Prospective trial of ifosfamide, paclitaxel, and cisplatin in patients with advanced non-transitional cell carcinoma of the urothelial tract.
ABSTRACT Non-transitional cell carcinomas account for 5% to 10% of urothelial tract tumors and are each characterized by unique demographics, risk factors, and patterns of spread. A unifying feature of these malignancies is their aggressive course and poor outcome with standard chemotherapeutic regimens. Given the rarity of these tumors, no prospective data are available to guide management.
Patients with unresectable/metastatic adenocarcinoma or squamous cell, small cell, sarcomatoid, or poorly differentiated carcinoma of the urothelial tract were eligible for enrollment. Treatment consisted of paclitaxel 200 mg/m2 intravenously on day 1, cisplatin 70 mg/m2 intravenously on day 1, ifosfamide 1500 mg/m2 intravenously on days 1 to 3 plus mesna. Granulocyte colony-stimulating factor was administered with each cycle. The treatment was started again every 3 to 4 weeks for a maximum of six cycles.
A total of 20 patients were enrolled. They had the following histologic types: adenocarcinoma in 11, squamous cell carcinoma in 8, and small cell carcinoma in 1. Patients received a median of four cycles (range one to six). The treatment was generally well tolerated, and the toxicity was predominantly hematologic. Overall, 7 (35%) of 20 patients (95% confidence interval 15% to 59%) achieved a major response (3 partial and 4 complete). The median survival for patients with adenocarcinoma was 24.8 months (95% confidence interval 10.2 to 32.3), and for those with squamous cell carcinoma it was 8.9 months (95% confidence interval 5.4 to not yet reached).
The results of our study have shown that this regimen (ifosfamide, paclitaxel, and cisplatin) is active in patients with advanced non-transitional cell carcinoma of the urothelial tract. To our knowledge, this is the first prospective study of a chemotherapeutic regimen in this patient population.
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ABSTRACT: Urachal carcinoma (UrC) is a rare but highly malignant epithelial cancer and commonly found in the urachal remnant which connects the dome of the bladder to the umbilicus via the ligamentum commune. Because of the specificity of the tumor location and its rarity, the diagnosis of UrC is often difficult. Although surgery is the treatment of choice for UrC, it still has a high incidence of local recurrence and distant metastasis and there are few modestly standard chemotherapy regimens for these patients (response rate 30-40%). Thus, the treatment of local recurrence and distant metastasis of UrC following surgery has been a challenge. We review the clinical diagnosis and therapy of UrC and factors related to its prognosis.Asia-Pacific Journal of Clinical Oncology 10/2012; · 0.91 Impact Factor
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ABSTRACT: PURPOSE: Urachal carcinomas are rare urologic neoplasms that arise along the urachal remnant from the umbilicus to the dome of the bladder. No published study has examined the diagnostic accuracy of modern preoperative testing to differentiate urachal carcinoma from a benign urachal cyst and spare resection of potentially benign urachal tissue. Our objective was to determine if a urachal mass can be safely diagnosed preoperatively. MATERIALS AND METHODS: 104 patients with a urachal mass treated between 1979 and 2011. Exclusion criteria were unresectable metastatic disease at presentation, patients that did not undergo surgery, and management by transurethral resection alone. Of the patients that remained, only 65 had both preoperative diagnostic testing and definitive pathologic results available for analysis. Mean age was 51 years, 86% were Caucasian and 65% were male. Accuracy of diagnosis based on preoperative tests was compared to final pathology (cancer or benign). RESULTS: Fifty-seven tumors (87%) were malignant and the majority of masses (83%) were adenocarcinoma. Compared to computed tomography, cytology, and exploration under anesthesia, transurethral resection of the bladder tumor has the highest sensitivity (0.93), specificity (1), and positive predictive value (1), but a low negative predictive value (0.5). Limitations included small cohort size and few benign urachal masses for comparison. CONCLUSIONS: No test has a high enough negative predictive value to prevent excision of a urachal mass. With few treatment options for localized, advanced, and metastatic urachal cancer, these data suggest that early excision remains the best treatment for a suspicious urachal mass.The Journal of urology 10/2012; · 3.75 Impact Factor
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ABSTRACT: Non-transitional cell carcinomas of the urothelial tract comprise 5–10% of urothelial cancers. Clinical information regarding the clinical behavior and chemotherapy outcome of non-transitional cell carcinomas of the urothelial tract are incomplete due to their rarity. The object of this study was to evaluate the clinical features and the efficacy of palliative chemotherapy in advanced non-transitional cell carcinomas of the urothelial tract. We analyzed the clinical records of 21 consecutive patients who received palliative chemotherapy for unresectable or metastatic non-transitional cell carcinomas of the urothelial tract between January 1995 and November 2007. All the 21 patients received first-line chemotherapy with platinum-based regimens which are known to be effective in transitional cell urothelial carcinomas. The median age of the patients was 57years (range, 27–71years). The primary sites of involvement were the bladder, urethra, urachus, and ureter in 43%, 29%, 19%, and 10% of the patients, respectively. Adenocarcinoma was the most common histological type (67%); squamous cell carcinoma and small cell carcinoma comprised 24 and 10% of the histologic types, respectively. With a median duration of follow-up of 32months (range, 12–71months), the median overall survival for all 21 patients from the day of first-line chemotherapy was 13months (95% CI, 6.8–19.2). The expected 1-year survival rate was 50.6% (95% CI, 28.6–72.5). Univariate analysis showed a better median overall survival in patients with adenocarcinoma, compared to non-adenocarcinomas (47 vs. 10months, P=0.049). The median overall survival of patients who received platinum-based palliative chemotherapy for advanced non-transitional cell carcinomas was comparable to previous studies for patients with transitional cell carcinomas. Adenocarcinomas appear to have a favorable prognosis for the survival of the patients who received platinum-based chemotherapy for advanced non-transitional cell carcinomas.Medical Oncology 26(2):186-192. · 2.15 Impact Factor