Objectives Radiosurgery (RS) using high-dose hypo-fractionated radiation is a novel treatment for renal cell carcinoma. This study investigates long-term oncological outcomes of RS for upper tract urothelial carcinoma (UTUC) in patients unfit for surgery or with a solitary kidney. Methods We performed a retrospective analysis of three prospective institutional databases from tertiary referral centers, including patients with UTUC treated with RS between 2008 and 2024. Results The study included 45 patients with a median age of 71.9 years (range 47.8-89.1). Of these, 28 had high-grade disease, and 9 carcinoma in situ (CIS). Twenty-eight patients had a solitary kidney. The median RS dose per fraction was 25 Gy (range 10-25). The median number of fractions was 1 (range 1-4 fractions). The median follow-up was 27.6 months (range 3.1-150.3), and the median overall survival (OS) was 91.7 months (95% CI 72.0-111.5). OS did not correlate with tumor grade or CIS. The median OS for low-grade patients was 52.06 months, while for high-grade patients, it was 87.90 months. Treatment response included complete response in 37 patients (82.2%), partial response in 2 (4.4%), stable disease in 2 (4.4%), and progression in 2 (4.4%). The median baseline and follow-up CKD-EPI were 64.2 and 53.5 mL/min/1.73 m2, respectively. Three patients (6.7%) required hemodialysis. Conclusions RS for UTUC is an effective local ablation therapy with durable long-term control and should be considered in patients not suitable for surgical approaches. It should be evaluated as a potential new standard of care in prospective studies in conjunction with peri-interventional systemic therapy.
Cancers. 2026 Mar 19*** epublish ***
Michael Staehler, Iulia Blajan, Can Aydogdu, Annabel Graser, Marina Hoffmann, Isabel Brinkmann, Gerald B Schulz, Allen Yen, Jonathan J Cheng, Christoph Fürweger, Sarah P Psutka, Raquibul Hannan, Alexander Muacevic
Department of Urology, University of Munich, D-81377 Munich, Germany., European Radiosurgery Center Munich (ERCM), D-81377 München, Germany., Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX 75390, USA., Department of Radiation Oncology, University of Washington, Seattle, WA 98195, USA., Department of Urology, University of Washington, Seattle, WA 98195, USA.