Definitive Plan Research Articles

459 Timeline in Management of Muscle Invasive Bladder Cancer (MIBC): Single Centre Outcomes of District General Hospital

Abstract Aim According to the European Association of Urology (EUA) guidelines, patients with muscle invasive bladder cancer (MIBC) have better overall survival outcome if they receive definitive treatment within 90 days from point of referral. Our objective was to assess the average timeline of these patients from their 2 week wait (2WW) referral to definitive treatment. Method This was a retrospective study in all patients diagnosed with MIBC from 1st January 2018 to 31st December 2019 at Furness General Hospital (UHMBT). Treatment delay was defined as delay in more than 90 days from initial referral to definitive treatment (radical cystectomy /radical radiotherapy with or without adjuvant chemotherapy). Results 47 patients met the inclusion criteria. Patients had imaging within 27 days, with 32 patients (68%) having a computed tomography (CT) scan and 15 patients (32%) having magnetic resonance imaging (MRI). The duration from referral point to transurethral resection of bladder tumour (TURBT) was 40 days. Multidisciplinary team (MDT) discussion took place within 12 days post-surgery. On average, the journey from date of referral to MDT was 52 days. From MDT discussion to the first tertiary centre appointment took another 27 days making it a total of approximately 79 average days for the patient to have a definitive treatment plan. Conclusions 12 patients (26%) exceeded the 90-day mark from duration between referral to having treatment. This is mainly due to TURBT being used as the ‘stop the clock’ treatment. The trust has, thus, created a departmental standard operating procedure (SOP) with the aim of minimising this duration.

745 Prospective Evaluation of Virtual Consultations in Paediatric Surgery and Urology: Lessons from the Pandemic Times

Abstract Aim Virtual consultation (VC) became the new norm for providing outpatient clinics during the COVID-19 pandemic. This is likely to be adopted in some form going forward. This study prospectively evaluated the effectiveness&safety of VC undertaken at a UK tertiary paediatric surgical centre during the pandemic. Method Data on paediatric surgery/urology outpatient video/telephone consultations between May-June 2020 was prospectively collected. VC episodes were given outcomes (1,2or3) depending how well surgeons were able to make definitive diagnoses/plans. 6months later, findings at later face-to-face visit were retrospectively compared with earlier VC to assess accuracy of decision-making using VC. Telephone survey of patient experience was done. Results 186VC were evaluated. 95 (51%) were paediatric general surgical patients and 91 (49%) urology. 118 (63%) were follow-ups and 68 (37%) new. In 70% of cases, clinicians were able to make definitive diagnosis/plan using VC (outcome1) while 26% could be delayed till face-to-face consultation is safe (outcome2). 7 patients (4%) needed to be brought in urgently (outcome3). Clinicians were significantly more able to make definitive diagnosis/plan in urology and follow-up patients. Of those brought back for scheduled follow-up/surgery, there was 93% correlation between findings at physical consultation compared to the definitive plans made at VC. Patient survey showed 92% overall satisfaction rate. 75% felt VC is comparable to face-to-face/would use VC again. Conclusions This study provides evidence that VC is an effective&safe way to structure paediatric surgical outpatient care and it highlights the patient categories in which VC is most suitable.

Choledochal cyst perforation: experience from a centre with limited emergency resources

Spontaneous perforation in Choledochal cyst (CDC) is a very rare initial manifestation and more commonly seen beyond infantile age. The management is challenging due to acute presentation, poor general condition of the patient and inflamed tissue that may jeopardize the appropriateness of any surgical intervention. The aim of the study was to analyse this rarity depending on clinical findings, diagnostic difficulty and optimum management plan in a limited resource set-up. It was a retrospective observational study where five patients presenting to the casualty department with biliary peritonitis between January 2015 and December 2020 were included. They were analysed with respect to symptomatology, laboratory parameters, radiology, emergency intervention with findings and definitive management plan. A female preponderance (60%) was found. Mean age was 5.4 years. One was a known case of CDC. Abdominal pain was the most common symptom. Inflammatory markers like Total leucocyte count (TLC) and Erythrocyte sedimentation rate (ESR) were raised in all (100%). Lipase was raised in 40% (2/5). Anaemia and low serum albumin were non-specific findings. A dilated Common bile duct (CBD) on Ultrasound (US) was seen in 80% (4/5). Magnetic resonance cholangio pancreaticography (MRCP) demonstrated type I CDC in all. All underwent laparotomy with lavage and external drainage followed by interval definitive surgery. Pre-operative diagnosis of a perforated CDC may not be possible. Strong clinical suspicion and bilious peritoneal fluid may point to this rare complication. Minimum exploratory manoeuvre with good lavage and external drainage should be the optimum emergency intervention. Definitive bilio-pancreatic reconstruction should be performed when tissue oedema subsides and general condition is improved. This approach usually achieves a rewarding outcome.

Endoscopic Resection of Gastrointestinal Stromal Tumor: Is It Safe?

Recently, results from clinical studies of endoscopic resection of gastrointestinal stromal tumor (GIST) in the stomach are being reported. This procedure has several advantages, such as the provision of a definite diagnosis and therapeutic plan, avoidance of frequent follow-up examination, and reduction of patients’ anxiety. However, several concerns also exist such as a limited number of studies, low R0 resection rate, and relatively shorter follow-up period compared with surgical resection. Nevertheless, it is encouraging that most of the post-procedural complications have been treated with conservative management and that some of the patients did not show recurrence of the tumor during long-term follow-up. The selection of suitable cases and the experience of the endoscopists are the most important factors for successful endoscopic resection of gastric GIST. Development of novel procedures as well as collaboration with laparoscopic surgeons are currently in progress.

THE IMPORTANCE OF MUSIC IN THE STAGES OF GENERAL EDUCATION IN SUDAN

Science evolve obligates those who work in educational process and creative people in the field of music in Sudan to adopt the project of music education in stages of general education at the Ministry of education – Sudan. The importance of the research is looking for to explicate the importance and necessity of musicale education in the stages of general education in Sudan The study problem was identified with a main question: Why were musical education curricula courses not included in the general education stages in Sudan? Research will depend on descriptive method to reveal the problems confront musical education in the general education stage in Sudan. The research definition plan consists of three content axes, which literature is reviewed as follows: The first axis: deals with the introduction and previous studies. The second axis: include topics about the historical background of general education in Sudan, the essence of music, the essence of music education and the role that musical education plays in enhancing the cognitive skills of students of general education stages of Sudan. The third axis: contains the applied framework and then the conclusion of the study and includes the results and their discussion, recommendation, the research library, and appendices

3D Printed Patient-Specific Complex Hip Arthroplasty Models Streamline the Preoperative Surgical Workflow: A Pilot Study.

Introduction: Surgical planning for complex total hip arthroplasty (THA) often presents a challenge. Definitive plans can be difficult to decide upon, requiring unnecessary equipment to be ordered and a long theatre list booked. We present a pilot study utilising patient-specific 3D printed models as a method of streamlining the pre-operative planning process.Methods: Complex patients presenting for THA were referred to the research team. Patient-specific 3D models were created from routine Computed Tomography (CT) imaging. Simulated surgery was performed to guide prosthesis selection, sizing and the surgical plan.Results: Seven patients were referred for this pilot study, presenting with complex conditions with atypical anatomy. Surgical plans provided by the 3D models were more detailed and accurate when compared to 2D CT and X ray imaging. Streamlined equipment selection was of great benefit, with augments avoided post simulation in three cases. The ability to tackle complex surgical problems outside of the operating theatre also flagged potential complications, while also providing teaching opportunities in a low risk environment.Conclusion: This study demonstrated that 3D printed models can improve the surgical plan and streamline operative logistics. Further studies investigating the optimal 3D printing material and workflow, along with cost-benefit analyses are required before this process is ready for routine use.

Architecture Design of E-Information System Marketplace with Method Enterprise Architecture Planning

Utilization of a technology indispensable information on SMEs because they develop information technology will be more complete and would affect ongoing business developments. At this time, not a few developments and development of information system technology have failed, this is because it is not following the goals and needs of these business people. One technique that can be used to build/develop information system technology is the existence of Enterprise Architecture Planning, where this technique is a technique used to approach data quality planning by looking at the needs of the SME business in Enterprise Architecture Planning will be explained about applications, data architecture, technology and a roadmap for the implementation plan of the architecture. SMEs cannot be separated from the need that can define business needs and even information architecture so that the direction of business development policy strategies can be well planned. Information technology architecture modeling in SMEs, including application definition, data architecture, technology, and implementation plan mapping. The process when defining information technology architecture is reviewed and refers to processes that are common in the business of implementing E-Marketplace applications, especially in SMEs. The results of the research will produce a mapping of implementation plans that can be used as a reference in the development of an application to support the business functions of SMEs.

An overview on Siddha treatment guideline for diabetes mellitus

Diabetes mellitus is a heterogeneous metabolic disorder characterized by altered carbohydrate, lipid, and protein metabolism which causes hyperglycemia resulting from insufficient insulin secretion, insulin action, or both. The WHO projects that diabetes will be the seventh leading cause of death in 2030. Diabetes can be treated, and its consequences avoided or delayed with diet, physical activity, medication, and regular screening and treatment for complications. It has various synonyms (Verupeyar) in Siddha system of medicine such as Miguneer, VeguMoothiram, InippuNeer, MeghaNeer, and Madhumegham. The Siddha treatment guideline for diabetes discusses the following headings: Definition (Noi iyalbu), Synonyms (Veru peyar), Etiology (NoiVarum vazhi), Clinical features (Noi Kurikunangal), Disease classification (Noi Enn), Investigations (Ennvagai Thervu), Differential diagnosis, Humoral changes (Thirithoda Marupadugal), Management and treatment plan (Maruthuva Vazhimurai), Pharmacological treatment regimen, Non-pharmacological treatment regimen, Dietary regimen, Karpam, Varmam, Yogic practices, Prevention, Post-clinical care, and the single herbs used in the Siddha system of medicine which has a potent anti-diabetic, hypoglycemic activity.

Effectiveness of subsidized fertilizer distribution to rice farmer In Lemoe, Bacukiki District, Parepare, South Sulawesi

Subsidized fertilizer is one of the government’s efforts to ensure the availability of fertilizer. However, farmers have difficulty in accessing subsidized fertilizers. This study aims to find out the effectiveness of subsidized fertilizer distribution in Lemoe Village, Bacukiki District, Parepare City. The analysis method used is descriptive quantitative by using effectiveness analysis. The results showed that the distribution process there are 4 lines of fertilizer storage up to farmers. Subsidized fertilizer distribution is carried out in a closed system based on the Definitive Plan of Group Needs (RDKK) with the Highest Retail Price (HET) as stipulated in the Regulation of the Minister of Agriculture on Allocation and HET of Subsidized Fertilizer in the Agricultural Sector. Overall the distribution of fertilizer felt by farmers runs effectively, with this it can be known that the subsidized fertilizer distribution program in Lemoe Village, Bacukiki District, Parepare City has been implemented in accordance with the guidelines for the implementation of fertilizer subsidies.

The First Three Months of the COVID-19 Pandemic: The World Health Organization's Response

Abstract Infectious diseases are generally preventable public health problems; however, they cause epidemics, economic losses, and deaths at all levels worldwide. Especially with the effect of globalization, it has been observed much better with the COVID-19 pandemic, where viral outbreaks can rapidly affect all stages of life. Experiences show that not only national authorities, but also international organizations should play critical roles in the control of infectious diseases. Based on this perspective, in our study, the responses of the World Health Organization (WHO), which has a decisive role in international health policies, to prevent the spread of the COVID-19 pandemic in the first three-month period were examined. In addition, the possible effects of the national measures and policies taken by Canada, Turkey, Pakistan, and Tajikistan, which are in different income groups according to the World Bank, on the number of cases and deaths were discussed. In this context, the contributions, or potential effects of the WHO on the performance of these countries against the COVID-19 were interpreted. It was understood that the countries in different income groups have developed policies based on their capability at country level independent from other countries in the fight against COVID-19 outbreak. It has been evaluated that the success of countries in the fight against the outbreaks is affected by different parameters such as average age of the country's populations, health infrastructures and income levels that greatly affect access to medical supplies and equipment. However, it can be said that international organizations with institutional power such as WHO cannot play a leading role at the expected level in the prevention of the pandemic and ineffective in directing local policies and ensuring international coordination. Especially in the COVID-19 viral pandemic environment where fast and precise decisions are required, this leading role is desperately needed. The first quarterly decisions and meeting notifications of the WHO in the COVID-19 pandemic were examined in our study and it was understood that these outcomes cannot provide a definite and effective management plan to national health policy makers, although WHO presented diagnostic tools rapidly and, in some degree maintained the supply chain of medical equipment globally. As a result, when all these elements determined in our study were considered together; the need for an integrative, proactive, and fair international health institution that produces prompt, effective and constantly updated comprehensive policies should be emphasized.

Moral Injury.

Moral Injury.

Comparing Single-Page, Multipage, and Conversational Digital Forms in Health Care: Usability Study

BackgroundEven in the era of digital technology, several hospitals still rely on paper-based forms for data entry for patient admission, triage, drug prescriptions, and procedures. Paper-based forms can be quick and convenient to complete but often at the expense of data quality, completeness, sustainability, and automated data analytics. Digital forms can improve data quality by assisting the user when deciding on the appropriate response to certain data inputs (eg, classifying symptoms). Greater data quality via digital form completion not only helps with auditing, service improvement, and patient record keeping but also helps with novel data science and machine learning research. Although digital forms are becoming more prevalent in health care, there is a lack of empirical best practices and guidelines for their design. The study-based hospital had a definite plan to abolish the paper form; hence, it was not necessary to compare the digital forms with the paper form.ObjectiveThis study aims to assess the usability of three different interactive forms: a single-page digital form (in which all data input is required on one web page), a multipage digital form, and a conversational digital form (a chatbot).MethodsThe three digital forms were developed as candidates to replace the current paper-based form used to record patient referrals to an interventional cardiology department (Cath-Lab) at Altnagelvin Hospital. We recorded usability data in a counterbalanced usability test (60 usability tests: 20 subjects×3 form usability tests). The usability data included task completion times, System Usability Scale (SUS) scores, User Experience Questionnaire data, and data from a postexperiment questionnaire.ResultsWe found that the single-page form outperformed the other two digital forms in almost all usability metrics. The mean SUS score for the single-page form was 76 (SD 15.8; P=.01) when compared with the multipage form, which had a mean score of 67 (SD 17), and the conversational form attained the lowest scores in usability testing and was the least preferred choice of users, with a mean score of 57 (SD 24). An SUS score of >68 was considered above average. The single-page form achieved the least task completion time compared with the other two digital form styles.ConclusionsIn conclusion, the digital single-page form outperformed the other two forms in almost all usability metrics; it had the least task completion time compared with those of the other two digital forms. Moreover, on answering the open-ended question from the final customized postexperiment questionnaire, the single-page form was the preferred choice.

Application of RSClin to guide treatment recommendations for premenopausal patients with early-stage hormone-positive breast cancer and intermediate risk oncotype recurrence scores.

e12511 Background: The RSClin model, which incorporates the Oncotype Recurrence Score (RS) and clinicopathologic features, was recently developed to further tailor prognosis and prediction of chemotherapy benefit for patients with early-stage hormone positive (HR+) breast cancer (BC) (Sparano et al, 2020). The RSClin calculator is available online to assist treatment planning for situations where chemotherapy benefit is uncertain. Covariates include Oncotype RS, tumor grade, tumor size and patient age. The risk calculator generates a 10-year distant recurrence risk and absolute chemotherapy benefit. This tool may be especially helpful to determine treatment management for premenopausal patients with early-stage HR+ BC with intermediate risk (IR) Oncotype RS (16-25). We retrospectively applied RSClin to this patient population to determine if it would have changed treatment recommendations. Methods: We identified premenopausal women with node-negative early-stage BC with IR RS (16-25) within our large Oncotype database. Using the RSClin model, we selected >5% absolute chemotherapy benefit as a reasonable cutoff to recommend chemotherapy. We compared the treatment recommendation based on RSClin with the treatment previously recommended by breast oncologists at our large academic medical center in New York City. Results: There were 86 patients who met criteria with a median age of 46 years. Of these, 26 patients (30%) were recommended chemotherapy plus endocrine therapy (ET) and 60 (70%) were recommended ET alone. After applying the RSClin model (data available for 83/86 patients), 19 (23%) would have resulted in a change in treatment recommendation and 64 (77%) would have remained unchanged. Overall, 8 (10%) would have withheld chemotherapy when it was previously offered and 11 (13%) would have recommended chemotherapy when it was previously excluded. There were 8 (9%) secondary invasive breast events in this population, with 2 (2%) being ipsilateral, 3 (3%) being contralateral and 3 (3%) metastatic at a median follow up of 46.9 months. Conclusions: The RSClin model would have changed management of premenopausal patients with IR RS in 23% of patients. This model, although not yet prospectively validated, may help individualize therapy for patients with less definitive treatment plans. Using RSClin, we can aim to minimize recurrence rates and avoid unnecessary chemotherapy in selected patients. This model is easy to apply and will have important clinical utility moving forward.

REMOTE SENSING IMAGES CLASSIFICATION USING CONVOLUTIONAL NEURAL NETWORK

The Deep learning plays the vital role in day to day real time applications. Machine Learning helps in various fields, for example, Natural language Processing, Computer Vision, Medical diagnostics and remote sensing images classifications. The Convolutional Neural Net-works algorithms provide the higher exactness, solid capacity to data extraction. Remote satellite image classifications that are used for the examination of ecological and topographical fields are procured through remote sensing methods. The manual classification not suit-able for land field evaluation and definite report plan, .In this paper proposed the deep learning based remote satellite classification. In this system provides higher accuracy compared to the previous system

The Use of Cone Beam Computed Tomographic Imaging in a Paediatric Dentistry Department

Cone beam computed tomography (CBCT) is an emerging radiographic imaging modality. The diagnostic benefit must exceed the individual detriment that its generally higher radiation exposure may cause. Since limited studies exist on the use and impact of CBCT in paediatric dentistry, a service evaluation was carried out to explore the reasons for CBCT referral and to identify its impact on the treatment plan and/or management in a paediatric dentistry department. Clinical records for all paediatric patients who underwent a CBCT were reviewed, to identify the reason for referral and its influence on diagnosis or management, by comparing the provisional treatment plan with the definitive treatment plan, post-CBCT. A total of 130 paediatric patients underwent CBCT in a 12-month period, of which 52 satisfied the inclusion criteria. CBCTs were most commonly requested for the localisation of unerupted/impacted teeth 14/52 (27%), assessment of supernumerary teeth 12/52 (23%), and to investigate root resorption 9/52 (17%). All CBCTs provided additional information that assisted treatment planning, diagnosis, or management and, most significantly, 16/52 (31%) of treatment plans were changed based on CBCT findings. All CBCTs requested in this study were justified and confirmed or influenced the management of paediatric patients, ultimately reducing the risk of complications and further treatment.

Clinical Faceoff: The Complex Tibial Plafond Fracture: ORIF or Circular External Fixation?

Clinical Faceoff: The Complex Tibial Plafond Fracture: ORIF or Circular External Fixation?

FEASIBILITY TEST OF POOR RICE RECIPIENTS IN BENCOY SUKABUMI VILLAGE USING NAIVE BAYES

A regional head must have a work plan every regional head must have a work plan which is sure to be of benefit to the community. Assisting is a definite work plan in every region. A lot of assistance is usually given from the government to the community and must be managed by the village government so that the aid gets to the right hands. And to improve food security, the people in each region have activities to distribute Poor Rice as a subsidy from the government. In the distribution method, sometimes there are constraints in data collection so that poor rice or what we usually call Raskin is not suitable for distribution. Because of this, a way is needed so that the distribution is appropriate or not in the community in accepting the Raskin so that government assistance can be delivered properly and on target. By using secondary data obtained from Bencoy Village, 205 data were obtained containing the attributes of the eligibility category of Raskin recipients, and 6 categories of attributes were found with the classification method of the Naïve Bayes algorithm. The accuracy value obtained is 96.59%, proving that the prediction using the Naive Bayes algorithm has a good performance. The next results obtained are in the form of AUC value which after being calculated produces a value of 0.999 and this results in an application which is an implementation with a flow that is adjusted to the calculation algorithm in the form of a web-based application.

P09.48 Experience and Outcome of COVID-19-Positive Lung Cancer Patients from a Eastern Indian Hospital

The COVID-19 pandemic has caused unprecedented crisis in the care of non-Covid patients all across the globe and care for lung cancer patients is no exception. Lung Cancer patients are at increased risks of COVID due to increased mortality from dual aggressive pathology in the lungs. Our aim was to examine the impact of COVID-19 on lung cancer therapy and factors responsible delay in optimal care during the pandemic. This study included all patients with a diagnosis of lung cancer being treated at our Institute, a tertiary level referral hospital in eastern part of India during on going pandemic. Seven developed COVID-19, confirmed by RT-PCR method (Table 1). The mean age of the patients was 49 years. All the patients had metastatic lung cancer. All males had history of smoking. Hypertension was present in only one patient. Four patients (57%) died from concomitant COVID-19 at our institution.Three patients who recovered from COVID were stable. One of them (positive for ROS1) was switched over to Crizotinib and other patient resumed chemotherapy only after he had recovered from COVID-19. Most of the patients acquired COVID-19 infection during the process of evaluatio/chemotherapy and that further delayed the treatment.Table 1Demographic characteristics, Clinical parameters, Treatments, and Outcomes of Lung Cancer patients with COVID-19DetailsCase-1Case-2Case-3Case-4Case-5Case -6Case-7Age66 years46 years36 years22 years65 years61 years48 yearsSexMaleFemaleMaleFemaleFemaleMaleMaleDiagnosisNeuroendocrine cancer of lungPoorly differentiated carcinomaPoorly differentiated carcinoma with CD 31 positiveAdenocarcinoma lung TTF1 positiveNnosmall cell lung cancerAdenocarcinoma lungAdenocarcinoma lungStage4444444ECOG score2221411Treatment receivedCisplatin and etoposideNot givenNot givenCrizotinibNot givenCarboplatin and pemetrexedCarboplatin and pemetrexedNo of cyclesTwoNANA4 cycle of Carboplatin and pemetrexedNAOne6Mutation statusNilNot doneNot doneROS 1 positiveNAEGFR – NEGATIVEEGFR NegativeCOVID statusseveresevereSevereMildSevereModerateMildOutcomePatient expiredPatient expiredPatient expiredPatient discharged after 8 days of isolationPatient expiredPatient discharged after 8 days of isolationOn observationHospitalisation Duration12 days24 days12 days8 days6 days8 daysnilOutcomedeathdeathDeathOn Crizotinib treatmentdeathOn platinum doubletOn Maintenance Pemetrexed Open table in a new tab The results were disappointing because more than half of lung cancer patients died due to COVID-19. The disease course of COVID-19 has been more severe in patients with lung cancers with Chemotherapy. There have been delay in resuming treatment among survivors by few weeks. Fear of aggressiveness of disease was the key factor for interruption or delay in chemotherapy. Other variable factors like stage of cancer, palliative intent of chemotherapy, ECOG status were key determinants for interruption of treatment. The decision to temporarily suspend chemotherapy while waiting for recovery from SARS-CoV-2 and then restart, was not easy due to the risk of cancer progression. The findings amplify the importance of optimizing of lung cancer care in the context of the COVID-19 prevalence. The decisions need to be taken on the basis of individual cases rather than rely on a generalized approach. In resource limited country like India diverting the existing resources to an emergency leads to compromise of routine outpatient care, especially patients with chronic illness. We need to be flexible in restarting of services guided by local COVID prevalence, while awaiting a definite management plan for COVID-19.

The influence of 68Ga-prostate-specific membrane antigen PET/computed tomography on prostate cancer staging and planning of definitive radiation therapy.

Prostate-specific membrane antigen (PSMA) PET/computed tomography (CT) is a novel imaging tool with an evolving role in the management of prostate cancer. This study aims to retrospectively evaluate the impact of 68Ga-PSMA PET/CT on prostate cancer staging and definitive radiation therapy planning. Between April 2015 and June 2020, 366 men with prostate cancer were evaluated with 68Ga-PSMA PET/CT. Of these, 108 patients had PSMA PET/CT before radiation therapy. Radiation was given as primary treatment in 58 (54%) and as salvage radiation therapy for biochemical recurrence after primary surgery in 50 (46%) patients, respectively. Patient and disease characteristics were analyzed, and impact of PSMA PET/CT on disease staging and radiotherapy planning was evaluated in comparison to conventional imaging. Median age at presentation was 69 years, and median prostate-specific antigen was 18 ng/mL (3.6-400) for primary and 0.4 ng/mL (0.1-4.6) for salvage radiation, respectively. The combined change of disease stage rate was 36% (39/108) with 45% (26/58) in the subgroup of primary radiation and 26% (13/50) in the patients intended for salvage radiation. Upstaging was found in 24 (22%) and downstaging in 15 (14%) patients. Radiation planning was changed based on PSMA PET/CT in 34 (31%) patients, including 7 (6.4%) patients in which stereotactic body radiotherapy (SBRT) was added to oligometastatic sites. The radiation field was extended to include pelvic lymph node involvement in 21 patients. 68Ga-PSMA PET/CT changed the prostate cancer stage in around one-third of men. PSMA PET/CT significantly impacted radiation planning. Further prospective studies are still required.

Normal tissue complication probabilities (NTCP) of urethral stricture following salvage SBRT or HDR for periurethral recurrences following prior definitive radiation therapy.

246 Background: SBRT and HDR brachytherapy have emerged as definitive salvage re-irradiation options for men with locally recurrent prostate cancer after prior radiation therapy (RT). Toxicity with re-irradiation remains a concern in this setting, particularly for salvage of periurethral recurrences. We calculated the normal tissue complication probability (NTCP) of urethral stricture following salvage re-irradiation (HDR and SBRT) after previous definitive RT (external beam or HDR) for periurethral recurrences. Methods: Two upfront definitive treatment plans were generated for 5 men with localized prostate cancer: External Beam RT (EBRT1) to a dose of 79.2 Gy in 1.8 Gy fractions and HDR monotherapy (HDR1), 13.5 Gy x 2 implants. Periurethral recurrences were virtually created on diagnostic MRI scans for each of the five men and defined as a recurrent dominant intraprostatic lesion (DIL). Three salvage RT plans were generated for each patient (constraints in Table): HDR salvage (10 Gy whole gland; 13.5 Gy to DIL; 2 implants), SBRTr with maximal rectal sparing (constraints designed for salvage following prior EBRT; 30 Gy in 5 fractions whole gland; 40 Gy in 5 fractions to DIL), and SBRTu with maximal urethral sparing (constraints designed for patients with prior HDR monotherapy; same Rx). DVH data was collected for each plan (previous RT and each salvage approach) and the equivalent uniform dose (EUD) was calculated. NTCP for the urethral stricture in the summed plans (prior definitive treatment + each salvage plan) was calculated by the Lyman-Kutcher-Burman model using the following parameters: (α/β = 5Gy; TD50= 116.7; m = 0.23; n = 0.3). Results: Prescription coverage of 90% of the DIL volume was achieved for each plan. The mean NTCP of urethral stricture for EBRT1 + HDR salvage was 55.2% (range, 52.2-59.1%) and for HDR1 + HDR salvage was 49.2% (42.9-57.5%). For EBRT1 + SBRTr and EBRT1 + SBRTu the NTCP for urethral stricture was 54.0% (50.4-61.0%) and 43.2% (39.4-48.4%), respectively. The NTCP of urethral stricture for HDR1 + SBRTr was 48.1% (41.0-57.2%) and for HDR1 + SBRTu was 37.6% (30.9-44.6%). Conclusions: In this modeling analysis of salvage RT for periurethral recurrences following previous RT (EBRT or HDR monotherapy), the NTCP for urethral stricture was numerically lowest for salvage SBRT using maximum urethral sparing dose constraints in comparison to salvage SBRT with maximum rectal sparing constraints or salvage HDR brachytherapy. This type of analysis lends insight into personalized treatment planning based on previous RT modality and previous dose to organs at risk. Expanded analysis is underway. [Table: see text]