Pub Date : 2023-07-31DOI: 10.22465/juo.234600180009
J. Ku, H. Gu, Seong Hyeon Yu, E. Hwang, M. Han, J. Jung, Hunju Lee, Myung Ha Kim, C. Kwak, S. I. Kim
Purpose: There is a lack of guidelines for using angioembolization to manage renal cell carcinoma (RCC) patients with intractable symptoms. Therefore, the Korean Urologic Oncology Society (KUOS) developed a set of recommendations for angioembolization for RCC patients with intractable symptoms who are unfit for surgery.Materials and Methods: A rigorous systematic review was performed and GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology was used to rate the certainty of the evidence for the patient outcomes and to develop the evidence into recommendations. The steering group, guidelines development group, systematic review team, and external review group consisted of KUOS members involved in the guideline development process.Results: The guidelines address the benefits, harms, patients’ values and preferences, costs, and resources related to angioembolization by using a single clinical question: Does angioembolization improve the quality of life for RCC patients with intractable symptoms who are unfit for surgery?Conclusions: The guideline development panel suggests angioembolization for RCC patients with intractable symptoms compared with supportive therapies, including systemic treatment (very low certainty of evidence, weak recommendation).
{"title":"Korean Urologic Oncology Society Guidelines: Does Angioembolization Improve the Quality of Life for Renal Cell Carcinoma Patients With Intractable Symptoms Who Are Unfit for Surgery?","authors":"J. Ku, H. Gu, Seong Hyeon Yu, E. Hwang, M. Han, J. Jung, Hunju Lee, Myung Ha Kim, C. Kwak, S. I. Kim","doi":"10.22465/juo.234600180009","DOIUrl":"https://doi.org/10.22465/juo.234600180009","url":null,"abstract":"Purpose: There is a lack of guidelines for using angioembolization to manage renal cell carcinoma (RCC) patients with intractable symptoms. Therefore, the Korean Urologic Oncology Society (KUOS) developed a set of recommendations for angioembolization for RCC patients with intractable symptoms who are unfit for surgery.Materials and Methods: A rigorous systematic review was performed and GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology was used to rate the certainty of the evidence for the patient outcomes and to develop the evidence into recommendations. The steering group, guidelines development group, systematic review team, and external review group consisted of KUOS members involved in the guideline development process.Results: The guidelines address the benefits, harms, patients’ values and preferences, costs, and resources related to angioembolization by using a single clinical question: Does angioembolization improve the quality of life for RCC patients with intractable symptoms who are unfit for surgery?Conclusions: The guideline development panel suggests angioembolization for RCC patients with intractable symptoms compared with supportive therapies, including systemic treatment (very low certainty of evidence, weak recommendation).","PeriodicalId":125788,"journal":{"name":"Journal of Urologic Oncology","volume":"125 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124657673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-31DOI: 10.22465/juo.234600280014
Y. Jo, Jun Seok Kim, Yoo Sub Shin, Jongchan Kim, W. S. Jang, J. Park, W. Ham
Purpose: Although radical cystectomy (RC) and concurrent chemoradiotherapy (CCRT) are curative options for muscle-invasive bladder cancer (MIBC), the optimal treatment strategy for MIBC patients with a history of nephroureterectomy for upper tract urothelial carcinoma (UTUC) remains unclear. This retrospective analysis was conducted to compare survival rates and evaluate prognostic factors related to treatment outcomes.Materials and Methods: We conducted a multi-institutional retrospective study of patients with MIBC after nephroureterectomy for UTUC between 2005 to 2023. Out of 75 patients, 30 underwent bladder-preserving therapy (BPT), including 22 patients who underwent radiation therapy (RT) and 8 patients who underwent CCRT, while 45 patients underwent RC. The overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS) after BPT and RC were evaluated using Kaplan-Meier curves. Cox regression analysis was used to identify variables associated with OS, CSS, and PFS. Posttreatment changes in renal function were compared.Results: At 3 years, the OS, CSS, and PFS rates in the BPT group were 52.4%, 71.7%, and 31.3%, respectively, with no significant difference compared to RC. In multivariate analysis, bladder cancer T stage was the only predictive factor for OS, CSS, and PFS. Similar results were also observed in the RT group compared to RC. A significant decrease in renal function was detected among patients in the RC group, while patients in the BPT group maintained preserved renal function. Patients in the BPT group experienced a lower grade of toxicity after treatment compared to those in the RC group, and the rates of survival with functional bladder at 1 year, 3 years, and 5 years were 87.0%, 69.9%, and 69.9%, respectively.Conclusions: Bladder-preserving therapy, including RT alone, may be a viable treatment option for patients with MIBC who have undergone nephroureterectomy, as it can achieve comparable oncologic outcomes to RC, while potentially preserving bladder and renal function.
{"title":"Radical Cystectomy Versus Bladder-Preserving Therapy in Muscle-Invasive Bladder Cancer Patients After Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Multicenter Retrospective Analysis","authors":"Y. Jo, Jun Seok Kim, Yoo Sub Shin, Jongchan Kim, W. S. Jang, J. Park, W. Ham","doi":"10.22465/juo.234600280014","DOIUrl":"https://doi.org/10.22465/juo.234600280014","url":null,"abstract":"Purpose: Although radical cystectomy (RC) and concurrent chemoradiotherapy (CCRT) are curative options for muscle-invasive bladder cancer (MIBC), the optimal treatment strategy for MIBC patients with a history of nephroureterectomy for upper tract urothelial carcinoma (UTUC) remains unclear. This retrospective analysis was conducted to compare survival rates and evaluate prognostic factors related to treatment outcomes.Materials and Methods: We conducted a multi-institutional retrospective study of patients with MIBC after nephroureterectomy for UTUC between 2005 to 2023. Out of 75 patients, 30 underwent bladder-preserving therapy (BPT), including 22 patients who underwent radiation therapy (RT) and 8 patients who underwent CCRT, while 45 patients underwent RC. The overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS) after BPT and RC were evaluated using Kaplan-Meier curves. Cox regression analysis was used to identify variables associated with OS, CSS, and PFS. Posttreatment changes in renal function were compared.Results: At 3 years, the OS, CSS, and PFS rates in the BPT group were 52.4%, 71.7%, and 31.3%, respectively, with no significant difference compared to RC. In multivariate analysis, bladder cancer T stage was the only predictive factor for OS, CSS, and PFS. Similar results were also observed in the RT group compared to RC. A significant decrease in renal function was detected among patients in the RC group, while patients in the BPT group maintained preserved renal function. Patients in the BPT group experienced a lower grade of toxicity after treatment compared to those in the RC group, and the rates of survival with functional bladder at 1 year, 3 years, and 5 years were 87.0%, 69.9%, and 69.9%, respectively.Conclusions: Bladder-preserving therapy, including RT alone, may be a viable treatment option for patients with MIBC who have undergone nephroureterectomy, as it can achieve comparable oncologic outcomes to RC, while potentially preserving bladder and renal function.","PeriodicalId":125788,"journal":{"name":"Journal of Urologic Oncology","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123085915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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