Perioperative chemotherapy in upper tract urothelial carcinoma: a comprehensive review

To evaluate the role of neoadjuvant (NAC) and adjuvant chemotherapy (AC) in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU).

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.

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%.

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.

World journal of urology. 2017 Jan 10 [Epub ahead of print]

Atiqullah Aziz, Jakub Dobruch, Kees Hendricksen, Luis A Kluth, Andrea Necchi, Aidan Noon, Michael Rink, Florian Roghmann, Roland Seiler, Paolo Gontero, Wassim Kassouf, Shahrokh F Shariat, Evanguelos Xylinas, Young Academic Urologists Urothelial Carcinoma Group of the European Association of Urology

Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Department of Urology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland., Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Department of Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Department of Urology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK., Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany., Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada., Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy., Department of Urology, McGill University Health Center, Montreal, QC, Canada., Department of Urology, Medical University of Vienna, Vienna, Austria., Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, 27, rue du Faubourg Saint Jacques, 75014, Paris, France. .