Gagan Prakash

Clinical Outcomes With Dose-Escalated Adaptive Radiation Therapy for Urinary Bladder Cancer: A Prospective Study.

PURPOSE The purpose of this study was to assess feasibility, clinical outcomes, and toxicity in patients with bladder cancer treated with adaptive, image guided radiation therapy (IGRT) for bladder preservation as a part of trimodality treatment. The role of dose escalation was also studied. METHODS AND MATERIALS Forty-four patients with localized bladder cancer were enrolled in a prospective study. They underwent maximal safe resection of bladder tumor and concurrent platinum-based chemotherapy. Patients with large tumors were offered induction chemotherapy. Radiation therapy planning was done using either 3 (n=34) or 6 (n=10) concentrically grown planning target volumes (PTV). Patients received 64 Gy in 32 fractions to the whole bladder and 55 Gy to the pelvic nodes and, if appropriate, a simultaneous integrated boost to the tumor bed to 68 Gy (equivalent dose for 2-Gy fractions assuming α/β of 10 [EQD2]10 = 68.7 Gy). Daily megavoltage (MV) imaging helped to choose the most appropriate PTV encompassing bladder for the particular day (using plan-of-the-day approach). RESULTS Most patients (88%) had T2 disease. Sixteen patients (36%) received neoadjuvant chemotherapy. A majority of the patients (73%) received prophylactic nodal irradiation, whereas 55% of the patients received escalated dose to the tumor bed. With a median follow-up of 30 months, the 3-year locoregional control (LRC), disease-free survival, and overall survival (OS) were 78%, 66%, and 67%, respectively. The bladder preservation rate was 83%. LRC (87% vs 68%, respectively, P=.748) and OS (74% vs 60%, respectively, P=.36) rates were better in patients receiving dose escalation. Instances of acute and late Radiation Therapy Oncology Group (RTOG) grade 3 genitourinary toxicity was seen in 5 (11%) and 2 (4%) patients, respectively. There was no acute or late RTOG grade 3 or higher gastrointestinal toxicity. CONCLUSIONS Adaptive IGRT using plan-of-the-day approach for bladder preservation is clinically feasible, with good oncological outcomes and low rates of acute and late toxicities. Dose escalation is safe and possibly improves outcomes in bladder preservation.

Genitourinary cancers: Summary of Indian data

Tumors of the genitourinary system are one of the most common tumors encountered in clinical practice. The associated morbidity and mortality and the significant proportion of affected middle-age individuals have a major bearing on the death-adjusted life years compared to other malignancies. Genitourinary system tumors encompass a very broad spectrum with regard to age, location, histology, and clinical outcomes. Advances in diagnostic imaging, surgical techniques, radiotherapy equipment, and generation of newer chemotherapeutic and targeted agents over the past few years have helped improving treatment outcome. Several focused groups within India have been working on a range of topics related to genitourinary system tumors, and a significant body of work from India in the recent years is being increasingly recognized throughout the world. The present article summarizes the key published work related to the epidemiology of genitourinary system tumors in the Indian setting. A PubMed search was made for locating and selecting articles relevant to the topic.

Delayed complication of pelvic lymphocele: Ileal conduit obstruction.

Radical cystectomy is the standard treatment for muscle invasive bladder cancer. Lymphocele is a common sequalae of pelvic lymphadenectomy. We report an unusual presentation of pelvic lymphocele developing after radical cystectomy reconstructed with an ileal conduit where the patient developed obstruction of the ileal conduit loop due to external pressure of the lymphocele. Catheter drainage of the conduit relieved the symptoms and a computerized tomography scan showed a large lymphocele causing acute angulation and resultant obstruction of the ileal conduit. The patient was treated with percutaneous drainage of the lymphocele and remains symptom-free on follow-up at 1 year.

Simultaneous bilateral laparoscopic adrenalectomy for pheochromocytoma in multiple endocrine neoplasia (MEN) syndrome: Case report with review literature.

INTRODUCTION Laparoscopic adrenalectomy has gained favour as a preferred surgical approach in the multiple endocrine neoplasia (MEN) type 2 patients. Currently, there is limited literature on bilateral simultaneous laparoscopic adrenalectomy in MEN 2 syndrome. We reported two cases of bilateral pheochromocytoma associated with MEN 2 syndrome cured by simultaneous bilateral laparoscopic adrenalectomy. PRESENTATION OF CASE First patient presented with big lips since childhood and episodic abdominal pain. On investigations, he was diagnosed with features of MEN 2B syndrome. Second patient was hypertensive and presented with abdominal pain. On evaluation she had features of MEN 2A syndrome. DISCUSSION Minimally invasive approach was preferred in both cases. Bilateral simultaneous adrenalectomies were uneventfully done with acceptable operative time and blood loss with rapid perioperative recovery. These cases highlighted the feasibility of laparoscopic simultaneous bilateral adrenalectomy for pheochromocytomas in MEN 2 syndrome. CONCLUSION Laparoscopic simultaneous bilateral adrenalectomy is a safe feasible and preferable technique for pheochromocytomas associated with MEN 2 syndrome.

Tongue trail to kidney

Renal cell carcinoma (RCC) has the propensity to metastasize to any organ in the body. Tongue metastases from RCC is very rare with most of them being metachronous in nature. We present a rare case where patient presented with a tongue lesion leading to a diagnosis of RCC. Surgery is the preferred modality of treatment for tongue metastases.

Testicular Sperm Retrieval for Cryopreservation in Cancer Patients

Young men undergoing cancer therapy, who might be interested in future fertility, should have sperm cryopreserved prior to start of therapy. Ideally, it is the ejaculated semen which is cryopreserved. However, in some situations this is not possible and testicular sperm need to be retrieved and cryopreserved. Testicular sperm retrieval may be achieved by a simple needle aspiration biopsy or may need an aggressive procedure like testicular microdissection. This chapter discusses in details the indications and techniques for testicular sperm retrieval for cryopreservation in men undergoing cancer therapy.

Editorial comment on “Effects of tumor size and location on survival in upper tract urothelial carcinoma after nephroureterectomy”

© 2017 Indian Journal of Urology | Published by Wolters Kluwer Medknow Upper tract urothelial carcinoma (UTUC) is a rare cancer and accounts for 5% of all urothelial cancers. Because of its rarity, much less is known about this cancer, as compared to urothelial cancers of bladder. Joshi et al.[1] report a retrospective analysis of 8284 patients of UTUC undergoing nephroureterectomy. They evaluated the role of tumor size and location on 5-year overall survival of these patients. Data from the National Cancer Database was collected, and effect of factors such as T stage, pN stage, grade, tumor size, and tumor site (renal pelvis versus ureter) on overall survival was assessed. On multivariate analysis, the authors found that for tumor size <3.5 cm versus ≥3.5 cm, the 5-year overall survival was 45.9% and 58.5%, respectively. Tumor location was not found to make any difference in survival. We congratulate the authors for presenting results from one of the largest series of this rare malignancy. This study provides a wealth of information and raises a few questions.

Genetic status determines 18F-FDG uptake in pheochromocytoma/paraganglioma

Although few studies have demonstrated utility of 18F‐ fluoro‐2‐deoxy‐d‐glucose positron emission tomography/computerised tomography (18F‐FDG PET/CT) in benign pheochromocytoma/paragangliomas (PCC/PGLs), there limited data on factors predicting the FDG uptake in PCC/PGL.