EMUC15 - Resource Centre - Search Results

178 results (Loading...)

Video Filters×
  • organe

  • access

  • procedure

  • pathology

178 Abstracts

  • Introduction & Objectives

    To evaluate a possible role for prophylactic irradiation of the pelvic lymph-nodal area (WPRT) in the postoperative setting for prostate cancer (PCa) in increasing the risk of potentially radiation-induced second malignancies (SM).

    Material & Methods

    From 1993 to 2011, 1109 patients (pts) (median age=65 years) were treated with postoperative ADV (n=739) or SALV (n=370) non conformal RT (n=169), 3DCRT (n=670) or static-fields IMRT (SS-IMRT, n=57) at 1.80 Gy/fr (median dose=70.2Gy), with moderately hypofractionated regimens (median dose=2.35Gy/fr) with Tomotherapy (n=213) at a median 2Gy equivalent (EQD2, α/β=3) dose of 70Gy. WPRT was delivered to 336 pts at a median EQD2 dose of 50 Gy. 510 pts received adjuvant hormonal therapy for a median of 21 months. The median follow-up (FU) was 124 months.

    Results

    139 pts developed SM, including 73 in-field (IN) and 66 out-field (OUT), after a median of 65, 80 and 56 months, respectively. At univariate analysis, there was no statistical difference of 10-year risk SM/IN/OUT for pts receiving prostatic bed (PB) only or PB+WPRT (Figure 1a). No role emerged for RT dose, technique or fractionation. A borderline predictive role of the 10-year risk of SM was found in patients experiencing any (acute/late) GU+GE Grade≥2 (p=0.12), while GE and GU G≥2 showed a correlation with the risk of IN (p=0.21) and OUT (p=0.12), respectively. Age showed a statistically significant correlation with the risk of SM (p≤0.05). Of note, only for patients treated with WPRT, a slight correlation between IMRT techniques and increased risk of OUT (p= 0.26, HR= 1.78) emerged (Figure 1b). Multivariable analysis, including all variables with p65 years in all subgroups.

    Conclusions

    Though preliminary, this study does not indicate any additive risk of SM arising from the use of prophylactic WPRT in the postoperative setting for PCa. Overall, the risk of SM development appeared fundamentally as a function of aging. Nevertheless, in the sole pts treated with WPRT a slight correlation, absolutely to be confirmed, between IMRT techniques and risk of OUT emerged. An analysis focused on tumours arose at least 5 years after RT has been precluded owing  the low number of events (n=47, 4%).

  • Introduction & Objectives

    The aim of the study was to assess the EORTC risk tables usefulness in daily urological practice.

    Material & Methods

    444 patients treated for non-muscle invasive bladder cancer with WL bipolar TURBT were analyzed. After performed WL TURBT using the EORTC scoring system the total score for recurrence and progression for each patient was calculated separately.
    Patients were divided into 4 recurrence risk groups. Patients with total recurrence score 0 were classified to group I, 1-4 points to group II, 5-9 to group III, and 10-17 to group IV risk of recurrence. Follow-up and adiuvant therapy were done in according to EAU guidelines.

    Results

    106 patients (23,8’%) developed recurrent bladder tumour in 12 months of follow-up. Statistical analysis showed statistically relationship between the occurrence of recurrence after one year and recurrence risk groups. The risk of bladder tumour recurrence was statistically higher in intermediate-risk group. The recurrence rate was 0%, 28,6%, 44.7%, and 17,4% in I, II, III and IV recurrence risk group, respectively. About the staging and grading we observed a recurrence rate in PUNMPL  group of  3,48%,  in pTaLG of 6,55%, in pTaHG of 9,42%, in pT1LG of 1,02 %, in pT1HG of 6,96% and in pCISHG dell’1,84%.
    If we evaluate the progression, as an increasing recurrence in staging and grading of the primary lesion but always non-muscle invasive, in the analyzed group within one year occurred in 52 patients (11,7%). The risk of bladder tumour progression was statistically higher in intermediate-risk group. The recurrence rate was 0%, 19,2%, 55.7%, and 25,0% in I, II, III and IV progression risk group, respectively. Stratifying these data for staging (pT) and grading, we observed a progression in the 1,9% of PUNMPL, in the 53,8% of the pTaLG, in the 36,5% of the pTaHG, in the 1,92 % of the pT1LG and in the 7,6% of the pCISHG.
    Instead if we consider the progression as the transition to a stage pT2 or more, we observed it in 3 patients 0,67 %, two in the II and one in the other III risk group, both of them in the pTaHG group.

    Conclusions

    EORTC risk tables are useful to predict the possibility risk of recurrence and progression in patients with non-muscle invasive bladder cancer.

  • Introduction & Objectives

    Multiparametric magnetic resonance (MP-MRI) is considered the most accurate imaging modality for detecting prostate cancer. Preoperative staging is one of its potential applications. Information on the localization and extension of the tumour may influence decision which neurovascular bundle should be preserved. Extracapsular extension (ECE), however, is often difficult to visualize.
    The aim of this study was to find if MP-MRI is useful in predicting side-specific prostate cancer ECE or seminal vesicular invasion (SVI).

    Material & Methods

    This prospective study covers first two years after implementation of prostate MP-MRI in our centre. The consecutive group of 70 patients with prostate cancer, who underwent MP-MRI followed by radical prostatectomy was enrolled. 1.5 T MR scanner and endorectal coil were used to acquire images (T2-weighted, diffusion-weighted and dynamic contrast-enhanced). One radiologist assessed all imaging studies and scored lesions using a 5-point Likert scale. The following parameters were considered as potential predictors of stage T3 disease: Digital rectal examination, PSA and TRUS results, Gleason score, percentage of cancer in biopsy, presence and size of Likert scale score 4 or 5 lesions in MP-MRI. Analysis was performed for each side of the prostate separately in order to mimic decision on nerve-sparing. ROC analysis was used to find best cut-off values. Cut-off value of >15% of cancer in biopsy was chosen according to literature overview. Independent predictors of side-specific ECE or SVI were identified by multivariate logistic regression analysis.

    Results

    Mean age of 70 patients was 66. ECE or SVI was found in 35 patients (50%) and in 45 prostate sides (32%). Analysis revealed two independent predictors of side-specific ECE or SVI: Percentage of cancer in biopsy >15% (odds ratio 2.0; 95% confidence interval 1.4 – 3.0; P=0.001) and maximal dimension of MRI-detected lesion (score 4 or 5) > 15mm (odds ratio 1.8; 95% confidence interval 1.2 – 2.9; P=0.011). The model consisting of >15% cancer in biopsy specimens from one lobe or >15mm lesion in MP-MRI was characterized by 75% sensitivity, 72% specificity, 56% positive predictive value and 86% negative predictive value (AUC-0.736). For >15% cancer in biopsy AUC was 0.691 and for large lesions in MRI AUC was 0.643. Model accuracy was independent of study team experience: Similar characteristics were achieved in the first and in the second half of the group.

    Conclusions

    MRI-detected lesion size >15mm is an independent predictor of ECE or SVI. This variable significantly increases ability of biopsy parameters to predict prostate cancer stage, which may affect decision on preserving neurovascular bundles. Extensive experience in interpreting prostate MRI is not required to use this predictor.

  • Introduction & Objectives

    A combined diagnostic (white light cystoscopy–WLC and narrow band imaging–NBI) and treatment (bipolar plasma vaporization–BPV and biopsy resection) approach was compared to the standard protocol (WLC and monopolar transurethral resection of bladder tumours–TURBT) in large NMIBT cases.

    Material & Methods

    A matched–paired, index–control, cohort study included 260 patients with at least 1 bladder tumour ≥ 3 cm based on abdominal ultrasound, contrast CT and flexible WLC. Index patients (n = 130) were prospectively enrolled and underwent standard and NBI cystoscopy, followed by BPV (with tumour stage diagnostic and complete removal confirmation using bipolar resection). In the retrospectively selected control cases (n = 130), WLC and TURBT were solely applied. The matched pairs were determined based on the similar recurrence risk category established in accordance with the EORTC risk score. In all pathologically confirmed NMIBT cases, standard Re-TUR was performed at 4 weeks after the initial intervention, followed by 1 year’ BCG immunotherapy. The follow-up protocol included abdominal ultrasound, urinary cytology and WLC, performed every 3 months for a period of 2 years.

    Results

    When compared to TURBT, the BPV technique emphasized significantly reduced rates of obturator nerve stimulation (2.7% vs. 18.4%), bladder wall perforation (0.9% vs. 6.4%) and mean hemoglobin level drop (0.47 g/dl vs. 0.96 g/dl), as well as shorter catheterization period (48.6 hours vs. 74.1 hours) and hospital stay (2.9 days vs. 4.2 days). NBI cystoscopy was characterized by significantly improved tumour detection rates by comparison to WLC (CIS–95.3% vs. 65.1%; pTa–93.3% vs. 82.2%; overall NMIBT lesions – 95% vs. 84.2%). Patients displaying additional lesions in NBI were significantly more numerous when compared to WLC regardless of tumour stage (pTa–24.1% vs. 10.3%; pT1–33.7% vs. 7.2%; overall NMIBT–31.1% vs. 8%). Secondary to classical resection, pathologically confirmed, extended tumour margins were found at the NBI control in 10.7% of cases. NBI cystoscopy was characterized by a higher rate of false positive results (16% vs. 12.4%), however lacking statistical significance). At Re-TUR, significantly lower overall (6.3% vs. 17.4%) and primary site (3.6% vs. 12.8%) residual tumours’ rates were determined in the NBI-BPV group. The 1 (7.2% vs. 18.3%) and 2 (12.4% vs. 25.8%) years’ recurrence rates were significantly reduced in the NBI-BPV study arm.

    Conclusions

    The BPV procedure emphasized superior surgical safety, decreased bleeding risks and faster postoperative recovery. NBI cystoscopy significantly improved the NMIBT diagnostic accuracy, as more lesions were found in all tumour stages. The combined approach determined a significant reduction in tumour recurrence rates up to 2 years of follow-up.

    Acknowledgement
    This paper is supported by the Sectoral Operational Programme Human Resources Development (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU/159/1.5/S/137390.

  • Introduction & Objectives

    WLC (White Light Cystoscopy) is still considered the gold-standard and the most cost-effective method to detect the bladder cancer. Sometimes it fails to detect bladder lesions, especially when the cancer anatomy is not as usual. NBI improve visualization of bladder tumours even if specificity reported in literature (75%-77%) is slightly lower compared with WL (72%-83%). We evaluated the role of NBI-cystoscopy (NBI-C) in the outpatient setting.

    Material & Methods

    This is a prospective, comparative, non-randomized trial, recording the differences between the NBI-C and WLC in all patients scheduled for cystoscopy.  At this stage we report an interim analysis. For each procedure two urologist have been involved and a WLC was performed by the first investigator, followed by the second urologist performing the NBI-C and blinded to the first observer results. Switching between WLI and NBI was achieved by pushing a button on the head of the scope. All suspicious lesions were described in size, number and shape and were recorded on a standard bladder diagram. In every patients with suspicious lesions a cytology sample from  bladder wash out (BWO) was collected, and all patients with positive cytology or visible abnormalities were scheduled for TUR-T. The instrument used for this study was the Olympus Flexible Video Cystoscope CYF-VH. All the statistics analysis were performed with “IBM SPSS Statisitcs” software.

    Results

    At date, a total of 184 patients were enrolled and in 4 cases was impossible to perform a cystoscopic evaluation (1: Active hematuria; 3: Urethra stricture). 180 patients were evaluated; a total of 246 lesions were detected by NBI and WLI. The median number was 2.76 for NBI and 2.02 for WLI. 108/246 (43.9%) of lesions were identified by NBI and 138 by both technique. NBI and WLI (NBI+/WLI-) were discordant in 21.4% of positive cases. All sites identified by WLI were also detected by NBI. The patients were divided in 5 different “group of indications”: Bladder Cancer Follow-up (102/56.7%); Hematuria (33/18.3%); rUTI (11/6.1%); LUTS (25/13.9%); other (9/5%). Cytology samples were collected from 101 patients and were classified from our pathologist as: positive (17/16.8%); negative (52/51.4%); atypic cells (16/15.8%) and Inflammatory (16/15.8%). In the following table we described the statistics characteristics of our group.

     

    Category/Cytology WLI Negative NBI Negative WLI Positive NBI Positive
    Bladder Cancer FU 58 (32.2%) 48 (26.7%) 44 (24.4%) 54 (30%) p=0.001
    Hematuria 21 (11,7%) 13 (7.2%) 12 (6.7%) 20 (11.1%) p=0.001
    rUTI 9 (5%) 9 (5%) 2 (1.1%) 9 (1.1%)
    LUTS 23 (12.8%) 21 (11.7%) 2 (1.1%) 4 (5%)
    Other 1 (0.9%) 0 8 (4.4%) 9 (5%)
    Positive Cyt     17 (100%) 17 (100%)
    Atipyc Cells     8 (50%) 16 (100%) p=0.001
    Inflammatory Cells     12 (75%) 16 (100%)
    Negative     21 (40.4%) 27 (51.9%)

    Conclusions

    Our study, according with the literature’s data, confirm that NBI-C, compared with WLI improves the detection rate of suspicious bladder lesions without increasing the healthcare cost and toxicity for the patients. Also we suggest to use NBI as a “supplement” to standard WLC, especially in patients with BC history, hematuria and atypical cytology pattern. In the future further RCT will confirm the property of NBI assisted cystoscopy in the bladder cancer.

×