title: Adjuvant radiotherapy with and without concurrent chemotherapy for locally advanced transitional cell carcinoma of the renal pelvis and ureter.
abstract: OBJECTIVE
  Transitional cell carcinoma of the upper urinary tract is a relatively uncommon malignancy. The role of adjuvant radiation therapy and chemotherapy is not well defined. We retrospectively reviewed the records of 31 patients who underwent surgery followed by adjuvant radiotherapy with or without concurrent chemotherapy to determine overall outcome as well as impact of concurrent chemotherapy administration.
  
  
  METHODS
  Between 1970 and 1997, 31 patients with nonmetastatic transitional cell carcinoma of the upper urinary tract (renal pelvis in 13, ureter in 15, and renal pelvis and ureter in 3) were treated with radiotherapy following attempted curative resection. Most patients (28 of 31) had T3/4 and/or N+ disease. The median radiation dose was 46.9 Gy. Nine patients received methotrexate, cisplatin and vinblastine chemotherapy for 2 to 4 cycles, followed by concurrent cisplatin with radiation.
  
  
  RESULTS
  Median followup was 2.6 years in all patients and 8.5 years in survivors. Median survival in all patients was 2.4 years. Of the patients 16 (52%) experienced disease relapse, including 9 (29%) with distant metastases alone. Seven patients (23%) experienced locoregional failure with distant metastases developing in all except 1 within 8 months of locoregional failure diagnosis. Five-year actuarial overall survival, disease specific survival, locoregional control and metastasis-free survival rates were 39%, 52%, 67% and 48%, respectively. On univariate analysis patients had improved 5-year actuarial overall and disease specific survival with the administration of concurrent chemotherapy (27% vs 67%, p = 0.01 and 41% vs 76%, p = 0.06, respectively).
  
  
  CONCLUSIONS
  Our series suggests that the addition of concurrent cisplatin to adjuvant radiotherapy improves the ultimate outcome in patients with resected, locally advanced upper tract urothelial malignancies. This regimen should be considered in patients with T3/4 and/or node positive upper tract transitional cell carcinoma.
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA. czito001@mc.duke.edu
authors.forename: Brian
authors.initials: B
authors.lastname: Czito
authors.forename: Anthony
authors.initials: A
authors.lastname: Zietman
authors.forename: Donald
authors.initials: D
authors.lastname: Kaufman
authors.forename: Uri
authors.initials: U
authors.lastname: Skowronski
authors.forename: William
authors.initials: W
authors.lastname: Shipley
mesh_terms: D000206:Actuarial Analysis; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D007682:Kidney Pelvis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D010043:Outcome and Process Assessment, Health Care; D011838:Radiation-Sensitizing Agents / Q000627:therapeutic use; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate; D014513:Ureter / Q000473:pathology / Q000601:surgery; D014516:Ureteral Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery
chemical_list: D011838:Radiation-Sensitizing Agents; D002945:Cisplatin