Renal safety and efficacy of cisplatin-based chemotherapy in patients with a solitary kidney after nephroureterectomy for urothelial carcinoma of the upper urinary tract

PURPOSE : Little information is available about changes in renal function after cisplatin-based chemotherapy (CBCT) in patients with a solitary kidney. The authors evaluated the renal safety and efficacy of CBCT after nephroureterectomy for upper urinary tract-urothelial carcinoma (UUT-UC). METHODS : The data of patients who underwent nephroureterectomy for UUT-UC and received CBCT for adjuvant and/or palliative treatment were reviewed. Renal function changes and renal function-related adverse events (AEs) were analyzed, and objective tumor responses were assessed. RESULTS : Sixty patients were enrolled, and a median of 6 cycles (1-22) of CBCT were administered. After the 3rd cycle of CBCT, serum creatinine levels were significantly higher than at baseline, whereas mean creatinine clearances and estimated glomerular filtration rates were significantly lower. These renal function indicators also tended to be lower than baseline after the 6th-21st cycles, but these decreases were not significant. Significant AEs (≥grade 2) occurred in 10 patients (16.7%), and serious AEs (≥grade 3) developed in two that required temporary hemodialysis. Univariate analysis revealed that a low estimated glomerular filtration rate at baseline was related to the occurrence of a significant renal AE with borderline significance (Hazard ratio = 3.284, P = 0.100). The overall tumor response rate was 30.2%, and tumor response rates of 1st, 2nd, and 3rd line therapies were 36.4, 25.0, and 12.5%, respectively. CONCLUSIONS : Cisplatin-based chemotherapy can be administered in the majority of patients with UUT-UC with a solitary kidney after nephroureterectomy without inducing a serious AE, and provides acceptable efficacy.ope