Endocavitary treatment for upper tract urothelial carcinoma: A meta-analysis of the current literature

To assess the oncologic impact of adjuvant endocavitary instillation after kidney-sparing surgery (KSS) in the treatment of upper tract urothelial carcinoma (UTUC). METHODS: A meta-analysis of the available literature was performed using PUBMED and MEDLINE on June 2018. No time or language restrictions were applied. All included participants were substratified into 2 groups: Ta/T1 UTUC and upper tract (UT) carcinoma in situ. Subjects with higher stage disease, involvement of the bladder, or urethra were excluded. Predefined endpoints of interest were rates of cytology response, UT recurrence, UT progression, cancer-specific survival, and overall survival. RESULTS: Overall, 27 eligible reports for a total of 438 patients were identified and 18 studies included for quantitative analyses. All included reports were nonrandomized observational case series. Among studies that reported on UT recurrence, 154 (35%) patients developed UT recurrence during a median follow-up of 30 months. The overall pooled estimates for adjuvant instillations in Ta-T1 patients were 40% for UT recurrence, 94% for cancer-specific survival, and 71% for OS. Subanalyses stratified by regimen used and instillation approach did not show any significant differences. In patients with UT carcinoma in situ treated with BCG, the pooled estimates for cytology response, UT recurrence, and progression were 84%, 34%, and 16%, respectively. Similarly, comparison between instillation approaches did not show any significant differences. CONCLUSIONS: In this meta-analysis of presumed nonmuscle invasive patients treated with kidney-sparing surgery, endocavitary instillations for noninvasive UTUC, did not reveal any differences between the regimens and instillations approaches. Patients with Ta-T1 UTUC had an UT recurrence rate comparable to that reported in the literature for nontreated patients. To date, the efficacy of endocavitary instillations in UTUC remains to be demonstrated. Upcoming novel drugs promise to change this paradigm.