Clinical management of small cell carcinoma of the urinary tract (SCCUT): A single-center experience.

Abstract

216 Background: SCCUT is a rare but aggressive condition. No standard treatment has been established. The management of small cell lung cancer has been adopted by analogy. We aim to review the clinical features, therapy and natural course of patients with SCCUT. Methods: From 2002 to 2010 12 patients (pts) were diagnosed with SCCUT and treated at the Clínica Universidad de Navarra, Pamplona (Spain). Results: The median age was 62 (50-78). Male to female ratio was 11:1. The primary disease was prostate in 6/12 (50%) of cases, urinary bladder in 5/12 (41.7%) and kidney in 1/12 (8.3%). Overall, 5 pts (41.7%) had limited disease (LD) and 7 (58.3%) had extensive disease (ED) at onset. Basal serum levels of Neuronal Specific Enolase (NSE) were determined in 6 pts. In all of them levels over the upper-limit were observed. Treatment information was available for 10 pts, 5 with LD and 5 with ED. LD pts received multimodal therapy. Surgery (S) was the initial treatment in 4 pts (80%), 3 of them additionally received adjuvant treatment either with platinum-based chemotherapy (C) (2 pts) or chemoradiation (1 pt). The remainder received neoadjuvant C followed by radical S. Prophylactic whole brain radiation (WBR) was administered in 1 pt. Median progression-free-survival (PFS) for pts with LD was 9.3 months (m) (2-22 months). Median overall survival (OS) was 26 m. Pts with ED mostly received palliative chemotherapy with platinum-etoposide (80%) while 1 pt underwent palliative radiotherapy as exclusive therapy. Response rate for C was 75%: 2/4 complete response, 1/4 partial response and 1/4 disease stabilization. Median PFS was 3.3 m. WBR was administered in 2 pts with ED, 1 of them with prophylactic intent. Median OS was 14 m for ED pts. Conclusions: In our experience, SCCUT was more common among male pts and the prostate the most frequent primary site. Despite its chemosensitivity SCCUT showed an aggressive clinical course and poor prognosis in our series. SCCUT must be suspected in any genitourinary neoplasm of atypical or aggressive behavior. NSE serum levels may help to achieve an early diagnosis and to provide a proper systemic treatment up-front. [Table: see text] No significant financial relationships to disclose.