Adjuvant Radiotherapy for Locally Advanced Urothelial Carcinoma of

Adjuvant Radiotherapy for Locally Advanced Urothelial Carcinoma of the Upper Urinary Tract R 3 鄭詠仁 Yung-Jen Cheng M. D. 國立成功大學附設醫院 放射腫瘤科 Department of Radiation Oncology National Cheng Kung University Hospital, Tainan, Taiwan

Background Urothelial carcinoma of the upper urinary tract (UTUC) Ø Transitional cell carcinoma (TCC) of the renal pelvis or ureter Ø A rare entity of malignancy The role of adjuvant therapy after curative surgery to advanced stage UTUC?

Epidemiology in Taiwan (2013) Ref: 衛生福利部國民健康署 (2017, Jan 10) 102年癌症登記年報

Epidemiology in Europe report The European Association of Urology (EAU) Guideline Group Urothelial Carcinoma (TCC): Ø Bladder tumors: 90 -95% Ø Upper urinary tract: 5 -10% In Taiwan: 40. 9% (UTUC)

Prognosis outcome & Pattern of failure

p 12 centers, 1363 patients, 1992 -2006, retrospective Results Prognostic variables: Ø Ø Tumor grade T stage LN status LVI Neoadjuvant and/or adjuvant C/T was administered to 3% and 13% Postoperative R/T was administered to 2%

Pattern of failure 30 -year experience in 252 patients. Hall MC, Urology. 1998 – LR: 9% – new invasive urothelial tumors: 69% – DM: 22% – 30% with stage III and 52% with stage IV received post-OP R/T [Median dose: 39. 8 Gy. (range 10 to 60)] 65 patients with locally advanced disease (T 3 -4 N 0 or N+). Catton CN, Urol Oncol. 1996 – DM: 53%, and LRF: 35% – If N+, DM: 77%; LRF: 95% – 85% received post-OP R/T (35 Gy/ 20 fx)

Role of adjuvant C/T in locally advanced UTUC No randomized trials… Most extensive observational data from NCDB Ø 3253 patients, 2004 -2012, retrospective Ø AC or observation after RNU Renal function is a big question!

Aim of our study Define the benefit of adjuvant R/T following curative surgery of locally advanced UTUC by determining the clinical outcomes in our institution

Methods 2006 -2015 Pathological T 3/4 and/or N+ UTUC The administration of adjuvant R/T or chemotherapy (C/T) was at physician’s discretion All patient data, including staging information, treatment and outcome variables, were collected retrospectively by chart review Exclusion Distant metastasis Synchronous bladder cancer History of previous R/T History of any malignancy (unless free of cancer for at least 10 years)

Statistical Analysis Kaplan-Meier method & log-rank tests were used to estimate: Ø Ø Cancer-specific survival (CSS) Loco-regional recurrence-free survival (LRFS) Bladder recurrence-free survival (BRFS) Distant metastasis-free survival (DMFS) Differences in risk-adjusted outcomes between RT and non-RT groups were assessed using a multivariate Cox proportional hazards model

End points Loco-regional failure ü Any recurrence in the tumor bed, regional nodes, or in the ureteral stump Distant metastasis ü Any relapse outside the aforementioned regions excluding the bladder Bladder recurrence ü Pathologically confirmed recurrence within the bladder (not included in the R/T field) All events were timed from the beginning of initial radical surgery

Results

Results A total of 106 patients had p. T 3 -4 and/or N+ UTUC Post-OP R/T was administered in 20 (18. 9%) of patients Post-OP C/T was administered in 46 (43. 4%) of patients (most GC) Median dose of RT was 50. 4 Gy (range, 45. 0 to 64. 8 Gy), all IMRT Median follow-up time: 29. 3 months

Patient Demographics and Clinical Characteristics

Patient Demographics and Clinical Characteristics

Survival analysis 84. 4% vs. 73. 1% 81. 5% vs. 60. 9% 92. 3% vs. 77. 4% 73. 1% vs. 59. 1% p=0. 38

Multivariate analysis with Cox hazards regression

Conclusions In patients with locally advanced stage UTUC who had received curative surgery, the following adjuvant R/T may improve loco-regional control Adjuvant R/T may be another considerable treatment modality, especially as an alternative treatment for patient who is not suitable to receive adjuvant C/T More qualified patients recruitment and longer follow-up time are necessary for further persuasive results

Acknowledgements Presenter Supervisor 鄭詠仁 醫師 薛尉廷 醫師 Yung-Jen Cheng Wei-Ting Hsueh E-mail: waynealex 0000@gmail. com E-mail: seine@mail. ncku. edu. tw 國立成功大學附設醫院 放射腫瘤科 Department of Radiation Oncology National Cheng Kung University Hospital, Tainan, Taiwan

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