Systemic chemotherapy for upper tract urothelial cancer

The use of chemotherapy for upper tract urothelial cancer (UC) varies widely geographically and institutionally. There have been no large scale prospective studies to support use of perioperative chemotherapy for curative intent for upper tract UC. Based upon level 1 evidence supporting the use of neoadjuvant cisplatin based chemotherapy prior to radical cystectomy, many centers will extrapolate this data and use neoadjuvant cisplatin chemotherapy prior to nephroureterectomy. Others favor adjuvant chemotherapy based on pathologic stage following nephroureterectomy, or offer no chemotherapy at all. Loss of renal unit, and often vital renal function, can preclude the safe use of cisplatin in the post nephrectomy setting. The current evidence for use of perioperative chemotherapy for upper tract urothelial cancer and eligibility for cisplatin, the most active chemotherapeutic in urothelial cancer, will be reviewed.