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178 Abstracts

  • Introduction & Objectives

    The introduction of new life-prolonging treatments including docetaxel (D), cabazitaxel (C), abiraterone (A) and enzalutamide (E) have revolutionised the outcomes of patients with mCRPC. Treatment sequences remain variable dependent on physicians’ choices. The aim of this study is to evaluate outcomes in patients receiving cabazitaxel and its’ potential relevance on therapeutic sequencing.

    Material & Methods

    A retrospective study of mCRPC patients treated with cabazitaxel after progression during or following docetaxel at one centre in England. Data on thirty three patients relating to patients’ characteristics, treatments and clinical outcomes were collected from the medical records and anonymised for analysis.

    Results

    Thirty three patients analysed received a median (range) of 3 (2-4) different life-prolonging therapies. The median (interquartile range, IQR) age of patients commencing on cabazitaxel was 71.1 (67.4 – 75.1) years. Cabazitaxel was second line therapy after docetaxel in 22/33 (67%) patients. Median (IQR) time from mCRPC diagnosis to start of cabazitaxel was 1.5 (1.0-2.0) years. 

    Number of life-extending drugs Median [95% CI] OS from mCRPC diagnosis
    2 DC: N=7, 29.4 months [21.4-80.1]
    3 DAC: N=7, 26.2 months [22.1-40.4]
    DCA: N=15, 40.0 months [24.3-57.6]
    4 N=4, 32.1 months [15.1-.]


    The tabulated data describes the number of treatment used with the following sequences: 7 patients received 2 therapies (DC); 22 patients received 3 therapies (DAC: n=7; DCA: n=15); 4 patients received 4 therapies (DCAE: n=1; DACE: n=1; DCEA: n=1; DAEC: n=1). Overall survival was longer, with a 14 months addition in patients receiving second-line cabazitaxel compared to third-line following docetaxel and abiraterone.

    Conclusions

    Based on this one centre real-life practice sequencing data, there is evidence to suggest that cabazitaxel has optimal benefit on overall survival when used second line following docetaxel. This data is promising and may be the beginning to unlocking the sequencing conundrum. A multi-centre study is being carried out to validate this data further.

  • Introduction & Objectives

    Ablative therapies like cryotherapy (CR) and radiofrecuency (RF) are an alternative for treatment of small renal solid masses (SRSM) in patients with a high surgical risk, severe comorbidities, chronic renal failure or in selected patients with bilateral renal tumours and tumours in patients with solitary kidney. The objective of this study is to analyse the efficacy, complications and oncologic results of SRSM treatment through CR or RF.

    Material & Methods

    46 patients with SRSM diagnosed by contrast-enhanced computed tomography (CT) or contrast-enhanced ultrasound (US) and treated by CR or RF between May 2006 and December 2014 were retrospectively analysed. SRSM was defined as a solid renal mass smaller than 4 cm at ultrasound (US) or computed tomography (CT).
    The parameters analyzed were: Age, sex, tumour size and location, surgical approach, complications by Clavien-Dindo classification, treatment failure and mortality. The follow-up was performed by a combination of CT and US in 36 patients, and only by CT in 10 patients.
    Tumour persistence and local recurrence were defined as the presence of increased uptake of contrast in either of image studies (US or CT).

    Results

    39 patients (84.8%) were treated by CR and 7 patients (15.2%) were treated by RF. The median follow up period was 34 months (range 3-107). Table 1 shows the sample characteristics.

    Table 1. Characteristics of the sample.
      MEDIAN RANGE
    AGE 74 40-85
    Nº OF PROBES 2 2-4
    TUMOUR SIZE (cm) 2.8 3.5
      N %
    TUMOUR LOCATION
    Right kidney
    Left kidney
     
    25/46
    21/46
     
    54.4
    46.6
    SURGICAL APPROACH
    Percutaneous
    Laparoscopic
    Open surgery
     
    38/46
    7/46
    1/46
     
    82.6
    15.2
    2.2

    Previous biopsy to the ablative treatment was performed in 34 patients (73.9%), in 17 patients the biopsy was informed as malignant tumour, in 5 patients were informed as benign tumour and in 12 patients the biopsy was non-conclusive.
    Table 2 shows the complications and the persistence of the renal mass.

      N CLAVIEN-DINDO TREATMENT
    COMPLICATION
    Haematoma
    Active bleeding
    Urinary fistula
     
    7
    1
    1
     
    I
    IIIa
    IIIb
     
    Conservative
    Embolization
    Surgery
    TOTAL 9 19.6%  
      N PERCENTAGE  
    PERSISTENCE RENAL MASS
    Total
    Active Surveillance
    Cryoablation
    Surgery
    Decease
     
    12
    5
    2
    4
    1
     
    26.1%
    10.9%
    4.3%
    8.7%
    2.2%
     

     
    The persistence of the renal mass was higher in the group of patients treated by RF compared with the group of patients treated by CR (42.9% Vs 23.1%), although this difference was not statistically significant.
    During the follow up period 4 patients died, 1 patient died due to renal cancer progression and 3 died by other causes.

    Conclusions

    Tumour ablation by CR or RF is an effective and safe treatment of SRSM. Due to a lower complications rate, these ablative therapies could be considered an alternative to the classic surgical treatment of SRSM in selected patients.

  • Introduction & Objectives

    To assess temporal tends in radical cystectomy (RC) and pelvic lymph node dissection (PLND) in the Netherlands between 2006 and 2012.

    Material & Methods

    This nationwide, retrospective, population-based study included clinical stage I-III bladder cancer (BC) patients (cT1-4aN0M0) from the Netherlands Cancer Registry who underwent RC as primary treatment for urothelial carcinoma between 2006 and 2012. Performance rates of PLND at RC, median lymph node count (LNC) and rates of positive nodal (pN+) disease were determined per year and their relation with pN+ disease during the study period was analysed. Furthermore patient and hospital characteristics associated with the performance of PLND at RC were identified.

    Results

    In total, 3678 patients were included. Mean age was 66.7 year and 75.6% (n=2780) were male. Of all RCs, 49.8% (n=1833) was performed in non-teaching hospitals. Clinical stages of disease were evenly distributed over the study period. Ninety percent (n=3312) underwent RC plus PLND, with a median LNC of 10. Performance rate of PLND increased from 82.9% in 2006 to 95.6% in 2012 (p<0.001), median LNC increased from 6 to 12  (p<0.001) and the amount of pN+ disease increased from 17.4% to 23.0% (p<0.001), table 1. In academic hospitals (and 2 cancer centers) PLND was only omitted in 5.5%, vs. 9.5% and 12.4% in teaching and non-teaching hospitals, respectively (p<0.001). Median LNC was 15.0 in academic hospitals vs. 10.0 and 9.0 in teaching and non-teaching hospitals, respectively (p<0.001). Multivariate logistic regression analysis revealed females (Ref. male) and elderly patients (>70yr.) (Ref. <50yr.) were less likely to receive a PLND. Patients operated in academic hospitals were more likely to receive a PLND (Ref. non-teaching hospital), as well as those operated after 2007 (Ref. 2006). All p20/ yr.) did not influence the chance of receiving PLND. Limitations: Extent of PLND was not registered. 

    Table 1. Distribution of clinical stages of disease and the performance of PLND, with corresponding median lymph node counts and rate of node positive disease over time.

      2006 2007 2008 2009 2010 2011 2012 P-value
    RC, N 424 419 522 510 524 588 537 -
    Clinical stage I, % 11.3 14.3 13.4 13.3 9.5 13.6 12.4 0.088 (Chi-square)
     
     
    Clinical stage II, % 73.3 74.7 73.0 70.6 75.6 71.6 75.6
    Clinical stage III, % 15.3 11.0 13.6 16.1 14.9 14.8 13.4
    PLND, %
     
    82.9 84.3 89.9 88.3 91.1 95.4 95.6  
    Median LNC 7.0 8.0 9.0 9.0 11.0 13.0 12.0  
    pN+, %
     
    17.4 17.4 19.5 20.6 21.1 20.2 23.0  

    Conclusions

    In the Netherlands, the performance of PLND at RC and LNC has significantly increased during the period 2006 and 2012. This suggests improved pathological staging of clinical stage I-III BC. 

  • Introduction & Objectives

    Granulomas are inflammatory character nodulillares formations, consisting essentially of macrophages. There are several diseases that still under study mechanisms granulomatous reactions occur at different locations, including the genitourinary system, constituting a diagnostic challenge to the urologist.

    Describe through clinical cases presented to our urology department, radiological findings in granulomatous diseases that tend to generate diagnostic uncertainty with consequent clinical implication.

    Material & Methods

    Systematic study by plain radiography, ultrasound, computed tomography and nuclear magnetic resonance cases presented in our service as the testicular sarcoidosis and genitourinary tuberculosis.

    Results

    Sarcoidosis is a chronic disease of unknown etiology, characterized by noncaseating epithelioid granulomas in multiple organs and tissues. 
    Bilateral hilar lymphadenopathy is the most common radiographic finding. 30% of patients present with extrapulmonary disease, including the genitourinary system. Injuries to testicular level is a real challenge differential between tumour masses. In the case presented objectify as testicular lesions are characteristic, multiple hypoechoic and small. When the masses are in patients with confirmed sarcoidosis, sarcoidosis testicular possible should always be considered, because it can prevent unnecessary orchiectomies. Genitourinary tuberculosis is an important but unusual location, but is the second form of extrapulmonary tuberculosis. Diagnosis is difficult and often delayed because tuberculosis can mimic many other diseases. Imaging studies are very useful to detect the presence of tuberculosis and to monitor response to treatment. This review illustrates the radiological findings in genitourinary tuberculosis in patients with laboratory confirmation of the disease.

    Conclusions

    Granulomatous disease with genitourinary involvement are rare, and can simulate many of the diseases affecting the urinary tract, so it will be a diagnostic challenge for the urologist, which will require knowledge of the key findings in tests image of these institutions.

  • Introduction & Objectives

    Metastatic seminoma is the paradigm of a curable cancer. Pure seminomas stages II with bulky disease and stages III are generally treated with platinum-containing chemotherapy. BEP (bleomycin, etoposide and cisplatin) is the standard treatment. After chemotherapy, patients are evaluated with a CT scan. If there is found a residual tumour >3cm, a PET scan is recommended. A negative PET warrants follow-up. In a positive PET lesions must be regarded as harbouring viable tumour and should be resected, if technically possible.
    We want to evaluate the radiological responses to chemotherapy in pure seminomas, how residual mass dimension influenced our clinical decisions and the number of unnecessary procedures due to false-positive results on PET.

    Material & Methods

    This retrospective study involved two Centers: Institut Català d'Oncologia - l'Hospitalet and Hospital de Santa Maria. The authors reviewed patients’ files with pure seminoma stages II and III treated with BEP or EP from 1996 to 2014 to evaluate the type of responses to chemotherapy and the clinical decisions in front of residual masses.

    Results

    Fifty patients with pure seminoma stages II and III were eligible for evaluation. The median age was 36 years old (range 22-54). The median follow-up was 4.3 years. All patients had primary testicular seminoma except two that had primary mediastinal disease. Forty three patients had stage II and seven had stage III disease. All patients belong to good IGCCCG prognostic group except two. Thirty four patients had been treated with BEP and sixteen with EP. Twenty six patients (52%) had radiological complete response and were disease free in the last follow-up. Twenty four patients (48%) had partial response. The median diameter of the residual masses was 2.8cm (1-15). A PET was performed in fourteen patients (28%) with residual masses above 2cm. The median time between ending chemotherapy and PET evaluation was 6 weeks. PET was positive in four patients. The median SUV was 6.5 (2.5–7.6). One patient had inoperable disease and is in surveillance without disease progression. The other three were operated but only one had viable tumor. There were no long term chemotherapy or surgical related complications. The three patients with residual masses between 2 and 3cm had negative PET. Two patients with negative PET have progressed after 10 and 15 months. They were treated with TIP (paclitaxel, etoposide and ifosfamide) and surgery and are currently free of disease. Two patients with retroperitoneal masses above 3cm undergone surgery without having done a PET. There was no viable tumor. Eight patients had residual masses with less than 2cm and are free of disease.

    Conclusions

    Patients with metastatic seminoma treated with chemotherapy have a high percentage of cure. PET is actually the better tool to guide clinical management of residual tumors, particularly for surveillance. In our population there was no benefit to do a PET for lesions <3cm. Due to some false-positive PET results, some patients were overtreated. It is important to optimize the selection of patients for surgery.

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