Sequential adjuvant chemotherapy after surgical resection of high-risk urothelial carcinoma Journal Article


Authors: Gallagher, D. J.; Milowsky, M. I.; Iasonos, A.; Maluf, F. C.; Russo, P.; Dalbagni, G.; Donat, M. S.; Boyle, M. G.; Zheng, J.; Riches, J.; Bajorin, D. F.
Article Title: Sequential adjuvant chemotherapy after surgical resection of high-risk urothelial carcinoma
Abstract: BACKGROUND: Despite definitive surgery, the survival of patients with high-risk urothelial carcinoma (UC) is poor. Adjuvant cisplatin-based chemotherapy may be beneficial, but it is restricted by the need for normal renal function (RF). Sequential administration of adjuvant chemotherapy facilitates drug delivery and improves survival in patients with breast cancer. The objective of this study was to evaluate the feasibility and survival impact of adjuvant, sequential chemotherapy in patients with high-risk UC. METHODS: Fifty patients were treated on 2 simultaneous protocols between 1997 and 2004. The patients on Protocol A (normal RF) received doxorubicin and gemcitabine (AG) followed by paclitaxel and cisplatin. The patients on Protocol B (impaired RF) received AG followed by paclitaxel plus carboplatin. Overall survival (OS) and disease-specific survival (DSS) were compared with a group of 203 contemporary control patients who had similar pathology and RF and who underwent surgery alone. RESULTS: The median follow-up of protocol patients was 6.5 years (range, 0.9-8.6 years), and 25 patients remained alive. The median follow-up of the control group was 4.7 years (0.0-9.2), and 68 patients remained alive. The median OS for patients on Protocol A was greater than that for controls who had good RF (4.6 years vs 2.5 years; P = .03). The median OS for patients on Protocol B was greater than that for controls who had impaired RF (3.4 years vs 2 years; P = .04). DSS for the protocol and matched control groups was similar (good RF: 4.6 years vs 3 years; P = .24; impaired RF: 3.4 years vs 3.3 years; P = .40). CONCLUSIONS: In this nonrandomized study, adjuvant, sequential chemotherapy for patients with high-risk UC did not improve DSS over that observed with surgery alone. © 2009 American Cancer Society.
Keywords: adult; cancer chemotherapy; cancer survival; clinical article; controlled study; aged; aged, 80 and over; disease-free survival; middle aged; survival analysis; cancer surgery; overall survival; drug tolerability; neutropenia; cisplatin; doxorubicin; diarrhea; drug dose reduction; drug efficacy; drug safety; gemcitabine; paclitaxel; chemotherapy, adjuvant; combined modality therapy; neurotoxicity; follow up; antineoplastic agent; carboplatin; computer assisted tomography; infection; multiple cycle treatment; nephrotoxicity; anemia; blood toxicity; mucosa inflammation; neuropathy; stomatitis; thrombocytopenia; antineoplastic combined chemotherapy protocols; dehydration; kidney failure; urogenital tract cancer; urinary bladder neoplasms; high risk patient; risk; drug hypersensitivity; febrile neutropenia; heart palpitation; adjuvant chemotherapy; cardiotoxicity; thrombosis; cystectomy; nephroureterectomy; thorax radiography; blood cell count; granulocyte colony stimulating factor; disease-specific survival; dose-dense sequential therapy; urothelial cancer; mannitol; abdominal cramp; electrocardiogram; kidney impairment
Journal Title: Cancer
Volume: 115
Issue: 22
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2009-11-15
Start Page: 5193
End Page: 5201
Language: English
DOI: 10.1002/cncr.24570
PUBMED: 19670454
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 1" - "Export Date: 30 November 2010" - "CODEN: CANCA" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Junting Zheng
    130 Zheng
  2. Paul Russo
    446 Russo
  3. Dean Bajorin
    402 Bajorin
  4. Guido Dalbagni
    250 Dalbagni
  5. Sherri M Donat
    135 Donat
  6. Fernando Maluf
    10 Maluf
  7. Alexia Elia Iasonos
    179 Iasonos
  8. Mary G Boyle
    29 Boyle
  9. Jamie C Riches
    18 Riches