ADJUVANT CHEMOTHERAPY IS NOT EFFECTIVE IN HIGH RISK UROTHELIAL CARCINOMA OF THE UPPER URINARY TRACT

NEW YORK (Reuters Health) Jul 01 - Postoperative chemotherapy does not appear to provide a survival benefit in patients with high-risk urothelial carcinoma of the upper urinary tract (UUT-UC), according to a newly reported study by French and Greek researchers.
"There is no current evidence to support systematic chemotherapy in UUT-UC," coauthor Dr. Morgan Roupret of the Assistance Publique-Hopitaux de Paris told Reuters Health by email. "It has to be discussed on a case-by-case basis in a subjective manner between urologist and oncologist."
In fact, in a report of the study published online June 2nd in Cancer, the research team recommends that postoperative chemo be prohibited for these patients outside of randomized clinical trials.
UUT-UC is a rare cancer, accounting for only 5% to 10% of all urothelial carcinomas, the report notes, and so "randomized clinical trials comparing different treatment modalities are not available and data regarding adjuvant chemotherapy in locally advanced UUT-UCs are currently sparse."
The retrospective study included 627 patients from a French registry and a Greek clinic who had locally advanced/high-risk UUT-UC, including 140 patients who received chemotherapy within 6 months after surgery.
By far the most common surgical procedure in both the chemotherapy and non-chemotherapy groups was radical nephroureterectomy with bladder-cuff removal. Chemotherapy was most often cisplatin-based (52.8%) or carboplatin-based (39.2%). Patients received an average of 4.4 cycles.
The median survival in the study was 22.5 months, median recurrence-free survival was 16 months, and median metastasis-free survival was 19 months. These findings, according to the report, are consistent with data from other studies published in 2006, 2009 and 2010.
But adjuvant chemotherapy after nephroureterectomy did not significantly improve overall or cancer-specific survival. On multivariate analysis, positive surgical margins were the only independent predictor of cancer-specific mortality (p=0.03).
"We believe that neoadjuvant chemotherapy is an approach that should be evaluated more thoroughly for UUT-UCs (as it has been for bladder cancer)," the authors write.
Giving the chemo preoperatively, they add, would address the fact that loss of renal reserve after radical kidney surgery makes it difficult if not impossible to deliver effective doses of cytotoxic drugs.
SOURCE: http://bit.ly/lQ9kTl