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We evaluated the outcomes of salvage and palliative radiotherapy (RT) and prognostic factors in UTUC patients and find implications for salvage and palliative RT.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Between August 2006 and February 2021, 174 patients (median age, 68\u00a0years; range, 37\u201390) underwent salvage and palliative RT. Disease status at RT included initially diagnosed advanced disease (n\u2009=\u20098, 4.6%), local recurrence only (n\u2009=\u200956, 32.2%), distant metastasis only (n\u2009=\u200959, 33.9%), and local recurrence and distant metastasis (n\u2009=\u200951, 29.3%). The primary tumor location included the renal pelvis (n\u2009=\u200987, 50%), ureter (n\u2009=\u200977, 44.3%), and both (n\u2009=\u200910, 5.7%). Radical nephroureterectomy, chemotherapy, and immunotherapy were used in 135 (77.6%), 101 (58%), and 19 (10.9%) patients, respectively. Survival outcomes and prognostic factors were analysed using Cox and logistic regression analysis.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Salvage RT and palliative RT was administered in 73 (42%) and 101 (58%) patients, respectively. The median radiation dose was 45\u00a0Gy (range, 15\u201365). Two-dimensional (2D) or three-dimensional (3D) RT and intensity modulated RT (IMRT) were used in 61 (35.1%) and 113 (64.9%) patients, respectively. The median follow-up was 7.8\u00a0months. The median duration of overall survival (OS) was 13.4\u00a0months, and the 1-year OS was 53.5%. The median progression-free survival (PFS) was 4.7\u00a0months, and the 6-month PFS was 41.9%. The 6-month infield PFS was 84%. In multivariate analysis, RT method (2D\/3D vs. IMRT, p\u2009=\u20090.007) and RT response (p\u2009=\u20090.008) were independent prognostic factors for OS, and RT response correlated with PFS (p\u2009=\u20090.015). In subgroup analysis in patients with PD-L1 data, positive PD-L1 correlated with better PFS (p\u2009=\u20090.009). RT response-associated factors were concurrent chemotherapy (p\u2009=\u20090.03) and higher radiation dose (p\u2009=\u20090.034). Of 145 patients, 10 (6.9%) developed grade 3 acute or late toxicity.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Salvage and palliative RT for UTUC are feasible and effective. Patients with RT response using IMRT may have survival benefit from salvage and palliative RT. Positive PD-L1 status might be related to radiosensitivity. High-dose radiation with concurrent chemotherapy may improve RT response.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13014-022-02020-7","type":"journal-article","created":{"date-parts":[[2022,3,9]],"date-time":"2022-03-09T11:03:11Z","timestamp":1646823791000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Optimal management of recurrent and metastatic upper tract urothelial carcinoma: Implications of intensity modulated radiation therapy"],"prefix":"10.1186","volume":"17","author":[{"given":"Mi Sun","family":"Kim","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Woong Sub","family":"Koom","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jae Ho","family":"Cho","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Se-Young","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7165-3373","authenticated-orcid":false,"given":"Ik Jae","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,3,9]]},"reference":[{"key":"2020_CR1","doi-asserted-by":"publisher","first-page":"9","DOI":"10.3322\/caac.21208","volume":"64","author":"R Siegel","year":"2014","unstructured":"Siegel R, Ma J, Zou Z, et al. 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