Small-cell carcinoma of the genitourinary tract: a point of view

Letter to the Editor

Small-cell carcinoma of the genitourinary tract: a point of view


Nabil Ismaili



doi: http://dx.doi.org/10.3747/co.23.3035

The Editor

Current Oncology

11 November 2015

We read with great interest the article by Pervez et al.1 about genitourinary (gu) small-cell carcinoma (scc). The authors studied an important issue: management of gu scc, a rare and highly aggressive disease.

Genitourinary scc is a systemic disease. These poorly differentiated neuroendocrine tumours have high meta-static potential and are diagnosed at an advanced stage in most cases. Outcomes are poorer in gu scc than in the usual histologic types. Current knowledge about these tumours is limited and is based mainly on retrospective investigations and a few prospective studies26.

The authors conclude that patients with gu scc should be treated using a multimodality approach including chemotherapy analogous to that for the treatment of small-cell lung cancer1. We agree that chemotherapy plays a critical role in the treatment of this systemic disease. However, we do not agree that the treatment should be analogous to that used in the treatment of small-cell lung cancer. Rather, therapy should be guided by the anatomic site of the disease28.

Management of scc of the bladder is quite well defined. Surgery plays an important role2. In surgically resectable disease (cT1–cT4aN0M0), treatment should include neoadjuvant chemotherapy and radical cystectomy. According to a phase ii trial conducted by the MD Anderson group, the combination of neoadjuvant chemotherapy and surgery leads to a very encouraging outcome; median overall survival was reported to be 58 months9. In a large retrospective comparative study, the same group showed that, compared with surgery alone, neoadjuvant chemotherapy is highly effective (59.5 months vs. 18.3 months, p < 0.001)10. In advanced disease, platinum-based chemotherapy (cisplatin for fit patients) is the only treatment2,3,8. Prophylactic cranial irradiation should be considered in stage iii or iv scc of the bladder2,9.

The optimal management of scc of the prostate is not well defined. Current management has been extrapolated from small retrospective series and from the guidelines for small-cell lung cancer. In nonmetastatic disease, prostatectomy alone was not curative. Adjuvant chemotherapy with or without radiotherapy is indicated after prostatectomy. Concurrent chemoradiotherapy is a valuable option5,6. In advanced-stage disease, chemotherapy is generally considered to be the most important treatment for scc of the prostate. Androgen-deprivation therapy should be contemplated with the chemotherapy. Radiotherapy can be useful in the case of brain metastases, symptomatic bone metastases, or spinal cord compression5,6.

Nabil Ismaili Mohammed IV University Hospital of Marrakech Marrakech, Morocco Cheikh Khalifa Ibn Zaid Hospital and Université Mohammed VI des Sciences de la Santé Casablanca, Morocco

CONFLICT OF INTEREST DISCLOSURES

I have read and understood Current Oncology’s policy on disclosing conflicts of interest, and I declare that I have none.

REFERENCES

1. Pervez N, El-Gehani F, Joseph K, et al. Genitourinary small-cell carcinoma: a single-institution experience. Curr Oncol 2013;20:258–64.
cross-ref  pubmed  pmc  

2. Ismaili N. A rare bladder cancer—small cell carcinoma: review and update. Orphanet J Rare Dis 2011;6:75.
cross-ref  

3. Ismaili N, Arifi S, Flechon A, et al. Small cell cancer of the bladder: pathology, diagnosis, treatment and prognosis. Bull Cancer 2009;96:E30–44.
pubmed  

4. Ismaili N, Heudel PE, Elkarak F, et al. Outcome of recurrent and metastatic small cell carcinoma of the bladder. BMC Urol 2009;9:4.
cross-ref  pubmed  pmc  

5. Nadal R, Schweizer M, Kryvenko ON, Epstein JI, Eisenberger MA. Small cell carcinoma of the prostate. Nat Rev Urol 2014;11:213–19.
cross-ref  pubmed  pmc  

6. Aparicio A, Tzelepi V. Neuroendocrine (small-cell) carcinomas: why they teach us essential lessons about prostate cancer. Oncology (Williston Park) 2014;28:831–8.

7. Ismaili N. Optimal management of extra-pulmonary small cell carcinoma and the role of prophylactic cranial irradiation. Strahlenther Onkol 2012;188:632–3.
cross-ref  pubmed  

8. Ismaili N. Editorial comment from Dr Ismaili to local control rate and prognosis after sequential chemoradiation for small cell carcinoma of the bladder. Int J Urol 2013;20:784–5.
cross-ref  

9. Siefker-Radtke AO, Kamat AM, Grossman HB, et al. Phase ii clinical trial of neoadjuvant alternating doublet chemotherapy with ifosfamide/doxorubicin and etoposide/cisplatin in small-cell urothelial cancer. J Clin Oncol 2009;27:2592–7.
cross-ref  pubmed  

10. Lynch SP, Shen Y, Kamat A, et al. Neoadjuvant chemotherapy in small cell urothelial cancer improves pathologic downstaging and long-term outcomes: results from a retrospective study at the MD Anderson Cancer Center. Eur Urol 2013;64:307–13.
cross-ref  


Correspondence to: Nabil Ismaili, Department of Medical Oncology, Mohammed VI University Hospital, Marrakech, Morocco. E-mail: ismailinabil@yahoo.fr

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Current Oncology, VOLUME 23, NUMBER 3, June 2016

Mohammed IV University Hospital of Marrakech, Marrakech, Morocco, Cheikh Khalifa Ibn Zaid Hospital and Université Mohammed VI des Sciences de la Santé, Casablanca, Morocco.







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