ADJUVANT CHEMOTHERAPY WITH CISPLATIN / CYCLOPHOSPHAMIDE / DOXORUBICIN FOR PATIENTS WITH UROTHELIAL CARCINOMA OF THE UPPER URINARY TRACT

Abstract

Background Urothelial carcinoma of the upper urinary tract is relatively uncommon and the benefit of adjuvant chemotherapy has not yet been established. We evaluated the efficacy of adjuvant chemotherapy after radical surgery for patients with primary urothelial carcinoma of the renal pelvis and ureter in a randomized controlled trial. Methods Forty patients who underwent radical surgery for localized and locally-invasive upper urinary tract carcinoma without metastasis were randomly assigned to two groups treated with and without adjuvant chemotherapy using cisplatin, cyclophosphamide and doxorubicin (CISCA) to compare the overall, cancer-specific, and recurrence-free survivals between them. UFT was administered orally at a dose of 200-400 mg/day to both groups for 2 years after surgery. Results The median follow-up was 80.5 months. The overall survival and cancer-specific survival rates showed no significant differences (P=0.61 and P=O.28, respectively) between the two groups. The 10-year recurrence-free survival rates also showed no difference between the 2 groups treated with and without adjuvant chemotherapy (68.8% and 54.4%, respectively, P=0.20). All recurrent cases showed recurrence of non-muscle invasive bladder cancer, and thereafter only one patient progressed with distant metastasis. The morbidity of recurrence, particularly within 2 years, and the total number of recurrences tended to be smaller in the adjuvant chemotherapy group than in the non-adjuvant chemotherapy group (P＜0.063). Conclusion Adjuvant chemotherapy with CISCA after radical surgery showed no significant survival benefit for the patients with localized and locally-invasive urothelial carcinoma of the upper urinary tract while recurrence of bladder cancer decreased significantly in the adjuvant chemotherapy group compared to the non-adjuvant group.