Urothelial Carcinoma of the Upper Urinary Tract That Becomes Resectable After Neoadjuvant Chemotherapy: A Case Report and Review of the Literature

Abstract

Upper tract urothelial carcinoma (UTUC) is less common than bladder cancer, but its incidence is increasing. Neoadjuvant chemotherapy (NAC) has been the treatment focus for locally invasive and high-grade UTUC. Herein, we aimed to present a case of a locally advanced non-metastatic UTUC, which was thought to be unresectable due to local invasion, but surgically treated successfully after NAC. A 64-year-old male patient was admitted to another hospital because of right flank pain, which was not accompanied by macroscopic haematuria. He did not have comorbidities in his anamnesis, but he had a history of smoking 40 packs/year. A locally invasive right kidney tumour was detected in cross-sectional imaging performed at another hospital. He underwent surgery in that hospital, but radical nephroureterectomy could not be performed because of local invasion. He presented to our urology department. He was subsequently started with cisplatin-based NAC, which led to the resolution of local invasion. After NAC, right radical nephroureterectomy and ipsilateral bladder cuff excision with subcostal and Gibson incisions were performed. No signs of mass invasion or lymph node involvement were detected intraoperatively. He was examined 3 months after surgery. On cystourethroscopy, the bladder was normal and cytology was benign. No recurrence or metastasis was detected on the whole-body computed tomography. NAC is one of the valuable multimodal treatment options, enables surgery in locally invasive UTUC and contributes positively to survival rate.

Keywords

• oncology
• urooncology
• urothelial carcinoma
• nephrectomy
• nephroureterectomy
• neoadjuvant chemotherapy