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11.03.2023 | Topic Paper

The role of perioperative chemotherapy for upper tract urothelial carcinoma patients treated with radical nephroureterectomy

verfasst von: Ugo Pinar, Giorgio Calleris, Elisabeth Grobet-Jeandin, Pietro Grande, Daniel Benamran, Constance Thibault, Paolo Gontero, Morgan Rouprêt, Thomas Seisen

Erschienen in: World Journal of Urology | Ausgabe 11/2023

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Abstract

Purpose

To summarize evidence regarding the use of neoadjuvant (NAC) and adjuvant chemotherapy (AC) among patients treated with radical nephroureterectomy (RNU).

Methods

A comprehensive literature search of PubMed (MEDLINE), EMBASE and the Cochrane library was performed to identify any original or review article on the role of perioperative chemotherapy for UTUC patients treated with RNU.

Results

With regards to NAC, retrospective studies consistently suggested that it may be associated with better pathological downstaging (pDS) ranging from 10.8 to 80% and complete response (pCR) ranging from 4.3 to 15%, while decreasing the risk of recurrence and death as compared to RNU alone. Even higher pDS ranging from 58 to 75% and pCR ranging from 14 to 38% were observed in single-arm phase II trials. With regards to AC, retrospective studies provided conflicting results although the largest report from the National Cancer Database suggested an overall survival benefit in pT3–T4 and/or pN + patients. In addition, a phase III randomized controlled trial showed that the use of AC was associated with a disease-free survival benefit (HR = 0.45; 95% CI = [0.30–0.68]; p = 0.0001) in pT2–T4 and/or pN + patients with acceptable toxicity profile. This benefit was consistent in all subgroups analyzed.

Conclusions

Perioperative chemotherapy improves oncological outcomes associated with RNU. Given the impact of RNU on renal function, the rational is stronger for the use of NAC which impacts final pathology and potentially prolongs survival. However, the level of evidence is stronger for the use of AC that has been proven to decrease the risk of recurrence after RNU with a potential survival benefit.

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Titel: The role of perioperative chemotherapy for upper tract urothelial carcinoma patients treated with radical nephroureterectomy
verfasst von: Ugo Pinar
Giorgio Calleris
Elisabeth Grobet-Jeandin
Pietro Grande
Daniel Benamran
Constance Thibault
Paolo Gontero
Morgan Rouprêt
Thomas Seisen
Publikationsdatum: 11.03.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: World Journal of Urology / Ausgabe 11/2023
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-023-04330-1

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The role of perioperative chemotherapy for upper tract urothelial carcinoma patients treated with radical nephroureterectomy