NEOADJUVANT CHEMOTHERAPY FOR LOCALLY ADVANCED UROTHELIAL CANCER OF THE UPPER URINARY-TRACT

Cisplatin-based multiple-drug chemotherapy is currently considered the most effective treatment for advanced and metastatic urothelial cance rs. We treated 15 patients with Locally advanced urothelial cancers of the upper urinary tract using the cisplatin-based multiple-drug regim en in a neoadjuvant setting. The regimens administered were: M.-VAC (m ethotrexate, vinblastine, doxorubicin and cisplatin); MEC (methotrexat e, etoposide and cisplatin), or M-VEC (methotrexate, vinblastine, epir ubicin and cisplatin). Total nephroureterectomy was performed in all p atients and response was evaluated pathologically. Of 15 patients 2 (1 3%) achieved a pathological complete response, 6 (40%) a pathological partial response, for an overall response rate of 53% (95% confidence limits 29-77%). The median durations of response were 54 months for pa tients with a pathological complete response and 15.5 months for patie nts with a pathological partial response. One of six patients with a p athological partial response and 4 of 7 with no remission died of canc er. While a positive relationship between the pathological response an d prognosis was observed, adequate follow-up is needed to assess the a bility of neoadjuvant chemotherapy to improve the prognosis of patient s with locally advanced urothelial cancer of the upper urinary tract.