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Sequential endoluminal gemcitabine and docetaxel for the treatment of clinically non-invasive high-grade upper tract urothelial carcinoma.
McElree, Ian M; Belzer, Alex; Mott, Sarah L; Packiam, Vignesh T; O'Donnell, Michael A; Steinberg, Ryan L.
Afiliación
  • McElree IM; Carver College of Medicine, University of Iowa, Iowa City, IA.
  • Belzer A; Carver College of Medicine, University of Iowa, Iowa City, IA.
  • Mott SL; Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA.
  • Packiam VT; Department of Urology, University of Iowa, Iowa City, IA.
  • O'Donnell MA; Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA; Department of Urology, University of Iowa, Iowa City, IA.
  • Steinberg RL; Department of Urology, University of Iowa, Iowa City, IA. Electronic address: Ryan-steinberg@uiowa.edu.
Urol Oncol ; 42(1): 20.e9-20.e15, 2024 01.
Article en En | MEDLINE | ID: mdl-37805338
ABSTRACT

PURPOSE:

There is an unmet need for effective renal sparing treatments for upper tract urothelial carcinoma (UTUC). Gemcitabine/Docetaxel (Gem/Doce) has shown favorable efficacy in nonmuscle invasive bladder cancer. We report the outcomes of patients treated with endoluminal Gem/Doce for noninvasive high-grade UTUC.

METHODS:

A retrospective review of patients treated with Gem/Doce for clinically noninvasive high-grade UTUC with no radiographic or endoscopically visible disease, either at diagnosis or following ablation, was performed. Treatment was instilled via nephrostomy or retrograde ureteral catheter. Induction instillations were performed weekly for 6 weeks, followed by 6 monthly instillations if disease-free. Recurrence was defined as biopsy-proven disease or high-grade (HG) cytology. Progression was defined by development of muscle invasion, metastases, or death due to cancer. Survival was assessed with the Kaplan-Meier method.

RESULTS:

The final cohort included 31 patients with 41 upper tract units, 51% of which would have been dialysis dependent with nephroureterectomy. Median (IQR) age was 74 years (68-81). Median follow-up was 29 months (IQR 20-58). Prior to treatment, 37 (90%) units presented with a localizing HG cytology (presumed occult CIS), and 4 (9.8%) with HG biopsy-proven disease. Sixteen (52%) patients reported any side effects; 5 were Grade 3 and 1 was Grade 5. Recurrence-free survival was 76%, 54%, and 40% at 1, 2, and 3 years, respectively. Five patients died from urothelial carcinoma. The 3-year progression-free and overall survival were 75% and 75%, respectively.

CONCLUSIONS:

Gem/Doce demonstrates promising safety and efficacy as a renal-sparing treatment option for high-grade UTUC in appropriately selected patients.
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Texto completo: 1 Base de datos: MEDLINE Asunto principal: Neoplasias Ureterales / Neoplasias de la Vejiga Urinaria / Carcinoma de Células Transicionales / Neoplasias Renales Idioma: En Revista: Urol Oncol Asunto de la revista: NEOPLASIAS / UROLOGIA Año: 2024 Tipo del documento: Article

Texto completo: 1 Base de datos: MEDLINE Asunto principal: Neoplasias Ureterales / Neoplasias de la Vejiga Urinaria / Carcinoma de Células Transicionales / Neoplasias Renales Idioma: En Revista: Urol Oncol Asunto de la revista: NEOPLASIAS / UROLOGIA Año: 2024 Tipo del documento: Article