Victor Matei

Sooner or Later? Outcome Analysis of 431 Prostate Cancer Patients Treated With Postoperative or Salvage Radiotherapy

PURPOSE To evaluate the outcome of postoperative radiotherapy (PORT) and salvage RT (SART) using a three-dimensional conformal two-dynamic arc (3D-ART) or 3D six-field technique in 431 prostate cancer patients. METHODS AND MATERIALS Of the 431 patients, 258 underwent PORT (started <6 months after radical prostatectomy) and 173 underwent SART because of biochemical failure after radical prostatectomy. The median patient age, preoperative prostate-specific antigen level, and Gleason score was 66 years, 9.4 ng/mL, and 7, respectively. The median radiation dose was 70 Gy in 35 fractions for both PORT and SART. The 3D six-field and 3D-ART techniques were used in 25.1% and 74.9% of patients, respectively. Biochemical failure was defined as a post-RT prostate-specific antigen nadir plus 0.1 ng/mL. RESULTS Acute toxicity included rectal events (PORT, 44.2% and 0.8% Grade 1-2 and Grade 3, respectively; SART, 42.2% and 1.2% Grade 1-2 and Grade 3, respectively) and urinary events (PORT, 51.2% and 2.3% Grade 1-2 and Grade 3-4, respectively; SART, 37.6% and 0% Grade 1-2 and Grade 3, respectively). Late toxicity also included rectal events (PORT, 14.7% and 0.8% Grade 1-2 and Grade 3-4, respectively; SART, 15.0% and 0.6% Grade 1-2 and Grade 3, respectively) and urinary events (PORT, 28.3% and 3.7% Grade 1-2 and Grade 3-4, respectively; SART, 19.3% and 0.6% Grade 1-2 and Grade 3, respectively). After a median follow-up of 48 months, failure-free survival, including biochemical and clinical failure, was significantly longer in the PORT patients (79.8% vs. 60.5%, p < 0.0001). Multivariate analysis showed that a prostate-specific antigen level postoperatively but before RT of >/=0.2 ng/mL (p < 0.001), Gleason score >6 (p = 0.025) and use of preoperative androgen deprivation (p = 0.002) correlated significantly with shorter failure-free survival. Multivariate analysis showed that PORT and the 3D-ART technique correlated with greater late urinary toxicity. CONCLUSION PORT and early referral for SART offer better disease control after radical prostatectomy. The greater urinary toxicity occurring after PORT and 3D-ART requires further investigation to improve the therapeutic index.

Treatment of Ureterointestinal Anastomotic Strictures by Diathermal or Cryoplastic Dilatation

BackgroundUreterointestinal anastomotic strictures (UAS) complicate 10–15% of surgeries for urinary diversion and are the main cause of deterioration in renal function. Treatments are surgical revision, management with autostatic stent, balloon dilatation, endoscopic incision, and percutaneous transrenal diathermy (Acucise). A new option is cryoplastic dilatation (Polar-Cath).PurposeTo assess the feasibility, complications, and preliminary results of UAS treatment using the Acucise and Polar-Cath systems.MethodsNineteen UAS, diagnosed by ultrasonography or computed tomography and sequential renal scintigraphy, occurred in 15 cancer patients after radical cystectomy and urinary diversion. Fifteen were managed with balloon diathermy and 4 by balloon cryoplasty in a three-stage procedure—percutaneous nephrostomy, diathermal or cryoplastic dilatation, and transnephrostomic control with nephrostomy removal—each separated by 15 days. All patients gave written informed consent.ResultsDilatations were successful in all cases. The procedure is simple and rapid (about 45 min) under fluoroscopic control and sedation. Procedural complications occurred in 1 (5%) patient with UAS after Wallace II uretero-ileocutaneostomy: a common iliac artery lesion was induced by diathermal dilatation, evident subsequently, and required surgical repair. Patency with balloon diathermy was good, with two restenoses developing over 12 months (range 1–22) of follow-up. With balloon cryoplastic dilatation, one restenosis developed in the short term; follow-up is too brief to assess the long-term efficacy.ConclusionOur short-term results with diathermal and cryoplastic dilatation to resolve UAS are good. If supported by longer follow-up, the techniques may be considered as first-choice approaches to UAS. Surgery should be reserved for cases in which this minimally invasive technique fails.

Gefitinib combined with endocrine manipulation in patients with hormone-refractory prostate cancer: quality of life and surrogate markers of activity.

We investigated efficacy of gefitinib in hormone-refractory prostate cancer. Between March 2003 and December 2004, 23 patients with hormone-refractory prostate cancer were assigned to receive 250 mg oral gefitinib daily in addition to antiandrogen and luteinizing hormone-releasing hormone analogue for at least 2 months or until disease progression. Patients with progression stopped antiandrogen therapy, and received gefitinib and the luteinizing hormone-releasing hormone analogue. Serum HER2 and epidermal growth factor receptor extracellular domain were evaluated every 2 months. Gefitinib treatment did not result in any objective measurable response or responses in prostate-specific antigen. Median time to progression was 70 days (33–336). Median overall survival was 293 days (25–75 percentile: 235–349). HER2 extracellular domain mean value was 9.6 ng/ml (range 6.9–13.3) at basal time and was 10.1 (range 6.0–14.1) after 2 months. Epidermal growth factor receptor mean basal value was 51.0 ng/ml (range 41.4–75.3). After 2 months of treatment the mean value was 51.1 ng/ml (range 41.5–61.4). One patient had reduction in the pain score from baseline without an increase in the analgesic score. Four patients (17%) out of 23 had pain progression with an increase from baseline of at least 25% in the analgesic score. The study was discontinued before target accrual was reached owing to lack of efficacy of the drug. Our results do not support the efficacy of gefitinib in combination with endocrine treatment for hormone-refractory prostate cancer.

Anterior prostatic tumours are difficult to diagnose without MRI

It is often uncertain whether a repeat biopsy is necessary in patients with at least one previous negative prostate biopsy but persistent suspicion of prostate cancer. Here we present the use of multi-parametric magnetic resonance imaging (mp-MRI) to successfully detect and localize a prostate cancer and we suggest that MRI can be useful in optimising repeat biopsy procedures of the prostate in patients with clinically significant carcinoma.

Thulium laser treatment of early stage penile cancer: Initial results and functional outcomes

Introduction and Objectives Traditional surgical treatment of penile carcinoma was amputation of the glans, resulting in organ dysfunction and disfigurement, with a strong impact on patient’s quality of life. Several conservative treatment modalities have been introduced with the goal of achieving conservative treatment. We present the initial experience with thulium laser excision of early stage penile lesions.

INTRAOPERATIVE RADIOTHERAPY FOR LOCALLY ADVANCED PROSTATE CANCER: THE EXPERIENCE OF THE EUROPEAN INSTITUTE OF ONCOLOGY

521 INTRAOPERATIVE RADIOTHERAPY FOR LOCALLY ADVANCED PROSTATE CANCER: THE EXPERIENCE OF THE EUROPEAN INSTITUTE OF ONCOLOGY Andrea Vavassori*, Mario Ciocca, Barbara Jereczek, Dario Zerini, Giovanni Ivaldi, Cristiana Fodor, Roberta Lazzari, Federica Cattani, Elena Rondi, Cristina Garibaldi, Raffaella Cambria, Victor Matei, Epifanio Scardino, Fabrizio Verweij, Gennaro Musi, Bernardo Rocco, Ottavio De Cobelli, Roberto Orecchia. Milan, Italy. INTRODUCTION AND OBJECTIVE: To present the technique adopted for intraoperative radiotherapy (IORT) for locally advanced prostate cancer. METHODS: Between June 2005 and February 2007, 24 patients (pts) with non-metastatic prostate cancer were treated with IORT before prostatectomy as part of their surgical procedure. Median