treatment consideration — with platinum-based chemotherapy regimens among the approaches evaluated in this setting.

The full protocol — including complete eligibility criteria, alternative regimens, sequencing, and specific treatment details — is available in the structured resource below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.eururo.2025.02.023

Strong criteria for high risk definition: High-grade cytology, High-grade URS biopsy, Local invasion on CT, Histological subtype.

Any of these factors needs to be present.

Offer platinum-based aCTx after RNU to eligible patients with pT2–T4 and/or pN+ disease.

The multicentre prospective phase 3 POUT RCT (n = 261) evaluated the benefit of four cycles of adjuvant chemotherapy with gemcitabine + platinum initiated within 90 d after RNU versus surveillance.

The treatment effect was consistent across chemotherapy regimens (carboplatin or cisplatin) and disease stage.

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