title: Radiotherapy may improve overall survival of patients with T3/T4 transitional cell carcinoma of the renal pelvis or ureter and delay bladder tumour relapse.
abstract: BACKGROUND
  Since transitional cell carcinoma (TCC) of the upper urinary tract is a relatively uncommon malignancy, the role of adjuvant radiotherapy is unknown.
  
  
  METHODS
  We treated 133 patients with TCC of the renal pelvis or ureter at our institution between 1998 and 2008. The 67 patients who received external beam radiotherapy (EBRT) following surgery were assigned to the radiation group (RT). The clinical target volume included the renal fossa, the course of the ureter to the entire bladder, and the paracaval and para-aortic lymph nodes, which were at risk of harbouring metastatic disease in 53 patients. The tumour bed or residual tumour was targeted in 14 patients. The median radiation dose administered was 50 Gy. The 66 patients who received intravesical chemotherapy were assigned to the non-radiation group (non-RT).
  
  
  RESULTS
  The overall survival rates for the RT and non-RT groups were not significantly different (p = 0.198). However, there was a significant difference between the survival rates for these groups based on patients with T3/T4 stage cancer. A significant difference was observed in the bladder tumour relapse rate between the irradiated and non-irradiated bladder groups (p = 0.004). Multivariate analysis indicated that improved overall survival was associated with age < 60 years, T1 or T2 stage, absence of synchronous LN metastases, and EBRT. Acute gastrointestinal and bladder reactions were the most common symptoms, but mild non-severe (> grade 3) hematologic symptoms also occurred.
  
  
  CONCLUSIONS
  EBRT may improve overall survival for patients with T3/T4 cancer of the renal pelvis or ureter and delay bladder tumour recurrence in all patients.
authors.affiliation: Department of Radiation Oncology of Zhongshan hospital, Fudan University, 136 Yi Xue Yuan Road, Shanghai 200032, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Chen
authors.forename: Zhao-Chong
authors.initials: ZC
authors.lastname: Zeng
authors.forename: Guo-Min
authors.initials: GM
authors.lastname: Wang
authors.forename: Li
authors.initials: L
authors.lastname: Zhang
authors.forename: Zong-Ming
authors.initials: ZM
authors.lastname: Lin
authors.forename: Li-An
authors.initials: LA
authors.lastname: Sun
authors.forename: Tong-Yu
authors.initials: TY
authors.lastname: Zhu
authors.forename: Li-Li
authors.initials: LL
authors.lastname: Wu
authors.forename: Jian-Ying
authors.initials: JY
authors.lastname: Zhang
authors.forename: Yuan
authors.initials: Y
authors.lastname: Ji
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000855:Anorexia / Q000209:etiology; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007682:Kidney Pelvis / Q000187:drug effects / Q000528:radiation effects* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D009367:Neoplasm Staging; D011379:Prognosis; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods; D011879:Radiotherapy Dosage; D016896:Treatment Outcome; D014513:Ureter / Q000187:drug effects / Q000528:radiation effects* / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery