How would you approach treatment for a cT1N0M0 urothelial carcinoma of the ureter, high grade in a non-surgical candidate due to medical comorbidities?

Although there is limited data using radiation therapy or chemo-radiation in UTUC, in a non-surgical candidate, this may be a reasonable approach to consider in selected patients. This would be an extrapolation from the promising data from RTOG 0926, a single arm, phase II trial investigating trimodality bladder preservation therapy for recurrent, high-grade non-muscle invasive urothelial cancer (HGT1). 37 patients were enrolled and 34 were evaluable. Promising outcomes were seen with a three-year freedom from cystectomy rate of 88%. Overall survival at 3 and 5 years was 69% (95% CI: 53%, 85%) and 53% (95% CI: 35%, 72%), respectively. The rate of distant metastatic disease at 3 and 5 years was 12% (95% CI: 4%, 26%) and 20% (95% CI: 8%, 37%)...

Radiation therapy and systemic chemotherapy are reasonable options if surgery is not feasible.