BACKGROUND: To investigate the impact of perioperative chemo(radio)therapy in advanced primary urethral carcinoma (PUC).
PATIENTS AND METHODS: A series of 124 patients (86 men, 38 women) were diagnosed with and underwent surgery for PUC in 10 referral centers between 1993 and 2012. Kaplan-Meier analysis with log-rank testing was used to investigate the impact of perioperative chemo(radio)therapy on overall survival (OS). The median follow-up was 21 months (mean: 32 months; interquartile range: 5-48).
RESULTS: Neoadjuvant chemotherapy (NAC), neoadjuvant chemoradiotherapy (N-CRT) plus adjuvant chemotherapy (ACH), and ACH was delivered in 12 (31%), 6 (15%) and 21 (54%) of these patients, respectively. Receipt of NAC/N-CRT was associated with clinically node-positive disease (cN+; P = 0.033) and lower utilization of cystectomy at surgery (P = 0.015). The objective response rate to NAC and N-CRT was 25% and 33%, respectively. The 3-year OS for patients with objective response to neoadjuvant treatment (complete/partial response) was 100% and 58.3% for those with stable or progressive disease (P = 0.30). Of the 26 patients staged ≥cT3 and/or cN+ disease, 16 (62%) received perioperative chemo(radio)therapy and 10 upfront surgery without perioperative chemotherapy (38%). The 3-year OS for this locally advanced subset of patients (≥cT3 and/or cN+) who received NAC (N = 5), N-CRT (N = 3), surgery-only (N = 10) and surgery plus ACH (N = 8) was 100%, 100%, 50% and 20%, respectively (P = 0.016). Among these 26 patients, receipt of neoadjuvant treatment was significantly associated with improved 3-year relapse-free survival (RFS) (P = 0.022) and OS (P = 0.022). Proximal tumor location correlated with inferior 3-year RFS and OS (P = 0.056/0.005).
CONCLUSION: In this series, patients who received NAC/N-CRT for cT3 and/or cN+ PUC appeared to demonstrate improved survival compared with those who underwent upfront surgery with or without ACH.
Written by:
Gakis G, Morgan TM, Daneshmand S, Keegan KA, Todenhoefer T, Mischinger J, Schubert T, Zaid HB, Hrbacek J, Ali-El-Dein B, Clayman RH, Galland S, Olugbade K, Rink M, Fritsche HM, Burger M, Chang SS, Babjuk M, Thalmann GN, Stenzl A, Efstathiou JA. Are you the author?
Department of Urology, University of Tuebingen, Tuebingen, Germany; Department of Urology, University of Michigan, Ann Arbor, USA; Institute of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles; Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, USA; Department of Urology, University of Tuebingen, Tuebingen, Germany; 2nd Medical School, Department of Urology, Charles University, Prague, Czech Republic; Urology and Nephrology Center, Mansoura Clinic, Mansoura, Egypt; Department of Radiooncology, Massachusetts General Hospital, Harvard Medical School, Boston, USA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg; Department of Urology, University Hospital Regensburg, Regensburg, Germany; Department of Urology, University Hospital Bern, Bern, Switzerland.
Reference: Ann Oncol. 2015 May 12. pii: mdv230.
doi: 10.1093/annonc/mdv230
PubMed Abstract
PMID: 25969370