The Role of Systemic Chemotherapy in Management of Upper Tract Urothelial Cancer

Upper tract urothelial cancer (UTUC) accounts for roughly 5 % of all urothelial cancers. At presentation, 30 % of patients demonstrate invasive and/or locally advanced disease, 30–40 % have regional lymph node involvement, and 20 % harbor metastatic disease. Systemic recurrence and progression rates...

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Bibliographic Details
Published in:Current urology reports 2013-04, Vol.14 (2), p.94-101
Main Authors: Gayed, Bishoy A., Thoreson, Gregory R., Margulis, Vitaly
Format: Article
Language:English
Subjects:
Antineoplastic Agents - administration & dosage
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Carcinoma, Transitional Cell - drug therapy
Carcinoma, Transitional Cell - surgery
Chemotherapy, Adjuvant
Humans
Kidney Neoplasms - drug therapy
Kidney Neoplasms - surgery
Kidney Pelvis
Medicine
Medicine & Public Health
Neoadjuvant Therapy
Nephrectomy
Nephrology
Section Editor
Treatment Outcome
Ureter - surgery
Ureteral Neoplasms - drug therapy
Ureteral Neoplasms - surgery
Urology
Urothelial Cancer (A Sagalowsky
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Summary:Upper tract urothelial cancer (UTUC) accounts for roughly 5 % of all urothelial cancers. At presentation, 30 % of patients demonstrate invasive and/or locally advanced disease, 30–40 % have regional lymph node involvement, and 20 % harbor metastatic disease. Systemic recurrence and progression rates after surgery for patients with advanced disease range between 45–60 %. Five-year cancer specific survival rates for pT2 and pT3 tumors are 73 % and 40 %, respectively. Median survival for patients with pT4 disease is approximately 6 months. Nonetheless, there is a lack of improvement in the rates of systemic recurrence and progression in patients with advanced UTUC. Extrapolating evidence obtained from experience with multi-modal therapy of patients with urothelial bladder cancer, additional improvements in oncological outcomes for patients with UTUC can be achieved through integration of effective systemic chemotherapy with local tumor control. We provide an overview of the rationale and utilization strategies of peri-operative systemic chemotherapy in patients with UTUC.
ISSN:1527-2737
1534-6285
DOI:10.1007/s11934-013-0307-z