Due to the rarity of upper tract urothelial carcinoma (UTUC), robust evidence regarding the optimal timing of chemotherapy is limited, with most literature supporting adjuvant chemotherapy. We aim to share the experience of neoadjuvant chemotherapy (NACT) on post-operative histological outcomes, recurrence risk, and overall survival rates in patients with UTUC.

This case series includes three patients with locally advanced UTUC, aged 71, 50, and 42 years, consisting of one female and two males, treated with NACT f/b radical nephroureterectomy (RNU) between January 2022 and December 2023. Computed tomography (CT) imaging of the abdomen was performed before and after NACT. Patients were in-operable, locally advanced based on radiological imaging and hence were planned for NACT. All patients received five cycles of platinum-based chemotherapy, followed by RNU. All patients were followed up for 6 months.

All three patients tolerated the chemotherapy well and underwent surgery three weeks after the last dose. The reduction in tumor size facilitated uneventful surgical procedures. Chemotherapy response, measured using RECIST criteria version 2, showed a significant decrease in lesion size, with a mean reduction of 92.18% (SD 8.88%, 95% CI). Histopathological examination revealed complete response (ypT0N0) in two patients, while the third patient had high-grade urothelial carcinoma with 10% squamous differentiation (pT1N0). All 3 patients on last follow up are doing well without recurrence.

This case series highlights the potential benefits of neoadjuvant chemotherapy (NACT) for UTUC, including significant tumor size reduction, which can facilitate easier surgical intervention and ultimately improve disease-free and overall survival outcomes.