Impact of perioperative chemotherapy on survival in patients with advanced primary urethral cancer: Results of the international collaboration on primary urethral carcinoma.

Abstract

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.

Partial Urethrectomy for Female Urethral Transitional Epithelial Cell Carcinoma

“…Lokal nüks için ise literatürün önerdiği kemoradyoterapi uygulandı. Yakın zamanda yapılan retrospektif bir çalışmada lokal ileri evre hastalığı olan hastalarda cerrahi öncesi verilecek sisplatin bazlı kombine kemoterapilerin etkili olduğu, lenf nodu pozitif olan hastalarda dahi sağkalımı uzattığı bildirilmektedir (8…”

Current Disease Management of Primary Urethral Carcinoma

“…1, and Tables 1 and 2) [11][12][13][14][15][16][17][18][19][20]. Two large multicentric studies reported on the same cohort [14,15]. Three other studies were of single-center nature [13,16,21].…”

“…A total of 12 studies with 7853 patients were included according to the statement of Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) protocols ( Fig. 1, and Tables 1 and 2) [11][12][13][14][15][16][17][18][19][20]. Two large multicentric studies reported on the same cohort [14,15].…”

“…This strategy has, indeed, become the preferred option. A distal location of the primary tumor has been shown to result in better survival [14,15,17]. Of note, the NCCN always recommends urethrectomy in men with or without cystoprostatectomy if the tumor is located in the bulbous urethra [23].…”

“…Similar to bladder cancer [51], perioperative CHT seems to improve oncological survival. Reported alternatives for patients who are unable to receive a platinum-based CHT are rare and consist of mitomycin/5-fluorouracil with or without RT, paclitaxel with or without gemcitabine, carmustin/interleukin-2, or dacarbazine [14,16]. Mitomycin and 5-fluorouracil in combination with concurrent RT showed promising results, with more than half of the patients being disease free after 5 yr [48].…”