Transitional cell carcinoma of the upper urinary tract: staging by MRI

Weeks, Susan M.; Brown, Elizabeth D.; Brown, Jeffrey J.; Adamis, M. K.; Eisenberg, Lara B.; Semelka, Richard C.

doi:10.1007/bf00203373

Cited by 24 publications

(9 citation statements)

References 16 publications

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“…Our findings support the development of neoadjuvant chemotherapy protocols in patients considering nephroureterectomy for UTUC. However, selection of patients for such trials will require careful consideration because our ability to stage the upper tract clinically is limited with currently available technologies [24[en]26]. Further development of imaging technologies with resolution capable of better assessing the regional lymph nodes and the depth of invasion of UTUC will be important.…”

Section: Discussionmentioning

confidence: 99%

Changes in Renal Function Following Nephroureterectomy May Affect the Use of Perioperative Chemotherapy

et al. 2010

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Background Nephroureterectomy alone fails to adequately treat many patients with advanced upper tract urothelial carcinoma (UTUC). Perioperative platinum-based chemotherapy has been proposed but requires adequate renal function. Objective Our aim was to determine whether the ability to deliver platinum-based chemotherapy following nephroureterectomy is affected by postoperative changes in renal function. Design, settings, and participants We retrospectively reviewed data on 388 patients undergoing nephroureterectomy for UTUC between 1991 and 2009. Four institutions were included. Intervention All patients underwent nephroureterectomy. Measurements All patients had serum creatinine measured before and after surgery. The value closest to 3 mo after surgery was taken as the postoperative value (range: 2[en]52 wk). Estimated glomerular filtration rate (eGFR) was calculated using the abbreviated Modification of Diet in Renal Disease study equation. EGFR values before and after surgery were compared using the paired t test. We chose an eGFR of 45 and 60 ml/min per 1.73 m2 as possible cut-offs for chemotherapy eligibility and compared eligibility before and after surgery using the chi-square test. Results and limitations Our cohort of 388 patients included 233 men (60%) with a median age of 70 yr. Mean eGFR decreased by 24% after surgery. Using a cut-off of 60 ml/min per 1.73 m2, 49% of patients were eligible for chemotherapy before surgery, but only 19% of patients remained eligible postoperatively. Using a cut-off of 45 ml/min per 1.73 m2, 80% of patients were eligible preoperatively, but only 55% remained eligible after surgery. This distribution persisted when we limited the analysis to patients with advanced pathologic stage (T3 or higher). Patients older than the median age of 70 yr were more likely to be ineligible for chemotherapy both pre- and postoperatively by either definition, and they were significantly more likely to have an eGFR <45 ml/min per 1.73 m2 postoperatively, regardless of their starting eGFR. This study is limited by its retrospective nature, and there was some variability in the timing of postoperative serum creatinine measurements. Conclusions EGFR is significantly diminished after nephroureterectomy, particularly in elderly patients. These changes in renal function likely affect eligibility for adjuvant cisplatin-based therapy. Accordingly, we suggest strong consideration of neoadjuvant regimens.

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Section: Discussionmentioning

confidence: 99%

Changes in Renal Function Following Nephroureterectomy May Affect the Use of Perioperative Chemotherapy

et al. 2010

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“…Urothelial cell carcinoma can occur in the entire urinary collecting system: renal collecting system, ureters, and bladder [19]. Because urothelial cell carcinoma is early and strongly enhancing [7,8,20], serial attenuation measurements in the unenhanced, corticomedullary, and excretory phases can confirm the presence of urothelial cell carcinoma [6] or nonenhancing blood clots. Therefore, the whole urinary tract is imaged in the unenhanced, corticomedullary, and excretory phases for patients in whom urothelial cell carcinoma is strongly suspected.…”

Section: Dahlman Et Almentioning

confidence: 97%

How Much Dose Can Be Saved in Three-Phase CT Urography? A Combination of Normal-Dose Corticomedullary Phase With Low-Dose Unenhanced and Excretory Phases

Dahlman¹,

Molen²,

Magnusson³

et al. 2012

American Journal of Roentgenology

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“…TCC generally is a hypovascular tumor and most often centered in the renal pelvis although variations occur [11].…”

Section: Discussionmentioning

confidence: 99%

MRI findings of primary small-cell carcinoma of kidney

Karadeniz-Bilgili

Semelka

Hyslop

et al. 2005

Magnetic Resonance Imaging

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Transitional cell carcinoma of the upper urinary tract: staging by MRI

Abstract: The results of this preliminary study show that MRI stages transitional cell cancers relatively well; however, MRI is not able to detect superficial invasion of renal parenchyma.

Cited by 24 publications

References 16 publications

Changes in Renal Function Following Nephroureterectomy May Affect the Use of Perioperative Chemotherapy

Changes in Renal Function Following Nephroureterectomy May Affect the Use of Perioperative Chemotherapy

How Much Dose Can Be Saved in Three-Phase CT Urography? A Combination of Normal-Dose Corticomedullary Phase With Low-Dose Unenhanced and Excretory Phases

MRI findings of primary small-cell carcinoma of kidney

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