Supplementary Material for: Transarterial selective internal radiation therapy with yttrium-90 for liver metastatic urothelial carcinoma of the ureter as a bridging therapy to immunotherapy: a case report with a 10-year follow-up.

Primary transitional cell carcinoma of the ureter is a rare type of cancer with metastasis presented in approximately 25% at diagnosis. Due to its rarity and poor prognosis, the management of this neoplasm is still controversial, and the development of new therapies is of uttermost importance. Herein, we describe a case of a 54-year-old patient diagnosed with transitional cell carcinoma of the left ureter submitted to left nephroureterectomy (pT3N2M0) and methotrexate, vinblastine, doxorubicin, and cisplatin adjuvant chemotherapy. A single liver metastasis was detected and combination chemotherapy with gemcitabine and carboplatin was initiated along with Stereotactic Body Radiation Therapy. Despite these 2 previous chemotherapy regimens, the patient presented disease progression and transarterial selective internal radiation therapy (SIRT) with yttrium-90 was indicated. This locoregional treatment was performed with the administration of 1.2 GBq yttrium-90 resin microspheres (SIR-Spheres®, Sirtex Medical Limited, Sydney, NSW, Australia) into the right hepatic artery. Another systemic treatment was immunotherapy using nivolumab with excellent tolerability. After 10 years of follow-up, at the last clinical evaluation, the patient had no clinical symptoms and the last imaging follow-up using positron emission tomography–computed tomography scan showed complete response. This report introduces upper urinary tract urothelial carcinoma as a distinct type of malignancy in which SIRT can be safely implemented. As a transition method to nivolumab, it was successful. There might be a potential therapeutic synergism between these 2 treatment modalities.

输尿管原发性移行细胞癌（Primary transitional cell carcinoma of the ureter）是一类罕见恶性肿瘤，确诊时约25%的患者已发生转移。鉴于其发病率极低且预后不佳，该肿瘤的临床管理仍存在争议，因此开发新型治疗方案至关重要。
本文报告1例54岁左侧输尿管移行细胞癌患者：患者接受左侧肾输尿管切除术（pT3N2M0），并辅以甲氨蝶呤、长春碱、多柔比星和顺铂的辅助化疗。后续检出单发肝转移灶，遂启动吉西他滨联合卡铂的联合化疗方案，并联合立体定向体部放射治疗（Stereotactic Body Radiation Therapy）。
尽管已接受上述2种化疗方案，患者仍出现疾病进展，因此启动经动脉选择性内放射治疗（transarterial selective internal radiation therapy, SIRT），采用钇-90（yttrium-90）进行治疗。该局部区域治疗通过右肝动脉输注1.2 GBq钇-90树脂微球（SIR-Spheres®，Sirtex Medical Limited，澳大利亚新南威尔士州悉尼市）完成。
后续患者接受另一项全身治疗——纳武利尤单抗（nivolumab）免疫治疗，耐受性极佳。
经过10年随访，末次临床评估显示患者无任何临床症状；末次正电子发射断层显像-计算机断层扫描（positron emission tomography–computed tomography, PET-CT）影像学随访结果提示肿瘤完全缓解。
本报告证实，上尿路尿路上皮癌（upper urinary tract urothelial carcinoma）是一类可安全实施经动脉选择性内放射治疗的独特恶性肿瘤；该治疗作为纳武利尤单抗的过渡疗法取得了成功，二者或存在潜在的治疗协同效应。