Renal Pelvis Cancer with Resectable Clinical Lymph Node Metastasis — Next Step After Induction Chemotherapy Did Not Achieve Tumour Response
This protocol applies to patients with upper urinary tract urothelial carcinoma (UTUC) presenting with resectable clinical lymph node metastasis and no distant metastases, who have already undergone induction platinum-based combination chemotherapy as the preceding treatment line.
Previous Treatment Line & Failure Condition
The prior line used induction platinum-based combination chemotherapy — gemcitabine plus cisplatin for cisplatin-eligible patients, or gemcitabine plus carboplatin for cisplatin-ineligible patients. The target for that line was tumour response to induction chemotherapy. When that response goal is not achieved, this protocol represents the defined next clinical step.
Treatment Approach (Partial Overview)
For eligible patients in this situation, the approach centres on surgical resection of the upper urinary tract in combination with structured dissection of the regional lymph nodes. Patient selection, the full surgical scope, multidisciplinary decision-making criteria, and any additional management are detailed in the complete protocol.
References
DOI: 10.1016/j.eururo.2025.02.023
- Patients with resectable cN+ disease should be offered induction PBC.
- RNU with template-based LND can be discussed in a multidisciplinary team and with patients who respond to initial systemic therapy.
- For patients whose cancer progresses, second-line treatment can be offered, similar to the approach for distant metastatic disease.
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