Recommendations of adjuvant therapy after surgical resection of UTUC was updated in NCCN guideline of 2021.Adjuvant radiotherapy combined with chemotherapy was recommended for patients of T3-4 or N+. However, the renal insufficiency after RNU limits the use of adjuvant chemotherapy of UTUC. Adjuvant radiotherapy alone may be another option. This study aims to verify the real-world choices and effectiveness of adjuvant therapies in UTUC patients with recurrence risk factors.
Patients with high recurrence factors (T2-4, N+, G3 and multifocal tumor) of UTUC patients after radical nephroureterectomy (RNU) in our hospital since 2020 were prospectively recommended to use adjuvant therapy. Patients' adverse events, recurrence and survival rates were investigated. This trial was registered at Chinese Clinical Trial Registry (ChiCTR2100044477).
Between 2020 and 2022, 195 UTUC patients with recurrence factors had been enrolled. The median follow up time was 13 months. Nearly half of the patients (90 patient) with high-risk factors refused to receive adjuvant treatment. The other 105 patients received adjuvant therapy. Thirty-six patients (34.3%) received adjuvant chemotherapy; 43 patients (41.0%) received adjuvant radiotherapy. Fifteen patients (14.3%) received adjuvant combination therapy (chemo-radiotherapy). The 1-year recurrence-free survival (RFS) rates were59.4% and77.5%, respectively in control group and adjuvant therapy group (P = 0.008). The 1-year overall survival (OS) rates were 89.7% and 98.2%, respectively in control group and adjuvant therapy group (P = 0.011). The 1-year recurrence-free survival (RFS) rates of adjuvant chemotherapy and radiotherapy were 58.6%.and 90.2% (P = 0.003). The combination therapy group had the most serious side effects, grade 3 and 2 hematotoxicity were 40% and 20% respectively. Grade 3 hematotoxicity were 22.2% for adjuvant chemotherapy group. Side effects of adjuvant radiotherapy alone were mild. Only one patient had grade 3 hematotoxicity.
Although both NCCN guidelines suggest UTUC patient with more than T2 stage and N+ to receive adjuvant therapy, nearly half of them refused any adjuvant therapies. The prognosis of these patients without adjuvant therapy were poor. The side effects of chemoradiotherapy in UTUC is serious. Adjuvant radiotherapy has less side effects and the effectiveness are equivalent to adjuvant chemotherapy in high risk UTUC patients.
International journal of radiation oncology, biology, physics. 2023 Oct 01 [Epub]
X Li, X S Gao, H Li
Department of Radiation Oncology, Peking University First Hospital, Beijing, China.