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Perioperative chemotherapy in upper tract urothelial carcinoma: a comprehensive review

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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.

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Authors contribution

AA, JD, KH, LAK, AN, AN, MR, FR, RS, PG, WK, SFS and EX contributed to protocol/project development, data collection, data analysis and manuscript writing/editing.

Author information

Authors and Affiliations

  1. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Atiqullah Aziz, Luis A. Kluth & Michael Rink

  2. Department of Urology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland

    Jakub Dobruch

  3. Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands

    Kees Hendricksen

  4. Department of Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Andrea Necchi

  5. Department of Urology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK

    Aidan Noon

  6. Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany

    Florian Roghmann

  7. Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada

    Roland Seiler

  8. Department of Urology, University of Bern, Bern, Switzerland

    Roland Seiler

  9. Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy

    Paolo Gontero

  10. Department of Urology, McGill University Health Center, Montreal, QC, Canada

    Wassim Kassouf

  11. Department of Urology, Medical University of Vienna, Vienna, Austria

    Shahrokh F. Shariat

  12. Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, 27, rue du Faubourg Saint Jacques, 75014, Paris, France

    Evanguelos Xylinas

  13. INSERM U955 Eq07 Department of Urology, CHU Mondor, 51, avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France

    Evanguelos Xylinas

Authors
  1. Atiqullah Aziz
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  2. Jakub Dobruch
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  3. Kees Hendricksen
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  4. Luis A. Kluth
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  5. Andrea Necchi
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  6. Aidan Noon
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  7. Michael Rink
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  8. Florian Roghmann
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  9. Roland Seiler
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  10. Paolo Gontero
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  11. Wassim Kassouf
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  12. Shahrokh F. Shariat
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  13. Evanguelos Xylinas
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Consortia

For the Young Academic Urologists Urothelial Carcinoma Group of the European Association of Urology

Corresponding author

Correspondence to Evanguelos Xylinas.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants performed by any of the authors.

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Aziz, A., Dobruch, J., Hendricksen, K. et al. Perioperative chemotherapy in upper tract urothelial carcinoma: a comprehensive review. World J Urol 35, 1401–1407 (2017). https://doi.org/10.1007/s00345-016-1995-z

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  • DOI: https://doi.org/10.1007/s00345-016-1995-z

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