EMUC15 - Resource Centre - Search Results

178 results (Loading...)

Video Filters×
  • organe

  • access

  • procedure

  • pathology

178 Abstracts

  • Introduction & Objectives

    To determine the efficacy of combined androgen block (CAB) vs. GnRH agonist monotherapy in terms of bone mineral density (BMD) change during 12 months post-treatment initiation in prostate cancer patients.

    Material & Methods

    This was a multi-center, prospective observational study on patients who were scheduled to receive continuous androgen deprivation therapy (ADT) with CAB (CAB group) or GnRH agonist monotherapy (GnRH group). BMD was measured from baseline to 12 month post-ADT initiation by dual energy x-ray absorptiometry. We also investigated the underlying factors affecting BMD and estimated the 10-year probability of major fractures among the patients with Fracture Risk Assessment Tool.

    Results

    BMD significantly decreased in the CAB and GnRH groups, with no group wise differences. However, the non-inferiority of the CAB group was not determined with statistical significance. The proportion of patients with osteopenia or osteoporosis was slightly increased after the 12th month post-ADT initiation. Ten-year probability of hip fracture and major osteoporotic fracture was approximately 3% and 5%, respectively.

    Conclusions

    Non-inferiority of CAB therapy to GnRH monotherapy in terms of the BMD loss was not determined, but a significant decrease of BMD was observed by 12 months ADT, with no differences between the 2 groups. BMD loss induced by 12 months ADT did not induce detrimental effects on bone health in terms of increased bone fracture risk. This was the first prospective study on BMD changes as a predictor of fracture during ADT in an Asian population.

  • Introduction & Objectives

    To determine the effectiveness for detection of metastases of Whole Body- Diffusion weighted imaging-MRI (WB-DWI-MRI) vs F-18 Choline-PET/CT (Cho-PET/CT) in patients with biochemically recurrent prostate cancer (PCa), and select those who could benefit from ablative SBRT (SABR), in oligometastatic patients, as well as evaluating the response to it.

    Material & Methods

    After approval of the ethics committee, between October 2014 and March 2015, 46 consecutive patients from our center who meet the pre-screening criteria, were enrolled in a controlled prospective-pilot-study. They had biochemical relapse after radical or salvage radiotherapy, and subsequently a bone scan, total body CT and pelvic MRI. Based on these tests, were classified as polimetastatic, oligometastatic, local relapse or without lesions. 29 asymptomatic patients with negative studies or oligometastatic state,  after signing an informed consent, became part of the study. WB-DWI-MRI and Cho-PET/CT explorations were made in less than 1 week between the two by studies and in the same equipments. All were read by experienced radiologist and nuclear medicine specialist, blinded from the other findings.
    If patients were candidates for SABR, subsequently they were assessed every 3 months with both tests.
    Analysis of  correlation by statistical kappa (κ) between this two techniques, and the Best Value Comparator (BVC). This was performed by a multidisciplinary team, based on the clinical and biological data for every patient, to determine the sensitivity and specificity of each test. After SABR we performed again correlation within.

    Results

    29 patients were enrolled. Medians: Age 70 years, PSA of 3,17 ng/mL and testosterone 1,42 ng/mL, at time of the studies.
    Location in the Cho-PET/CT: Iliac/sacroiliac lymph-nodes 17,2%, 17.2% bone metastases, intraprostatic  lesions 13.8% and 17.2% extrapelvic lymph-nodes. In WB-DWI-MRI, bone: Acetabulum 11.76%, sacroiliac/pubic 17.65%, sacrum 11.76%, spine 11.76% and  lymph-node 5.88%.
    Cho-PET/CT allowing detects lesions in 16 patients, who are not observable in the WB-DWI-MRI. There is agreement in 7 and only in 3 cases had WB-DW-MRI imagines  not been observables in the Cho-PET/CT. 
    The κ obtained was of 0.1 so that the correlation between tests is poor, the p-value is not significant, so the null hypothesis of κ = 0 is accepted. Besides the value of κ On the basis of the BVC, 10 patients presented metastases in bone and 14 in lymph nodes. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of WB-DWI-MRI were estimated to be 44,44%, 63,64%, 85,71% and 18,93%. For Cho-PET/CT, sensitivity, specificity, PPV and NPV were 95,74%, 60%, 91,84% and 75%. Both sensitivity and specificity were not comparable. The test that best fits with the BVC was the Cho-PET/CT. 
    Based on the findings of the Cho-PET/CT, 4 patients were candidates for SABR and complete response was observed after treatment in Cho-PET/CT assessment at 3 months.

    Conclusions

    There is no agreement between results of WB-DWI-MRI and Cho-PET/CT, latter allowing increased detection of no significant lesions on WB-DWI-MRI, especially in lymph-node metastases. If the lesions have been detected by Cho-PET/CT, with these initial data, we consider that have to assess the response to SABR with the same technique.

  • Introduction & Objectives

    Laparoscopic radical cystectomy (LRC) is a technically high-demanding procedure requiring advanced laparoscopic skills. LRC aims to offer the benefits of a complete minimally invasive approach with equivalent oncologic outcomes of open surgery. LRC can be a cost-effective alternative for open radical cystectomy (ORC). We report our results of laparoscopic radical cystectomy in 122 patients with urothelial cell cancer performed by a single surgeon (LF) in a non-academic centre and compare clinical outcome with the results of open radical cystectomy in 71 patients.

    Material & Methods

    From January 2005 till October 2014, 193 patients underwent a radical cystectomy for muscle invasive bladder cancer or BCG-resistant high-risk superficial bladder cancer. LRC was performed in 122 patients; 71 patients had an ORC. All the laparoscopic procedures were performed by the same urologist. The open procedures were performed by four experienced urologists. No patients were excluded for the laparoscopic approach, except when preoperative it was deemed not technically feasible. Patients who underwent an open procedure were diagnosed before 2008 or were preoperatively seen by urologists who only perform ORC and did not refer for the minimal invasive approach. Patient characteristics and operative data are reported. Data regarding patients who underwent LRC were prospectively collected. Data regarding the ORC group were retrospectively collected from the medical records.

    Results

    Patient characteristics are comparable in both groups: Medium age of 68 years, mean BMI of 25 and mean Charlson comorbidity index of 3. Peri-operative outcome show differences in OR-time, blood loss and transfusion rate, hospital stay and need for ICU or MC admission (table 1).
    Post-operative (<90days) less major complications are seen in the LRC group, but without significant difference.
    Oncologic results are equal (table 2). Overall survival after 4 years is comparable: 50,5% in the LRC vs 55,7% in the ORC group.

    Table 1: Peri-operative variables in our serie.

    Variables LRC (n=122) ORC (n=71) Significance
    Operation time (min) Mean (SD)
    Median
    358 (81)
    343
    294 (71)
    272
    P < 0.00
    Blood loss (ml) Mean (SD)
    Median
    630 (589)
    400
    2171 (1268)
    2172
    P < 0.00
    Hospital stay
    (days)
    Mean (SD)
    Median
    17 (16)
    13
    22 (24)
    15
    P = 0.011
    Blood
    Tranfusion
    Total 29 23,8% 28 41,1% P = 0.014
    IC/ MC transfer IC
    MC
    Ward
    19
    18
    84
    15,7%
    14,9%
    69,4%
    48
    15
    6
    69,6%
    21,7%
    8,8%
    P < 0.00
    P < 0.237
    P < 0.00

    Table 2: Oncologic outcome in our serie.

    Variables  
    LRC (n=122)
     
    ORC (n=71)
     
    Significance
    Pathological stage pT0
    pT1
    pTis
    pT2
    pT3
    pT4
     
    18 (14,8%)
    16 (13,1%)
    10 (8,2%)
    22 (18%)
    39 (32%)
    17 (13,9%)
     
    pT0
    pT1
    pTis
    pT2
    pT3
    pT4
     
    16 (22,5%)
    7 (9,9%)
    4 (5,6%)
    8 (11,3%)
    19 (26,8%)
    5 (7%)
     
    NS
    Total lymph nodes  Mean (SD)
      Median
    15 (6)
    15
     
    11 (7)
    10
     
    NS
    Positive lymph nodes
     
    31/122 25,4% 12/59 20,3% NS
    Positive Surgical Margins
     
    15/122 12,3% 8/58 13,7 % NS
    Prostate cancer 27/96 28,1% 13/49 26,5% NS

    Conclusions

    Our data suggest that LRC is a safe and minimally invasive alternative to ORC with significant benefits: Less blood loss and blood transfusions, reduction of ICU admission and hospital stay, while preserving equal oncological outcomes compared to ORC in our department. Longer follow up is needed to evaluate the oncological outcome, still the mid-term outcome of both techniques is equivalent.

  • Introduction & Objectives

    ARN-509 and abiraterone acetate (AA) target the androgen receptor (AR) axis via different mechanisms and may have complementary activity in mCRPC. ARN-509, a potent and selective AR antagonist, inhibits AR nuclear translocation and DNA binding without significant AR agonist properties (Clegg. Cancer Res. 2012). AA is a prodrug of abiraterone, a CYP17 specific inhibitor that blocks androgen synthesis. No overlapping toxicities are expected for the combination. This phase 1b study evaluates potential pharmacokinetic drug-drug interaction, antitumor activity, and safety of ARN-509 in combination with AA + prednisone (P) (NCT02123758).

    Material & Methods

    Pts with progressive mCRPC and Eastern Cooperative Oncology Group performance status ≤ 2 received AA (1000 mg/d) + P (5 mg BID) beginning on Cycle 1 Day 1 (C1D1) with the addition of ARN-509 (240 mg/d) on C1D8 in 28-day treatment cycles. Efficacy assessment was based on Response Evaluation Criteria in Solid Tumours and Prostate Cancer Working Group 2 criteria.

    Results

    29 pts started treatment on study. Median age was 70 years (range 49-83) and median prostate-specific antigen (PSA) was 111.0 µg/L (range 4.1-2597.0 µg/L). Bone, nodal, and visceral disease were present in 25 (86%), 16 (55%), and 7 (24%) pts, respectively. 13 (45%) pts were previously treated with docetaxel, 12 (41%) with AA, 10 (34%) with enzalutamide (ENZ). 15 pts were discontinued from the study (12 for disease progression, 2 for consent withdrawal, 1 for physician decision). The proportion of pts who had a confirmed PSA response ≥ 50% while receiving ARN-509 with AA + P was 38% (95% CI, 21-58). Most common drug-related adverse events (AEs) were grade 1/2 and included fatigue (n = 13 pts), dysgeusia (n = 6 pts), and hypokalemia (n = 6 pts). Grade 3/4 drug-related AEs were hypokalemia (n = 2 pts), hyponatremia (n = 1 pt), fatigue (n = 1 pt), and increased alanine aminotransferase (n = 1 pt), and were managed by drug interruption and supportive measures.

    Conclusions

    Interim data indicate that ARN-509 in combination with AA + P is well tolerated in pts with mCRPC. Results indicate that ARN-509 with AA + P shows antitumour activity in pts with mCRPC, including both AA + P– and ENZ-pretreated patients. Further study of the efficacy and safety of ARN-509 and AA + P for mCRPC is warranted.

  • Introduction & Objectives

    Significance of Urocortin (Ucn or UcnI), UcnIII and their’ receptors; Corticotropin Releasing Factor Receptor 1 and 2 (CRFR1 and CRFR2), and the binding protein; Corticotropin-Releasing Hormone-Binding Protein (CRHBP) in oncology is growing rapidly. CRF system in human includes Ucn, and Ucn3, CRFR1 and CRFR2, and CRHBP. Expression and pathophysiological implication of CRF system in several different human cancers has been thoroughly reviewed. Recently, we reported the mRNA expression loss and DNA hypermethylation of CRHBP and its correlation with aggressiveness of tumor in clear cell renal cell carcinoma (cc-RCC). However there is no data available about silencing
    of CRHBP gene and a possible functional role of CRHBP in invasivness in kidney cancer. The objective of our study was to asses the silencing profile of CRHBP and showing its possible role in invasiveness in kidney cancer.

    Material & Methods

    mRNA analysis of four cell lines (A498, ACHN, RCC-GS, RCC-HS) before and following treatment of cells with 5-aza-2´-deoxycytidine (5-AZA) were carried out. Cells were incubated on days 2-4 with normal medium complemented with 0.125µM 5-AZA and allowed to recover during days 5-8 incubation in normal medium. Real – time impedance analyses of cells grown upon microelectrodes were applied to measure possible effects of CRHBP on proliferation and invasiveness of cancer cells.

    Results

    Analysis of four cell lines showed that the degree of relative methylation is reduced and mRNA expression concurrently increases between 50 and 150 fold following treatment of cells with 5-aza-2´-deoxycytidine (5-AZA). Inverse relationship of CRHBP CGI methylation and relative mRNA expression levels in renal cancer specimens indicates epigenetic silencing (P<0.0001). We found, that CRHBP-suppression may substantially affect the invasiveness of RCC cell lines. RCC-GS, derived from a metastatic primary tumor, showed a significantly increased capability to pass a 2.5% matrigel-layer used as a measure for invasiveness (p<0.001). Corresponding analyses for RCC-HS as a model for a localized cancer and 786-O demonstrated no significant changes vs. the controls in invasion
    characteristics.

    Conclusions

    For the first time we showed a functional analysis, confirming the silencing of CRHBP gene in cc-RCC. Inverse relationship of CRHBP CGI methylation and relative mRNA expression levels in renal cancer specimens indicates epigenetic silencing Moreover Real – time impedance analyses could show a significant role of CRHBP in invasivness of tumor in CC-RCC.

×