Consolidation With Radiation or Concurrent Chemo-Radiation After Chemotherapy Results in Durable Complete Remissions of Isolated Nodal Recurrences of Urothelial Cancer: A Case Series and Review.

Locoregional nodal recurrence of urothelial cell carcinoma of the bladder or upper tract can occur after definitive surgical management as the solitary site of metastasis. This may be related to the extent of the lymphadenectomy done at the time of the initial surgical extirpation of the cancer. Historically, lymph node dissection has been the mainstay of treatment for nodal recurrence of urothelial cancer when it occurs in the retroperitoneal area even in the setting of previously dissected retroperitoneal lymph nodes and typically after chemotherapy. Chemotherapy alone may be utilized, resulting in major responses, including complete responses, but these typically are not durable over time without surgical consolidation. The role of radiation therapy alone or concurrent with chemotherapy in the setting of nodal recurrence in urothelial cancer has not been described. We describe the new finding from our experience with this modality in 4 patients, 2 of them with upper tract disease, in whom all had durable remissions after chemotherapy followed by consolidation with radiation alone (1 patient) or concurrent chemoradiation with acceptable toxicity. Our conclusion was that radiation or chemoradiation as consolidative therapy should be considered in the treatment of retroperitoneal nodal recurrences of urothelial carcinoma. This finding might impact the clinical practice in isolated nodal recurrences of urothelial cancer. (C) 2016 Elsevier Inc. All rights reserved.