Adjuvant chemotherapy with paclitaxel and carboplatin in patients with advanced carcinoma of the upper urinary tract: A study by the Hellenic Cooperative Oncology Group
Adjuvant chemotherapy with paclitaxel and carboplatin in patients with advanced carcinoma of the upper urinary tract: A study by the Hellenic Cooperative Oncology Group
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DOI：
10.1200/jco.2004.09.043
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发表时间：
2004-06-01
影响因子：
45.3
通讯作者：
Dimopoulos, MA
中科院分区：
文献类型：
--
作者：
Bamias, A;Deliveliotis, C;Dimopoulos, MA
目的.根治性手术是上尿路癌的首选治疗方法。然而，大约50%的T期大于或等于3或淋巴结受累的患者死于其疾病，主要是由于远处转移的发展。因此，需要有效的辅助全身治疗。我们前瞻性研究了一组接受手术治疗的高危上尿路癌患者，以评估紫杉醇和卡铂联合作为辅助治疗的可行性。36例肿瘤分期≥ 3期或淋巴结受累的患者在术后每3周接受4个周期的紫杉醇175 mg/m2和卡铂（曲线下面积5，Calvert公式）治疗。中位随访时间为40.6个月。化疗耐受性良好，32例患者（89%）接受完整的卡铂和紫杉醇剂量没有延迟。最常见的3/4级毒性是中性粒细胞减少（39%），仅1例（3%）合并发热。仅1例病例报告了3级或4级非血液学毒性。5年生存率为62%（95% CI，35%至69%），而5年无病生存率为40.2%（95% CI，15.8%至64.6%）。局部失败率为30%，而发生远处转移的患者为17%。随访期间，2级肿瘤患者无复发，而3级肿瘤患者复发率为60%。紫杉醇和卡铂辅助化疗是可行的，并可能降低高危上尿路癌远处转移的风险。(C)2004年，美国临床肿瘤学会。
Purpose. Radical surgery represents the treatment of choice for carcinoma of the upper urinary tract. Nevertheless, approximately 50% of patients with stage T greater than or equal to 3 or lymph node involvement die from their disease, mainly as a result of the development of distant metastases. Therefore, there is a need for effective adjuvant systemic treatment. We prospectively studied a cohort of patients who underwent surgery for high-risk carcinoma of the upper urinary tract to assess the feasibility of the combination of paclitaxel and carboplatin as adjuvant treatment.Patients and Methods. Thirty-six patients with tumor stage greater than or equal to 3 or lymph node involvement were treated with four cycles of paclitaxel at 175 mg/m(2) and carboplatin (area under the curve 5, Calvert Formula) every 3 weeks following surgery.Results. Median follow-up was 40.6 months. Chemotherapy was well tolerated with 32 patients (89%) receiving full carboplatin and paclitaxel doses without delays. The most frequent grade 3/4 toxicity was neutropenia (39%) which was complicated with fever in only one case (3%). Nonhematologic grade 3 or 4 toxicities were reported in only one case. Five-year survival was 62% (95% Cl, 35% to 69%), while 5-year disease-free survival was 40.2% (95% Cl, 15.8% to 64.6%). Local failure rate was 30%, as opposed to 17% of patients who developed distant metastases. No patients with grade 2 tumors relapsed during follow-up, as opposed to 60% of patients with grade 3 tumors,Conclusion. Adjuvant chemotherapy with paclitaxel and carboplatin is feasible and may reduce the risk of distant metastases in high-risk upper urinary tract carcinoma. (C) 2004 by American Society of Clinical Oncology.