title: Adjuvant chemotherapy with paclitaxel and carboplatin in patients with advanced carcinoma of the upper urinary tract: a study by the Hellenic Cooperative Oncology Group.
abstract: OBJECTIVE
  Radical surgery represents the treatment of choice for carcinoma of the upper urinary tract. Nevertheless, approximately 50% of patients with stage T >/= 3 or lymph node involvement die from their disease, mainly as a result of the development of distant metastases. Therefore, there is a need for effective adjuvant systemic treatment. We prospectively studied a cohort of patients who underwent surgery for high-risk carcinoma of the upper urinary tract to assess the feasibility of the combination of paclitaxel and carboplatin as adjuvant treatment.
  
  
  METHODS
  Thirty-six patients with tumor stage >/= 3 or lymph node involvement were treated with four cycles of paclitaxel at 175 mg/m(2) and carboplatin (area under the curve 5, Calvert Formula) every 3 weeks following surgery.
  
  
  RESULTS
  Median follow-up was 40.6 months. Chemotherapy was well tolerated with 32 patients (89%) receiving full carboplatin and paclitaxel doses without delays. The most frequent grade 3/4 toxicity was neutropenia (39%), which was complicated with fever in only one case (3%). Nonhematologic grade 3 or 4 toxicities were reported in only one case. Five-year survival was 52% (95% CI, 35% to 69%), while 5-year disease-free survival was 40.2% (95% CI, 15.8% to 64.6%). Local failure rate was 30%, as opposed to 17% of patients who developed distant metastases. No patients with grade 2 tumors relapsed during follow-up, as opposed to 60% of patients with grade 3 tumors.
  
  
  CONCLUSIONS
  Adjuvant chemotherapy with paclitaxel and carboplatin is feasible and may reduce the risk of distant metastases in high-risk upper urinary tract carcinoma.
authors.affiliation: Department of Clinical TherapeuticsUniversity of Athens, School of Medicine, Athens, Greece. abamias@med.uoa.gr
authors.forename: A
authors.initials: A
authors.lastname: Bamias
authors.forename: Ch
authors.initials: Ch
authors.lastname: Deliveliotis
authors.forename: G
authors.initials: G
authors.lastname: Fountzilas
authors.forename: D
authors.initials: D
authors.lastname: Gika
authors.forename: A
authors.initials: A
authors.lastname: Anagnostopoulos
authors.forename: M P
authors.initials: MP
authors.lastname: Zorzou
authors.forename: E
authors.initials: E
authors.lastname: Kastritis
authors.forename: C
authors.initials: C
authors.lastname: Constantinides
authors.forename: P
authors.initials: P
authors.lastname: Kosmidis
authors.forename: M A
authors.initials: MA
authors.lastname: Dimopoulos
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D007682:Kidney Pelvis; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage; D011446:Prospective Studies; D015996:Survival Rate; D014516:Ureteral Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery
chemical_list: D016190:Carboplatin; D017239:Paclitaxel