title: Utilization of Systemic Chemotherapy in Advanced Urothelial Cancer: A Retrospective Collaborative Study by the Hellenic Genitourinary Cancer Group (HGUCG).
abstract: BACKGROUND
  Advanced urothelial cancer (AUCa) is associated with poor long-term survival. Two major concerns are related to nonexposure to cisplatin-based chemotherapy and poor outcome after relapse. Our purpose was to record patterns of practice in AUCa in Greece, focusing on first-line treatment and management of relapsed disease.
  
  
  METHODS
  Patients with AUCa treated from 2011 to 2013 were included in the analysis. Fitness for cisplatin was assessed by recently established criteria.
  
  
  RESULTS
  Of 327 patients treated with first-line chemotherapy, 179 (55%) did not receive cisplatin. Criteria for unfitness for cisplatin were: Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≥ 2, 21%; creatinine clearance ≤ 60 mL/min, 55%; hearing impairment, 8%; neuropathy, 1%; and cardiac failure, 5%. Forty-six patients (27%) did not fulfill any criterion for unfitness for cisplatin. The main reasons for these deviations were comorbidities (28%) and advanced age (32%). Seventy-four (68%) of 109 patients who experienced a relapse received second-line chemotherapy. The most frequent reason for not offering second-line chemotherapy was poor PS or limited life expectancy (66%).
  
  
  CONCLUSIONS
  In line with international data, approximately 50% of Greek patients with AUCa do not receive cisplatin-based chemotherapy, although 27% of them were suitable for such treatment. In addition, about one third of patients with relapse did not receive second-line chemotherapy because of poor PS or short life expectancy. Enforcing criteria for fitness for cisplatin and earlier diagnosis of relapse represent 2 targets for improvement in current treatment practice for AUCa.
authors.affiliation: Department of Clinical Therapeutics, University of Athens, Athens, Greece.
authors.forename: Aristotle
authors.initials: A
authors.lastname: Bamias
authors.affiliation: Division of Oncology, Department of Medicine, University Hospital, University of Patras Medical School, Patras, Greece.
authors.forename: Stavros
authors.initials: S
authors.lastname: Peroukidis
authors.affiliation: 1st Department of Medical Oncology, "Agios Savvas" Hospital, Athens, Greece.
authors.forename: Sophia
authors.initials: S
authors.lastname: Stamatopoulou
authors.affiliation: Department of Clinical Therapeutics, University of Athens, Athens, Greece.
authors.forename: Kimon
authors.initials: K
authors.lastname: Tzannis
authors.affiliation: Department of Clinical Therapeutics, University of Athens, Athens, Greece. Electronic address: koutsoukos.k@gmail.com.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Koutsoukos
authors.affiliation: 3rd Department of Clinical Oncology, Theagenion Cancer Hospital, Thessaloniki, Greece.
authors.forename: Charalambos
authors.initials: C
authors.lastname: Andreadis
authors.affiliation: Department of Medical Oncology, University Hospital of Heraklion, and Medical School, University of Crete, Heraklion, Crete, Greece.
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Bozionelou
authors.affiliation: "Mitera" Hospital, Athens, Greece.
authors.forename: Nikos
authors.initials: N
authors.lastname: Pistalmatzian
authors.affiliation: 2nd Department of Urology, Sismanoglio Hospital, School of Medicine, University of Athens, Athens, Greece.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Papatsoris
authors.affiliation: Department of Urology, Athens University Medical School, Laiko Hospital, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Stravodimos
authors.affiliation: Department of Medical Oncology, General Hospital of Chania, Chania, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Varthalitis
authors.affiliation: "Lefkos Stavros" Hospital, Athens, Greece.
authors.forename: Michalis
authors.initials: M
authors.lastname: Karamouzis
authors.affiliation: Department of Medical Oncology, Venizelio Hospital, Heraklion, Greece.
authors.forename: Georgia
authors.initials: G
authors.lastname: Milaki
authors.affiliation: 3rd Department of Clinical Oncology, Theagenion Cancer Hospital, Thessaloniki, Greece.
authors.forename: Antonios
authors.initials: A
authors.lastname: Agorastos
authors.affiliation: Medical Oncology Department, 251 General Air Force Hospital, Athens, Greece.
authors.forename: Nikos
authors.initials: N
authors.lastname: Kentepozidis
authors.affiliation: Department of Medical Oncology, Venizelio Hospital, Heraklion, Greece.
authors.forename: Nikos
authors.initials: N
authors.lastname: Androulakis
authors.affiliation: Department of Medical Oncology, General Hospital of Chania, Chania, Greece.
authors.forename: Iliada
authors.initials: I
authors.lastname: Bompolaki
authors.affiliation: Division of Oncology, Department of Medicine, University Hospital, University of Patras Medical School, Patras, Greece.
authors.forename: Haralampos
authors.initials: H
authors.lastname: Kalofonos
authors.affiliation: Department of Medical Oncology, University Hospital of Heraklion, and Medical School, University of Crete, Heraklion, Crete, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Mavroudis
authors.affiliation: Department of Clinical Therapeutics, University of Athens, Athens, Greece.
authors.forename: Meletios A
authors.initials: MA
authors.lastname: Dimopoulos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000627:therapeutic use*; D005260:Female; D006115:Greece; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014571:Urologic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D019459:Urothelium / Q000473:pathology*
chemical_list: D002945:Cisplatin
keywords: Advanced urothelial cancer; Fitness for cisplatin; Patterns of practice