Atsushi Takamoto

Comparison of implant quality between intraoperatively built custom-linked seeds and loose seeds in permanent prostate brachytherapy using sector analysis

We compared the implant quality of intraoperatively built custom-linked (IBCL) seeds with loose seeds in permanent prostate brachytherapy. Between June 2012 and January 2015, 64 consecutive prostate cancer patients underwent brachytherapy with IBCL seeds (n = 32) or loose seeds (n = 32). All the patients were treated with 144 Gy of brachytherapy alone. Brachytherapy was performed using a dynamic dose calculation technique. Computed tomography/magnetic resonance imaging fusion-based dosimetry was performed 1 month after brachytherapy. Post-implant dose–volume histogram (DVH) parameters, prostate sector dosimetry, operation time, seed migration, and toxicities were compared between the IBCL seed group and the loose seed group. A sector analysis tool was used to divide the prostate into six sectors (anterior and posterior sectors at the base, mid-gland, and apex). V100 (95.3% vs 89.7%; P = 0.014) and D90 (169.7 Gy vs 152.6 Gy; P = 0.013) in the anterior base sector were significantly higher in the IBCL seed group than in the loose seed group. The seed migration rate was significantly lower in the IBCL seed group than in the loose seed group (6% vs 66%; P < 0.001). Operation time per seed was significantly longer in the IBCL seed group than in the loose seed group (1.31 min vs 1.13 min; P = 0.003). Other post-implant DVH parameters and toxicities did not differ significantly between the two groups. Our study showed more dose coverage post-operatively in the anterior base prostate sector and less seed migration in IBCL seed implantation compared with loose seed implantation.

Efficacy and safety of 3 day versus 7 day cefditoren pivoxil regimens for acute uncomplicated cystitis: multicentre, randomized, open-label trial

Background Fluoroquinolone-non-susceptible Escherichia coli isolated from patients with acute uncomplicated cystitis are a matter of increasing concern. Cefditoren pivoxil is an oral, &bgr;-lactamase-stable, extended-spectrum cephalosporin that is effective against fluoroquinolone-non-susceptible bacteria. Objectives To evaluate the clinical and microbiological efficacies of cefditoren pivoxil against acute uncomplicated cystitis and to determine the optimal duration of cefditoren pivoxil treatment. Methods We compared 3 and 7 day regimens of cefditoren pivoxil in a multicentre, randomized, open-label study. Results A total of 104 female patients with acute uncomplicated cystitis were enrolled and randomized into 3 day (n = 51) or 7 day (n = 53) treatment groups. At first visit, 94 bacterial strains were isolated from the 104 participants of which 81.7% (85/104) were E. coli. Clinical and microbiological efficacies were evaluated 5–9 days following administration of the final dose of cefditoren pivoxil. The clinical efficacies of the 3 and 7 day groups were 90.9% (40/44) and 93.2% (41/44), respectively (P = 1.000). The microbiological efficacies of the 3 and 7 day groups were 82.5% (33/40) and 90.2% (37/41), respectively (P = 0.349). There were no adverse events due to cefditoren pivoxil treatment, with the exception of a mild allergic reaction in one patient, after which the cefditoren pivoxil was exchanged for another antimicrobial. Conclusions Cefditoren pivoxil is safe and effective for uncomplicated cystitis, with no significant differences in clinical and microbiological efficacies between 3 and 7 day regimens.

Oncological impact of neoadjuvant hormonal therapy on permanent iodine-125 seed brachytherapy in patients with low- and intermediate-risk prostate cancer

To determine whether neoadjuvant hormonal therapy improves oncological outcomes of patients with localized prostate cancer treated with permanent brachytherapy.

V4-05 IMPACT OF THE 20 G ALL-SEEING NEEDLE AND 4.8 FR MICRO PCNL WITH THE HIGH DEFINITION IMAGE GUIDE (HDIG) SYSTEM

are placed using a combination of US and a transperineal electromagnetic-tracked MR/US fusion device (Invivo, Gainesville, FL). 48 hours’ post-ablation, the patient is imaged, fig 1, followed by re-imaging and MR/US fusion guided biopsy (FBx) at 3 months. All patient demographics, clinical variables, and complications were recorded. RESULTS: Todate, 2 patients havebeenenrolled in the trial, both with localizedGleason7PCadiagnosedusingMR/USFBx.Meanagewas 67 + 4.3 years and mean prostate specific antigen was 6.1 + 0.06 ng/ml. The mean tumor volume was 0.40 + 0.05 cc with a solitary lesion in each patient. Themean PSA decrease was 3.6 + 0.6 ng/ml, a 40.9% decrease at 1 month. No short-term complications were observed. The first patient underwent a follow up FBx at 3 months with no detectable cancer. CONCLUSIONS: Increasing interest in image guidance technologies and focal therapies has sparked a new generation of PCa treatment modalities. We have demonstrated the first safe and effective use of ultra-focal therapy using MR/US fusion technology in concert with GNP directed therapy to treat prostate tumors.

MP11-19 TARGETED ANTIBIOTIC PROPHYLAXIS BY β-LACTAMS BASED ON RECTAL SWAB CULTURE IS NOT SUFFICIENT TO PREVENT INFECTIVE COMPLICATIONS AFTER TRANSRECTAL PROSTATE BIOPSY

Group B: 188 patients who were given amikacin 15 mg / kg intramuscularly 60-120 min before the procedure. All patients underwent urinalysis and urine culture before and after the procedure. We identified post biopsy complications: bacteriuria, urinary tract infection, orchitis, pyelonephritis, sepsis, all of them were evaluated, all patients with a severe condition were hospitalized. The variables were correlated using Fishers Exact Test. RESULTS: In Group A, 4.3% of patients presented a febrile UTI and 0.97% presented sepsis. In Group B, 5.3% presented febrile UTI and .53% presented sepsis. Comparing both groups, we found no relationship between the dose and the risk for complications (p1⁄40.52). In the group analysis considering DM, a significant relationship for complication risks was not found, Group A (p1⁄40.62) and Group B (p1⁄40.58). The same in the analysis of overweight and obesity no significant relationship with complications was found, Group A (p1⁄40.85) and Group B (p1⁄40.65). CONCLUSIONS: Given its efficacy and simplicity, a single dose of 500mg of levofloxacin represents an excellent prophylaxis method in transrectal prostate biopsies guided by ultrasound. However, a single dose of amikacin shows similar results as levofloxacin, thus it can significantly reduce the cost of antibacterial therapy and have a similar safety profile.