Nephron sparing surgery (NSS) is considered for selected cases of upper tract urothelial carcinoma (UTUC) as it maintains renal function and avoids morbidity associated with radical nephroureterectomy (RNU). The appropriate selection of patients suitable for NSS without compromising oncological outcomes can sometimes be difficult, given the limitations of diagnostic modalities. Recurrence rates for UTUC can be as high as 36 to 54% after NSS. Intraluminal adjuvant therapy can be attempted following NSS to reduce recurrence, but delivery to the upper tract is more challenging than into the bladder. Bacillus Calmette-Guerin (BCG) and chemotherapy such as Mitomycin (MMC) have been administered via nephrostomy or ureteric catheter, which requires invasive/repeated instrumentation of the upper urinary tract. Drug delivery by reflux from bladder instillation along indwelling stents has also been tried but can potentially be unreliable. Recently, a gel formulation of mitomycin has been developed for the controlled exposure of the upper urinary tract to treatment over a number of hours. Drug-eluting stents to deliver chemotherapy to the upper urinary tract have been developed but have not yet entered clinical practice. Endoluminal phototherapy utilising an intravenous photosensitising agent is another novel approach that has recently been described. Intraluminal therapies may be beneficial in decreasing recurrence rates in UTUC, but currently have some limitations in their usage.
对于部分上尿路尿路上皮癌（UTUC）病例，可考虑采用保留肾单位手术（NSS），该术式能维持肾功能并避免根治性肾输尿管切除术（RNU）相关并发症。由于诊断手段存在局限性，如何在保证肿瘤学疗效的前提下筛选适合NSS的患者有时较为困难。UTUC患者接受NSS后复发率可高达36%至54%。术后可尝试腔内辅助治疗以降低复发风险，但上尿路给药较膀胱给药更具挑战性。目前卡介苗（BCG）和丝裂霉素（MMC）等化疗药物需通过肾造瘘管或输尿管导管给药，这要求对上尿路进行侵入性/重复性器械操作。亦有研究尝试通过留置支架经膀胱灌注药物逆流给药，但该方法的可靠性可能不足。近期研发的丝裂霉素凝胶制剂可实现数小时内对上尿路的持续控释治疗。虽已开发出用于上尿路化疗的药物洗脱支架，但尚未进入临床应用阶段。利用静脉注射光敏剂进行腔内光疗是近期报道的另一创新疗法。腔内治疗可能有助于降低UTUC复发率，但目前临床应用仍存在一定局限性。
The Utility of Intraluminal Therapies in Upper Tract Urothelial Carcinoma: A Narrative Review
肿瘤(癌症)患者之家