title: Perioperative chemotherapy in upper tract urothelial carcinoma: a comprehensive review.
abstract: OBJECTIVE
  To evaluate the role of neoadjuvant (NAC) and adjuvant chemotherapy (AC) in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU).
  
  
  METHODS
  A comprehensive review of the current literature was performed searching for all studies investigating NAC and AC in UTUC in MEDLINE and https://clinicaltrials.gov , prior to April 2016. The following keywords were used: "ureteral neoplasms," "urothelium," "ureter," "upper tract urothelial," "chemotherapy," "adjuvant," "neoadjuvant" and relevant variants.
  
  
  RESULTS
  No randomized trials investigated the role of AC or NAC for UTUC. There was one prospective study with n = 36 patients investigating AC with carboplatin-paclitaxel. We included 14 retrospective studies (four in the NAC and ten in the AC setting), with a total of 694 patients receiving cisplatin-based or non-cisplatin-based AC after RNU and 1437 patients undergoing RNU alone. We found that the current literature, mainly based on retrospective studies, suggests significant overall and cancer-specific survival benefits for AC in UTUC. NAC appears promising, with favorable pathologic response rates up to 14%.
  
  
  CONCLUSIONS
  Evidence is scarce for both NAC and AC use in UTUC. This comprehensive review suggests promising response rates for NAC and a survival benefit for patients treated with AC. Prospective randomized trials are needed to establish the role of AC and NAC in UTUC.
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Atiqullah
authors.initials: A
authors.lastname: Aziz
authors.affiliation: Department of Urology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland.
authors.forename: Jakub
authors.initials: J
authors.lastname: Dobruch
authors.affiliation: Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: Kees
authors.initials: K
authors.lastname: Hendricksen
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Luis A
authors.initials: LA
authors.lastname: Kluth
authors.affiliation: Department of Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Necchi
authors.affiliation: Department of Urology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.
authors.forename: Aidan
authors.initials: A
authors.lastname: Noon
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Rink
authors.affiliation: Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Roghmann
authors.affiliation: Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada.|Department of Urology, University of Bern, Bern, Switzerland.
authors.forename: Roland
authors.initials: R
authors.lastname: Seiler
authors.affiliation: Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Gontero
authors.affiliation: Department of Urology, McGill University Health Center, Montreal, QC, Canada.
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna, Austria.
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.affiliation: Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, 27, rue du Faubourg Saint Jacques, 75014, Paris, France. evanguelosxylinas@hotmail.com.|INSERM U955 Eq07 Department of Urology, CHU Mondor, 51, avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France. evanguelosxylinas@hotmail.com.
authors.forename: Evanguelos
authors.initials: E
authors.lastname: Xylinas
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant / Q000379:methods*; D002945:Cisplatin / Q000008:administration & dosage; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy*; D007682:Kidney Pelvis; D020360:Neoadjuvant Therapy / Q000379:methods*; D009392:Nephrectomy; D017239:Paclitaxel / Q000008:administration & dosage; D014513:Ureter / Q000601:surgery; D014516:Ureteral Neoplasms / Q000188:drug therapy*; D013520:Urologic Surgical Procedures
chemical_list: D016190:Carboplatin; D017239:Paclitaxel; D002945:Cisplatin
keywords: Adjuvant chemotherapy; Neoadjuvant chemotherapy; Radical nephroureterectomy; Upper urinary tract tumors; Urothelial carcinoma