Perioperative chemotherapy in upper tract urothelial carcinoma: a comprehensive review

• Published in: World journal of urology Vol. 35; no. 9; pp. 1401 - 1407
• Main Authors: Aziz, Atiqullah, Dobruch, Jakub, Hendricksen, Kees, Kluth, Luis A., Necchi, Andrea, Noon, Aidan, Rink, Michael, Roghmann, Florian, Seiler, Roland, Gontero, Paolo, Kassouf, Wassim, Shariat, Shahrokh F., Xylinas, Evanguelos
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2017; Springer Nature B.V
• Subjects: Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Bladder cancer; Carboplatin; Carboplatin - administration & dosage; Carcinoma, Transitional Cell - drug therapy; Chemotherapy; Chemotherapy, Adjuvant - methods; Cisplatin; Cisplatin - administration & dosage; Clinical trials; Humans; Invited Review; Kidney Neoplasms - drug therapy; Kidney Pelvis; Medicine; Medicine & Public Health; Neoadjuvant Therapy - methods; Nephrectomy; Nephrology; Oncology; Paclitaxel; Paclitaxel - administration & dosage; Response rates; Studies; Survival; Ureter; Ureter - surgery; Ureteral Neoplasms - drug therapy; Urologic Surgical Procedures; Urology; Urothelial carcinoma; Urothelium; Neoadjuvant chemotherapy; Adjuvant chemotherapy; Urothelial carcinoma; Radical nephroureterectomy; Upper urinary tract tumors
• ISSN: 0724-4983; 1433-8726
• DOI: 10.1007/s00345-016-1995-z

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.