Adjuvant Radiotherapy for Upper Tract Urothelial Carcinoma: Systematic Review and Meta-Analysis.

Autor: Zalay O; Division of Radiation Oncology, University of Ottawa, Ottawa, ON K1H 8L6, Canada., Yan M; Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada., Sigurdson S; Department of Oncology, McMaster University, Hamilton, ON L8V 5C2, Canada., Malone S; Division of Radiation Oncology, University of Ottawa, Ottawa, ON K1H 8L6, Canada., Vera-Badillo FE; Department of Oncology, Queen's University, Kingston, ON K7L 5P9, Canada.; Canadian Cancer Trials Group, Queen's Cancer Research Institute, Kingston, ON K7L 2V5, Canada., Mahmud A; Department of Oncology, Queen's University, Kingston, ON K7L 5P9, Canada.
Jazyk: angličtina
Zdroj: Current oncology (Toronto, Ont.) [Curr Oncol] 2022 Dec 20; Vol. 30 (1), pp. 19-36. Date of Electronic Publication: 2022 Dec 20.
DOI: 10.3390/curroncol30010002
Abstrakt: Purpose: Upper tract urothelial carcinoma (UTUC) is a rare form of malignancy comprising only 5% of urothelial cancers. The mainstay of treatment is radical nephroureterectomy (RNU) with bladder cuff excision. Neoadjuvant or adjuvant chemotherapy is often used in locally advanced disease. The role of adjuvant radiotherapy (RT), however, remains controversial. To further explore the potential role of adjuvant RT, we performed a systematic review and meta-analysis of the literature from 1990 to present.
Methods and Materials: We identified 810 candidate articles from database searches, of which 67 studies underwent full-text review, with final inclusion of 20 eligible studies. Among the included studies, there were no randomized controlled trials and a single prospective trial, with the remainder being retrospective series. We performed quantitative synthesis of the results by calculating the pooled odds ratios (OR) for the primary outcome of locoregional recurrence (LRR) and secondary outcomes of overall survival (OS), cancer-specific survival (CSS) and distant recurrence (DR).
Results: Adjuvant RT, which was mostly prescribed for locally advanced or margin-positive disease following RNU, significantly reduced locoregional recurrence risk OR 0.43 (95% CI: 0.23-0.70), and the effect remained significant even following subgroup analysis to account for adjuvant systemic therapy. The effect of adjuvant RT on 3-year OS, 5-year CSS and DR was non-significant. However, 5-year OS was unfavourable in the adjuvant RT arm, but study heterogeneity was high, and analysis of small-study effects and subgroups suggested bias in reporting of outcomes.
Conclusions: Adjuvant RT in the setting of locally advanced UTUC improves locoregional control following definitive surgery, but does not appear to improve OS. Higher-quality studies, ideally randomized controlled trials, are needed to further quantify its benefit in this setting, and to explore multi-modal treatments that include systemic agents given concomitantly or sequentially with RT, which may offer an OS benefit in addition to the locoregional control benefit of RT.
Databáze: MEDLINE
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