Radiographic response after neoadjuvant chemotherapy (NAC) for upper tract urothelial carcinoma (UTUC) correlates with pathologic response at the time of nephroureterectomy or distal ureterectomy, Jonathan Coleman, MD, of Memorial Sloan Kettering Cancer Center in New York City, and colleagues reported at the 20th annual meeting of the Society of Urologic Oncology in Washington DC.

In a phase 2 trial of 43 patients with high-risk localized UTUC (ie, high grade disease on biopsy and/or radiographic evidence of cT2-4 disease with positive select cytology), 9 patients had pT0N0, 18 pT1N0, and 16 higher than pT1N0. All underwent computed tomography urography (CTU) before and after NAC unless contraindicated. The initially visible lesion was deemed a mass in 34 (median pre-NAC size: 3.1 cm) and thickening in 9. UTUC disease appeared in the renal pelvis alone in 25 cases, ureter alone in 13, and both areas in 5. Twenty-six patients (60.5%) also displayed hydronephrosis prior to chemotherapy.

After 4 cycles of gemcitabine and cisplatin for NAC, 10 patients experienced a complete response, 20 had a partial response, and 13 had stable disease. None showed radiographic progression during chemotherapy.

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Patients with a complete radiographic response were far more likely to have a pathologic response (pT1N0 or lower) than patients with a partial response (90% vs 65%) or stable disease (90% vs 38%).

“Radiographic response, in addition to other pre-operative predictors, may play a useful role in counseling and optimizing management of patients with UTUC,” Dr Coleman and his team concluded.

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Tracey A, Wong N, Ghafoor S, et al. Radiographic predictors of pathologic response to neoadjuvant chemotherapy in patients with high-grade upper tract urothelial carcinoma: Results of a phase II clinical trial. Presented at the 20th annual meeting of the Society of Urologic Oncology held December 4 to 6, 2019, in Washington DC. Poster 157.