Perioperative chemotherapy in upper tract urothelial carcinoma: a comprehensive review.

Abstract

PURPOSE:

To evaluate the role of neoadjuvant (NAC) and adjuvant chemotherapy (AC) in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU).

METHODS:

A comprehensive review of the current literature was performed searching for all studies investigating NAC and AC in UTUC in MEDLINE and https://clinicaltrials.gov , prior to April 2016. The following keywords were used: "ureteral neoplasms," "urothelium," "ureter," "upper tract urothelial," "chemotherapy," "adjuvant," "neoadjuvant" and relevant variants.

RESULTS:

No randomized trials investigated the role of AC or NAC for UTUC. There was one prospective study with n = 36 patients investigating AC with carboplatin-paclitaxel. We included 14 retrospective studies (four in the NAC and ten in the AC setting), with a total of 694 patients receiving cisplatin-based or non-cisplatin-based AC after RNU and 1437 patients undergoing RNU alone. We found that the current literature, mainly based on retrospective studies, suggests significant overall and cancer-specific survival benefits for AC in UTUC. NAC appears promising, with favorable pathologic response rates up to 14%.

CONCLUSIONS:

Evidence is scarce for both NAC and AC use in UTUC. This comprehensive review suggests promising response rates for NAC and a survival benefit for patients treated with AC. Prospective randomized trials are needed to establish the role of AC and NAC in UTUC.

• Authors: Atiqullah Aziz, Jakub Dobruch, Kees Hendricksen, Luis A Kluth, Andrea Necchi, Aidan Noon, Michael Rink, Florian Roghmann, Roland Seiler, Paolo Gontero, Wassim Kassouf, Shahrokh F Shariat, Evanguelos Xylinas, Young Academic Urologists Urothelial Carcinoma Group of the European Association of Urology
• Journal: World journal of urology (World J Urol) Vol. 35 Issue 9 Pg. 1401-1407 (Sep 2017) ISSN: 1433-8726 [Electronic] Germany
• PMID: 28074261 (Publication Type: Journal Article, Review)

Chemical References

• Carboplatin
• Paclitaxel
• Cisplatin

Topics

• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Carboplatin (administration & dosage)
• Carcinoma, Transitional Cell (drug therapy)
• Chemotherapy, Adjuvant (methods)
• Cisplatin (administration & dosage)
• Humans
• Kidney Neoplasms (drug therapy)
• Kidney Pelvis
• Neoadjuvant Therapy (methods)
• Nephrectomy
• Paclitaxel (administration & dosage)
• Ureter (surgery)
• Ureteral Neoplasms (drug therapy)
• Urologic Surgical Procedures