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Adjuvant Chemotherapy With Paclitaxel and Carboplatin in Patients With Advanced Carcinoma of the Upper Urinary Tract: A Study by the Hellenic Cooperative Oncology Group

From the Departments of Clinical Therapeutics, and Department of Urology, University of Athens, School of Medicine; Medical Oncology Department, AHEPA Hospital, University of Thessaloniki, School of Medicine; 3 Hygia Hospital, Athens, Greece

Address reprint requests to Aristotle Bamias, MD, 31 Komninon St, Haidari 124 62, Athens, Greece; e-mail: abamias{at}med.uoa.gr

PURPOSE: 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.

PATIENTS AND METHODS: Thirty-six patients with tumor stage 3 or lymph node involvement were treated with four cycles of paclitaxel at 175 mg/m² 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.

CONCLUSION: Adjuvant chemotherapy with paclitaxel and carboplatin is feasible and may reduce the risk of distant metastases in high-risk upper urinary tract carcinoma.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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