Guang-Dar Juang

Trimodality bladder-sparing approach without neoadjuvant chemotherapy for node-negative localized muscle-invasive urinary bladder cancer resulted in comparable cystectomy-free survival

BackgroundTo retrospectively review the efficacy and organ preservation experience for muscle-invasive bladder cancer by trimodality therapy at our institution.MethodsBetween July 2004 and February 2012, seventy patients (M/F = 55/15; median age = 69 years) of lymph node negative localized muscle-invasive bladder cancer were treated primarily with trimodality approach including transurethral resection of bladder tumor (TURBT) prior to combined chemotherapy and radiotherapy (CCRT). Radiotherapy consisted of initial large field size irradiation with 3D conformal technique (3D-CRT), followed by cone-down tumor bed boost with intensity modulated radiotherapy (IMRT) technique. The median total doses delivered to bladder tumor bed and whole bladder were 59.4Gy and 40.0Gy, respectively. No patient received neoadjuvant chemotherapy (NAC). Weekly cisplatin was administered during radiotherapy. Toxicity was scored according to the RTOG criteria. Tumor response was evaluated both cystoscopically and radiographically 3 months after treatment.ResultsThe numbers of patients with T2, T3 and T4 lesions were 41, 16 and 13, respectively. Overall survival (OS) and progression-free survival (PFS) at 2 and 5 year were 65.7%, 51.9% and 50.8%, 39.9%, respectively, after a median follow-up time of 24 months. Local-regional control and distant metastasis free survival at 2 year were 69.8% and 73.5%, respectively. Complete response (CR) rate assessed three month after CCRT was 78.1%. Ten patients (20%) had local recurrence after initial CR (n = 50), 3 of them were superficial recurrence. One patient underwent radical cystectomy after recurrence. The overall 5-year bladder intact survival was 49.0% (95% CI, 35.5% to 62.5%). Acute toxicities were limited to grade 1-2. One patient developed late grade 3 GU toxicity.ConclusionsOur result suggested that trimodality bladder-sparing approach without NAC or dose-intensification could be well-tolerated with a high CR rate and bladder preserving rate for muscle-invasive bladder cancer.

Extramammary Paget's disease of the scrotum.

Extramammary Pagets disease is an uncommon intra-epidermal malignant neoplasm that arises in area rich in apocrine glands. Common sites of occurrence include the vulva, perianal region, perineum, and scrotum. The lesion may be accompanied by an invasive adenocarcinoma or adenocarcinoma in situ of the apocrine glands. Generally, the prognosis is poor. Herein, we report two cases of extramammary Pagets disease, one involving the penoscrotal area with bilateral inguinal and pelvic lymph node metastases, the other involving the scrotal area without metastases.

Complications after transrectal ultrasound-guided prostate biopsy: A 10-year experience in a single institution

Background: Transrectal ultrasound-guided prostate (TRUS-P) biopsy is the standard diagnostic procedure for patients with suspected prostate cancer. However, infectious complications can occur. Purpose: To analyze the patients from a single institution who were hospitalized for infectious complications after TRUS-P biopsy. Materials and Methods: From 2003 to 2012, 985 TRUS-P biopsy procedures were performed in a medical center in Northern Taiwan; among these, 28 patients were admitted for infectious complications following the procedure. A retrospective review of the medical records was performed, and data regarding the demographics, details of infectious complications, and hospital course of these patients were collected. Results: The median age of the patients was 62 (27–82) years; the comorbidity rate was 57.1% (16/28); the admission rate was 2.8% (28/985). The most common causative pathogen was Escherichia coli. More than half of the cultured E. coli were not resistant to fluoroquinolones. The median hospital stay was 6 (3–16) days, and one patient was admitted to the intensive care unit. No mortality was observed in this study. Although the number of biopsies increased, no obvious increasing trend in the number of hospitalizations was noted in recent years. Conclusion: TRUS-P biopsy can be safely performed, and no obvious increasing trend in infectious complications and resistant strains has been observed in recent years.