Patients with advanced nonmetastatic upper tract urothelial carcinoma (UTUC) may benefit from adjuvant radiation treatment, according to investigators.
In a multicenter study of data from 222 patients with pT3 UTUC who underwent radical nephroureterectomy, those who received adjuvant radiotherapy, compared with those who did not, had significantly improved 5-year local recurrence-free survival (83.9% vs 54.2%), 5-year distant metastasis-free survival (72.1% vs 48.1%), and 5-year cancer-specific survival (76.4% vs. 55.5%) after propensity score matching.
Patients who received adjuvant radiotherapy, compared with those who did not, had greater proportions of patients with ureter involvement (94.9 vs 64.5%), high-grade disease (97.4 vs 84.2%), lymph node involvement (53.8 vs 35.0%), and positive surgical margins (25.6 vs 7.7%).
The study found no significant difference in these outcomes between patients who received adjuvant chemotherapy and those who did not.
“Our findings that adjuvant radiotherapy significantly reduces not only local recurrence but
also distant metastasis in locally advanced UTUC are interesting,” investigators led by Myong Kim, MD, PhD, of Seoul National University Bundang Hospital, Seoul National
University College of Medicine, Sungnam, Korea, reported in the International Journal of Radiation Oncology Biology, Physics. “Patients with adverse pathologic characteristics can harbor occult remnant tumors, which cannot be detected by imaging or LND [lymph node dissection]. Our results suggest that radiation therapy for local treatment might also be helpful in controlling these occult remnant diseases.”
Of the 222 patients, 39 (17.6%) and 74 (33.3%) received adjuvant radiotherapy and adjuvant chemotherapy, respectively. Another 17 patients (7.7%) received concomitant adjuvant radiotherapy plus chemotherapy. The study population had a median follow-up duration of 34.4 months after nephroureterectomy. At the time of nephroureterectomy, the study population had a median age of 68 years; 65.8% of patients were men.
Kim M, Kim JK, Lee J, et al. Adjuvant treatments for advanced stage, non-metastatic upper tract urothelial carcinoma: A multicenter study. Int J Radiat Oncol Biol Phys. 2019; published online ahead of print.