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Systemic Chemotherapy for Upper Tract Urothelial Cancer

  • Surena F. Matin
Chapter

Abstract

Radical nephroureterectomy (RNU) with bladder cuff removal is considered the standard of care for most UTUC, but can be insufficient treatment for locally advanced cases, where recurrences are high and survival is short. Multimodality treatment with neoadjuvant and adjuvant chemotherapy has been an area of interest. Neoadjuvant chemotherapy (NAC) takes advantage of a patient’s maximal renal function, allowing optimal delivery of cisplatin-based regimens. Available single center retrospective series suggest a higher rate of pathological complete response with NAC as well as significantly improved 5 year overall and cancer-specific survival. A current trial evaluating NAC for both renally sufficient and renally impaired patients is currently underway. Adjuvant chemotherapy has primarily been analyzed in small retrospective uncontrolled series without consistent or convincing evidence of benefit. This is largely contributed by the high incidence of renal insufficiency after nephroureterectomy, as well as patient intolerance. A European prospective phase 3 study of adjuvant chemotherapy is underway.

Keywords

Upper tract urothelial cancer Chemotherapy Neoadjuvant Adjuvant 

Notes

Acknowledgements

The author would like to recognize the Monteleone Family Professorship for Research in Kidney and Bladder Cancer and the Eleanor and Scott Petty Fund for UTUC Research for their support.

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of UrologyUniversity of Texas MD Anderson Cancer CenterHoustonUSA

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