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Kaimakliotis HZ, Tachibana I, Woldu S, Labbate C, Jacob J, Murray K, Rose K, Sexton W, Dickstein R, Linehan J, Nieder A, Bjurlin M, Humphreys M, Ghodoussipour S, Quek M, O'Donnell M, Eisner BH, Matin SF, Lotan Y, Feldman AS. The ablative effect of mitomycin reverse thermal gel: Expanding the role for nephron preservation therapy in low grade upper tract urothelial carcinoma. Urol Oncol 2023; 41:387.e1-387.e7. [PMID: 37246135 DOI: 10.1016/j.urolonc.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 04/05/2023] [Accepted: 04/09/2023] [Indexed: 05/30/2023]
Abstract
PURPOSE Assess the real-world ablative effect of mitomycin reverse thermal gel for low-grade upper tract urothelial carcinoma (UTUC) in patients who undergo biopsy only or partial ablation and evaluate utility of complete ablation prior to UGN-101. MATERIAL AND METHODS We retrospectively reviewed low-grade UTUC patients treated with UGN-101 from 15 high-volume centers. Patients were categorized based on initial endoscopic ablation (biopsy only, partial ablation, or complete ablation) and by size of remaining tumor (complete ablation, <1cm, 1-3cm, or >3cm) prior to UGN-101. The primary outcome was rendered disease free (RDF) rate at first post-UGN-101 ureteroscopy (URS), defined as complete response or partial response with minimal mechanical ablation to endoscopically clear the upper tract of visible disease. RESULTS One hundred and sixteen patients were included for analysis after excluding those with high-grade disease. At first post-UGN-101 URS, there were no differences in RDF rates between those who at initial URS (pre-UGN-101) had complete ablation (RDF 77.0%), partial ablation (RDF 55.9%) or biopsy only (RDF 66.7%) (P = 0.14). Similarly, a complimentary analysis focusing on tumor size (completely ablated, <1cm, 1-3cm or >3cm) prior to UGN-101 induction did not demonstrate significant differences in RDF rates (P = 0.17). CONCLUSION The results of the early real-world experience suggest that UGN-101 may play a role in initial chemo-ablative cytoreduction of larger volume low-grade tumors that may not initially appear to be amenable to renal preservation. Further studies will help to better quantify the chemo-ablative effect and to identify clinical factors for patient selection.
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Affiliation(s)
| | - Isamu Tachibana
- Department of Urology, Indiana University Medical Center, Indianapolis, IN
| | - Solomon Woldu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Craig Labbate
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Joseph Jacob
- Department of Urology, State University of New York Upstate Medical Center, Syracuse, NY
| | - Katie Murray
- Department of Surgery, University of Missouri, Columbia, MO
| | - Kyle Rose
- Department of Urology, Moffitt Cancer Center, Tampa, FL
| | - Wade Sexton
- Department of Urology, Moffitt Cancer Center, Tampa, FL
| | - Rian Dickstein
- Department of Urology, University of Maryland Medical Center, Baltimore, MD; Department of Urology, Chesapeake Urology, Baltimore, MD
| | - Jennifer Linehan
- Department of Urology, Providence Specialty Medical Group, Santa Monica, CA
| | - Alan Nieder
- Department of Urology, Mount Sinai Medical Center, Miami Beach, FL
| | - Marc Bjurlin
- Department of Urology, University of North Carolina Medical Center, Chapel Hill, NC
| | | | - Saum Ghodoussipour
- Department of Urology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Marcus Quek
- Department of Urology, Loyola University Medical Center, Maywood, IL
| | - Michael O'Donnell
- Department of Urology, University of Iowa Health Care, Iowa City, IA
| | - Brian H Eisner
- Department of Urology, Massachusetts General Hospital, Boston, MA
| | - Surena F Matin
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Adam S Feldman
- Department of Urology, Massachusetts General Hospital, Boston, MA
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