{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T06:07:18Z","timestamp":1788847638212,"version":"build-2803163510"},"reference-count":34,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate oncologic outcomes of high\u2010dose radical radiotherapy (RT) in medically frail patients with upper tract urothelial carcinoma (UTUC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively reviewed 63 patients with UTUC who received definitive RT at four major academic hospitals (2014\u20132021) with significant comorbidities (age\u2010adjusted Charlson Comorbidity Index \u22653). Patients were stratified into high\u2010 and low\u2010dose groups using a biologically effective dose (BED\n                      <jats:sub>10<\/jats:sub>\n                      ) cutoff of 74.3\u2009Gy (from 63\u2009Gy\/35 fractions, assuming \u03b1\/\u03b2 ratio\u2009=\u200910). The median BED\n                      <jats:sub>10<\/jats:sub>\n                      was 64.8\u2009Gy (interquartile range 60.0\u201372.0) in the low\u2010dose group and 84.0\u2009Gy (interquartile range 78.4\u201386.4) in the high\u2010dose group. Baseline imbalances were addressed using inverse probability of treatment\u2010weighted (IPTW) in Cox proportional hazard models and Kaplan\u2013Meier analyses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The median follow\u2010up was 76\u2009months. The pelvic ureter was the most frequently involved site (57%), followed by the renal pelvis (33%) and the abdominal ureter (21%). In the IPTW\u2010adjusted cohort, the disease control rate was significantly higher with high\u2010dose RT (98% vs 62%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). High\u2010dose RT significantly improved IPTW\u2010adjusted locoregional control (3\u2010year LRC: 51% vs 29%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.041), freedom from distant metastasis (3\u2010year FFDM: 75% vs 39%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.001), freedom from progression (3\u2010year FFP: 43% vs 25%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.013), and overall survival (3\u2010year OS: 46% vs 11%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). Multivariate analysis identified higher RT dose as an independent prognosticator of improved FFP (adjusted hazard ratio [aHR]\u20090.96,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.018) and OS (aHR\u20090.93,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). Furthermore, pre\u2010RT gross haematuria (aHR\u20092.63,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.002) and age\u2010adjusted Charlson Comorbidity Index &gt;5 (aHR\u20092.85,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.007) were associated with worse OS.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A clear dose\u2013response relationship was observed in UTUC treated with definitive RT. High\u2010dose RT was associated with significantly improved survival and represents a safe alternative for medically frail patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bju.70392","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T08:42:07Z","timestamp":1785487327000},"page":"666-676","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Oncologic outcomes of radical radiotherapy in frail patients with upper tract urothelial carcinoma"],"prefix":"10.1111","volume":"138","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-9814-6872","authenticated-orcid":false,"given":"Willy Po\u2010Yuan","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Proton and Radiation Therapy Center Linkou Chang Gung Memorial Hospital  Taoyuan 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Chang Gung University  Taoyuan Taiwan"},{"name":"Division of Urology, Department of Surgery Linkou Chang Gung Memorial Hospital  Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I\u2010Hung","family":"Shao","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Medicine Chang Gung University  Taoyuan Taiwan"},{"name":"Division of Urology, Department of Surgery Linkou Chang Gung Memorial Hospital  Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hung\u2010Cheng","family":"Kan","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Medicine Chang Gung University  Taoyuan Taiwan"},{"name":"Division of Urology, Department of Surgery Linkou Chang Gung Memorial Hospital  Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Po\u2010Jung","family":"Su","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Medicine Chang Gung 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