Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, 03722, Seoul, Republic of Korea.
Radiat Oncol. 2022 Mar 9;17(1):51. doi: 10.1186/s13014-022-02020-7.
Upper tract urothelial carcinoma (UTUC) is rare and the treatment for recurrent or metastatic UTUC is unclear. We evaluated the outcomes of salvage and palliative radiotherapy (RT) and prognostic factors in UTUC patients and find implications for salvage and palliative RT.
Between August 2006 and February 2021, 174 patients (median age, 68 years; range, 37-90) underwent salvage and palliative RT. Disease status at RT included initially diagnosed advanced disease (n = 8, 4.6%), local recurrence only (n = 56, 32.2%), distant metastasis only (n = 59, 33.9%), and local recurrence and distant metastasis (n = 51, 29.3%). The primary tumor location included the renal pelvis (n = 87, 50%), ureter (n = 77, 44.3%), and both (n = 10, 5.7%). Radical nephroureterectomy, chemotherapy, and immunotherapy were used in 135 (77.6%), 101 (58%), and 19 (10.9%) patients, respectively. Survival outcomes and prognostic factors were analysed using Cox and logistic regression analysis.
Salvage RT and palliative RT was administered in 73 (42%) and 101 (58%) patients, respectively. The median radiation dose was 45 Gy (range, 15-65). Two-dimensional (2D) or three-dimensional (3D) RT and intensity modulated RT (IMRT) were used in 61 (35.1%) and 113 (64.9%) patients, respectively. The median follow-up was 7.8 months. The median duration of overall survival (OS) was 13.4 months, and the 1-year OS was 53.5%. The median progression-free survival (PFS) was 4.7 months, and the 6-month PFS was 41.9%. The 6-month infield PFS was 84%. In multivariate analysis, RT method (2D/3D vs. IMRT, p = 0.007) and RT response (p = 0.008) were independent prognostic factors for OS, and RT response correlated with PFS (p = 0.015). In subgroup analysis in patients with PD-L1 data, positive PD-L1 correlated with better PFS (p = 0.009). RT response-associated factors were concurrent chemotherapy (p = 0.03) and higher radiation dose (p = 0.034). Of 145 patients, 10 (6.9%) developed grade 3 acute or late toxicity.
Salvage and palliative RT for UTUC are feasible and effective. Patients with RT response using IMRT may have survival benefit from salvage and palliative RT. Positive PD-L1 status might be related to radiosensitivity. High-dose radiation with concurrent chemotherapy may improve RT response.
上尿路尿路上皮癌（UTUC）较为罕见，其复发性或转移性疾病的治疗方法尚不明确。我们评估了挽救性和姑息性放疗（RT）的疗效和 UTUC 患者的预后因素，并探讨了这些因素对挽救性和姑息性 RT 的影响。
2006 年 8 月至 2021 年 2 月，共 174 例患者（中位年龄 68 岁，范围 37-90 岁）接受了挽救性和姑息性 RT。RT 时的疾病状态包括初诊晚期疾病（n=8，4.6%）、局部复发（n=56，32.2%）、远处转移（n=59，33.9%）、局部复发和远处转移（n=51，29.3%）。肿瘤原发部位包括肾盂（n=87，50%）、输尿管（n=77，44.3%）和两者均有（n=10，5.7%）。135 例（77.6%）患者接受了根治性肾输尿管切除术，101 例（58%）患者接受了化疗，19 例（10.9%）患者接受了免疫治疗。使用 Cox 和 logistic 回归分析评估生存结果和预后因素。
分别有 73 例（42%）和 101 例（58%）患者接受了挽救性 RT 和姑息性 RT。中位放疗剂量为 45Gy（范围 15-65）。61 例（35.1%）和 113 例（64.9%）患者分别接受了二维（2D）或三维（3D）RT 和调强放疗（IMRT）。中位随访时间为 7.8 个月。中位总生存期（OS）为 13.4 个月，1 年 OS 为 53.5%。中位无进展生存期（PFS）为 4.7 个月，6 个月 PFS 为 41.9%。6 个月的局部无进展生存率（PFS）为 84%。多因素分析显示，放疗方法（2D/3D 与 IMRT，p=0.007）和放疗反应（p=0.008）是 OS 的独立预后因素，放疗反应与 PFS 相关（p=0.015）。在 PD-L1 数据的患者亚组分析中，PD-L1 阳性与更好的 PFS 相关（p=0.009）。与放疗反应相关的因素包括同期化疗（p=0.03）和更高的放疗剂量（p=0.034）。在 145 例患者中，有 10 例（6.9%）发生 3 级急性或迟发性毒性反应。
UTUC 的挽救性和姑息性 RT 是可行且有效的。使用 IMRT 进行放疗反应的患者可能从挽救性和姑息性 RT 中获益。PD-L1 阳性状态可能与放射敏感性有关。高剂量放疗联合化疗可能会提高放疗反应。
