Cancer Treatment Today

One can proceed to look at the question of adjuvant chemotherapy by extrapolating from bladder cancer, or considering ureteral cancer as a separate condition and assess the eidence in it.

NCCN recommends consideration of both neopadjuvant and adjuvant chemo as a category 2A on p. BL-5 of its bladder cancer guidelines. In its descriptive section it says that it should be considered based on risk factors and nodal status. It recommends gemcitabine and cisplatin or MVAC and specifically not carboplatin for adjuvant therapy. In its decriptive section it says that it should be considered based on risk factors and nodal status. It recommends gemcitabine and cisplatin but specifically not carboplatin; even for patients with reduced renal function it recommends split dose cisplatin instead of carboplatin.

For ureteral cancer, the use and potential benefit of both adjuvant and neoadjuvant chemotherapy is largely extrapolated from bladder cancer data and retrospective chart reviews, but recent studies have suggested a potential for benefit.. A recurrence-free rate as high as 50% has been demonstrated; however, a survival benefit has not yet been definitively proved.
Studies addressing the issue have few patients and are nonrandomized.

In the Upper Tract Urothelial Carcinoma Collaboration, the use of adjuvant chemotherapy did not result in longer cancer-specific survival; however, in that study, the patients who received chemotherapy had higher grade and stage disease (P <0.001). The study included 1390 total patients; 542 were identified as high-risk (pT3N0, pT4N0, and/or N+) and 121 (22%) received adjuvant therapy.

Randomized studies would be necessary since the pattern of spread, drainage and patterns of failure differ in this cancer from bladder cancer.

Adjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysis of individual patient data Advanced Bladder Cancer (ABC) Meta-analysis Collaboration. Advanced Bladder Cancer (ABC) Meta-analysis Collaboration.Eur Urol. 2005 Aug;48(2):189-199; discussion 199-201.

Sternberg CN, Donat SM, Bellmunt J, Millikan RE, Stadler W, De Mulder P, Sherif A, von der Maase H, Tsukamoto T, Soloway MS Chemotherapy for bladder cancer: treatment guidelines for neoadjuvant chemotherapy, bladder preservation, adjuvant chemotherapy, and metastatic cancer.Urology. 2007 Jan;69(1 Suppl):62-79.

Sternberg CN, Donat SM, Bellmunt J, et al: Chemotherapy for bladder cancer: treatment guidelines for neoadjuvant chemotherapy, bladder preservation, adjuvant chemotherapy, and metastatic cancer. Urology 69:62-79,2007.

Audenet F, Yates DR, Cussenot O, Roupret M. The role of chemotherapy in the treatment of urothelial cell carcinoma of the upper urinary tract (UUT-UCC). Urol Oncol. 2010 Sep 28. [Medline]. Hellenthal NJ, Shariat SF, Margulis V, Karakiewicz PI, Roscigno M, Bolenz C. Adjuvant chemotherapy for high risk upper tract urothelial carcinoma: results from the Upper Tract Urothelial Carcinoma Collaboration. J Urol. 2009 Sep. 182(3):900-6.