Radiotherapy for Advanced Upper Tract Urothelial Carcinoma Intolerant to Chemotherapy

Abstract

<h3>Purpose/Objective(s)</h3> To retrospectively investigate the safety and effectiveness of radiotherapy for advanced upper tract urothelial carcinoma (UTUC) intolerant to chemotherapy. <h3>Materials/Methods</h3> 20 patients with advanced UTUC who were not able to tolerate chemotherapy were retrospectively collected. All patients were treated with conventionally fractionated radiotherapy (50-67.6Gy/20-33f) or partial-SABR boost to the lesions (50-60Gy/20-25f with tumor center boosted with 6-8Gy/f, 3-5f) for bulky tumors. 2 patients underwent immunotherapy therapy. <h3>Results</h3> The median age was 77 years (range, 58-87 years). All patients underwent primary tumor resection, and no patients underwent metastatic resection. 17 (85%) enrolled patients were oligometastatic (1 to 5 metastases) at diagnosis. 18 (90%) received irradiation to all tumor lesions. Lymph node metastasis was predominant in the whole group (17/20). And other lesions were distributed in local recurrence (6/20), bone metastases (2/20) and abdominal wall/muscle (2/20). The median follow-up time is 38.5 months (range, 4.0-102.2 months). The local control rate (LRFS), progression-free survival rate (PFS) and overall survival rate (OS) of the whole group at 1 years were 90%, 48.9% and 84.4%, respectively. And at 3 years, LRFS, PFS and OS were 65.6%, 27.9% and 43%, respectively. Acutely, 13 patients developed mild gastrointestinal toxicity, generally of grade 1–2. And 7 patients developed acute grade 1–2 hematological toxicity, consisting mainly of anemia and leukopenia. In addition, no grade 3 or higher acute or late toxicities were observed. <h3>Conclusion</h3> For patients with advanced UTUC who were not able to tolerate chemotherapy, radiotherapy is a safe treatment and can achieve good local tumor control.