Management of Patients With Upper Urinary Tract Transitional Cell Carcinoma

Neoadjuvant and Adjuvant Chemotherapy

Urothelial tumors of the upper urinary tract are chemosensitive tumors.^[3,25,27] Most of the data regarding the clinical efficacy of chemotherapy in the neoadjuvant and adjuvant settings are based on experience from bladder TCC. The theoretical advantage of chemotherapy in the neoadjuvant setting includes eradication of subclinical metastatic disease, better tolerability before surgical extirpation, and the ability to deliver higher doses than in the adjuvant setting.^[3] Both the Advanced Bladder Cancer Meta-analysis Collaboration and the Southwest Oncology group have presented compelling data for the use of neoadjuvant platinum-based chemotherapy regimens before radical cystectomy.^[104,105] Regimens comprised of gemcitabine and cisplatin that provide a similar survival advantage to methotrexate–vinblastine–doxorubicin–cisplatin (MVAC), with a better safety profile and tolerability, increase the attractiveness of neoadjuvant chemotherapy.^[106] Similar management strategies are likely to be beneficial for upper-tract TCC, particularly in the setting of large, bulky tumors.

The role of adjuvant chemotherapy, however, is poorly defined with no randomized studies for bladder TCC available for comparison. Consensus opinion is that patients with pT3 disease or worse or pathologic lymph node involvement would be likely to benefit from adjuvant chemotherapy.^[3]

Nat Clin Pract Urol. 2007;4(8):432-443. © 2007 Nature Publishing Group

The authors declared no competing interests.