Adjuvant Treatments for Advanced Stage, Non-metastatic Upper Tract Urothelial Carcinoma

A Multicenter Study

Myong Kim, Jong Keun Kim, Jaehoon Lee, Young Seok Kim, Jae Lyun Lee, Cheol Kwak, Chang Wook Jeong, Seok-Soo Byun, Sang Cheol Lee, Chikara Ohyama, Youichi Arai, Hanjong Ahn

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Purpose: We assessed the efficacy of adjuvant treatments in patients with peripelvic/periureteral fat-infiltrating (pT3b), nonmetastatic upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy. Methods and Materials: The multicenter data of 222 patients with pT3bN0-x disease treated with radical nephroureterectomy were analyzed. The effects of adjuvant radiation therapy and chemotherapy on local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and cancer-specific survival (CSS) were evaluated. Results: Adjuvant radiation therapy and chemotherapy were given to 39 (17.6%) and 74 patients (33.3%), respectively. Seventeen patients (7.7%) received concomitant adjuvant radiation therapy and chemotherapy. The median follow-up duration was 34.4 months. After adjusting for age, sex, tumor location, multifocality, tumor grade, presence of lymphovascular invasion, surgical margin, execution of node dissection, and other types of concomitant adjuvant treatment (radiation therapy or chemotherapy) through propensity-scored matching, adjuvant radiation therapy significantly reduced the local recurrence (5-year LRFS, 83.9 vs 54.2%; P = .001), distant metastasis (5-year DMFS, 72.1 vs 48.1%; P = .032), and cancer-specific death (5-year CSS, 76.4% vs 55.5%; P = .038) in pT3b UTUC. However, in the same condition, adjuvant chemotherapy did not reduce the local recurrence (5-year LRFS, 69.0% vs 66.2%; P = .786), distant metastasis (5-year DMFS, 65.3% vs 61.1%; P = .436), and cancer-specific death (5-year CSS, 67.9% vs. 67.9%; P = .458) in pT3b UTUC. Conclusions: Our study suggests that adjuvant radiation therapy may be beneficial in patients with T3bN0-x UTUC; however, prospective clinical trials are needed to clarify this issue.

Original languageEnglish
Pages (from-to)819-827
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Volume104
Issue number4
DOIs
StatePublished - 15 Jul 2019

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Multicenter Studies
cancer
Carcinoma
metastasis
Survival
chemotherapy
radiation therapy
Radiotherapy
Neoplasm Metastasis
Recurrence
Neoplasms
Drug Therapy
Therapeutics
death
tumors
dissection
fats
Adjuvant Chemotherapy
Dissection
margins

Cite this

Kim, Myong ; Kim, Jong Keun ; Lee, Jaehoon ; Kim, Young Seok ; Lee, Jae Lyun ; Kwak, Cheol ; Jeong, Chang Wook ; Byun, Seok-Soo ; Lee, Sang Cheol ; Ohyama, Chikara ; Arai, Youichi ; Ahn, Hanjong. / Adjuvant Treatments for Advanced Stage, Non-metastatic Upper Tract Urothelial Carcinoma : A Multicenter Study. In: International Journal of Radiation Oncology Biology Physics. 2019 ; Vol. 104, No. 4. pp. 819-827.
@article{df21cf89d4a04fc68a0ac3b2e6735d0a,
title = "Adjuvant Treatments for Advanced Stage, Non-metastatic Upper Tract Urothelial Carcinoma: A Multicenter Study",
abstract = "Purpose: We assessed the efficacy of adjuvant treatments in patients with peripelvic/periureteral fat-infiltrating (pT3b), nonmetastatic upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy. Methods and Materials: The multicenter data of 222 patients with pT3bN0-x disease treated with radical nephroureterectomy were analyzed. The effects of adjuvant radiation therapy and chemotherapy on local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and cancer-specific survival (CSS) were evaluated. Results: Adjuvant radiation therapy and chemotherapy were given to 39 (17.6{\%}) and 74 patients (33.3{\%}), respectively. Seventeen patients (7.7{\%}) received concomitant adjuvant radiation therapy and chemotherapy. The median follow-up duration was 34.4 months. After adjusting for age, sex, tumor location, multifocality, tumor grade, presence of lymphovascular invasion, surgical margin, execution of node dissection, and other types of concomitant adjuvant treatment (radiation therapy or chemotherapy) through propensity-scored matching, adjuvant radiation therapy significantly reduced the local recurrence (5-year LRFS, 83.9 vs 54.2{\%}; P = .001), distant metastasis (5-year DMFS, 72.1 vs 48.1{\%}; P = .032), and cancer-specific death (5-year CSS, 76.4{\%} vs 55.5{\%}; P = .038) in pT3b UTUC. However, in the same condition, adjuvant chemotherapy did not reduce the local recurrence (5-year LRFS, 69.0{\%} vs 66.2{\%}; P = .786), distant metastasis (5-year DMFS, 65.3{\%} vs 61.1{\%}; P = .436), and cancer-specific death (5-year CSS, 67.9{\%} vs. 67.9{\%}; P = .458) in pT3b UTUC. Conclusions: Our study suggests that adjuvant radiation therapy may be beneficial in patients with T3bN0-x UTUC; however, prospective clinical trials are needed to clarify this issue.",
author = "Myong Kim and Kim, {Jong Keun} and Jaehoon Lee and Kim, {Young Seok} and Lee, {Jae Lyun} and Cheol Kwak and Jeong, {Chang Wook} and Seok-Soo Byun and Lee, {Sang Cheol} and Chikara Ohyama and Youichi Arai and Hanjong Ahn",
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Adjuvant Treatments for Advanced Stage, Non-metastatic Upper Tract Urothelial Carcinoma : A Multicenter Study. / Kim, Myong; Kim, Jong Keun; Lee, Jaehoon; Kim, Young Seok; Lee, Jae Lyun; Kwak, Cheol; Jeong, Chang Wook; Byun, Seok-Soo; Lee, Sang Cheol; Ohyama, Chikara; Arai, Youichi; Ahn, Hanjong.

In: International Journal of Radiation Oncology Biology Physics, Vol. 104, No. 4, 15.07.2019, p. 819-827.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Adjuvant Treatments for Advanced Stage, Non-metastatic Upper Tract Urothelial Carcinoma

T2 - A Multicenter Study

AU - Kim, Myong

AU - Kim, Jong Keun

AU - Lee, Jaehoon

AU - Kim, Young Seok

AU - Lee, Jae Lyun

AU - Kwak, Cheol

AU - Jeong, Chang Wook

AU - Byun, Seok-Soo

AU - Lee, Sang Cheol

AU - Ohyama, Chikara

AU - Arai, Youichi

AU - Ahn, Hanjong

N1 - Copyright © 2019 Elsevier Inc. All rights reserved.

PY - 2019/7/15

Y1 - 2019/7/15

N2 - Purpose: We assessed the efficacy of adjuvant treatments in patients with peripelvic/periureteral fat-infiltrating (pT3b), nonmetastatic upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy. Methods and Materials: The multicenter data of 222 patients with pT3bN0-x disease treated with radical nephroureterectomy were analyzed. The effects of adjuvant radiation therapy and chemotherapy on local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and cancer-specific survival (CSS) were evaluated. Results: Adjuvant radiation therapy and chemotherapy were given to 39 (17.6%) and 74 patients (33.3%), respectively. Seventeen patients (7.7%) received concomitant adjuvant radiation therapy and chemotherapy. The median follow-up duration was 34.4 months. After adjusting for age, sex, tumor location, multifocality, tumor grade, presence of lymphovascular invasion, surgical margin, execution of node dissection, and other types of concomitant adjuvant treatment (radiation therapy or chemotherapy) through propensity-scored matching, adjuvant radiation therapy significantly reduced the local recurrence (5-year LRFS, 83.9 vs 54.2%; P = .001), distant metastasis (5-year DMFS, 72.1 vs 48.1%; P = .032), and cancer-specific death (5-year CSS, 76.4% vs 55.5%; P = .038) in pT3b UTUC. However, in the same condition, adjuvant chemotherapy did not reduce the local recurrence (5-year LRFS, 69.0% vs 66.2%; P = .786), distant metastasis (5-year DMFS, 65.3% vs 61.1%; P = .436), and cancer-specific death (5-year CSS, 67.9% vs. 67.9%; P = .458) in pT3b UTUC. Conclusions: Our study suggests that adjuvant radiation therapy may be beneficial in patients with T3bN0-x UTUC; however, prospective clinical trials are needed to clarify this issue.

AB - Purpose: We assessed the efficacy of adjuvant treatments in patients with peripelvic/periureteral fat-infiltrating (pT3b), nonmetastatic upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy. Methods and Materials: The multicenter data of 222 patients with pT3bN0-x disease treated with radical nephroureterectomy were analyzed. The effects of adjuvant radiation therapy and chemotherapy on local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and cancer-specific survival (CSS) were evaluated. Results: Adjuvant radiation therapy and chemotherapy were given to 39 (17.6%) and 74 patients (33.3%), respectively. Seventeen patients (7.7%) received concomitant adjuvant radiation therapy and chemotherapy. The median follow-up duration was 34.4 months. After adjusting for age, sex, tumor location, multifocality, tumor grade, presence of lymphovascular invasion, surgical margin, execution of node dissection, and other types of concomitant adjuvant treatment (radiation therapy or chemotherapy) through propensity-scored matching, adjuvant radiation therapy significantly reduced the local recurrence (5-year LRFS, 83.9 vs 54.2%; P = .001), distant metastasis (5-year DMFS, 72.1 vs 48.1%; P = .032), and cancer-specific death (5-year CSS, 76.4% vs 55.5%; P = .038) in pT3b UTUC. However, in the same condition, adjuvant chemotherapy did not reduce the local recurrence (5-year LRFS, 69.0% vs 66.2%; P = .786), distant metastasis (5-year DMFS, 65.3% vs 61.1%; P = .436), and cancer-specific death (5-year CSS, 67.9% vs. 67.9%; P = .458) in pT3b UTUC. Conclusions: Our study suggests that adjuvant radiation therapy may be beneficial in patients with T3bN0-x UTUC; however, prospective clinical trials are needed to clarify this issue.

UR - http://www.scopus.com/inward/record.url?scp=85064273686&partnerID=8YFLogxK

U2 - 10.1016/j.ijrobp.2019.03.027

DO - 10.1016/j.ijrobp.2019.03.027

M3 - Article

VL - 104

SP - 819

EP - 827

JO - International Journal of Radiation Oncology Biology Physics

JF - International Journal of Radiation Oncology Biology Physics

SN - 0360-3016

IS - 4

ER -