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" |
