History Of Radiotherapy Research Articles

A Comparison of Capsular Contracture Rates after Implant-Based Breast Reconstruction Using ADM Versus Synthetic Mesh

Abstract Goals/Purpose Capsular contracture is a local complication in which there is tightening of the capsule around the implant. This complication has been shown to occur in 15-30% of implant-based breast reconstruction patients and often requires revision surgery for correction. Prior investigations have suggested that the use of ADM can reduce the risk for development of capsular contracture, with more recent research suggesting that synthetic mesh may provide the same benefit. Several meta-analyses have attempted to compare ADM and mesh use for the prevention of capsular contracture, but they all emphasize the continued need for clinical investigation with direct comparisons. The goal of this study is to assess our own reconstruction patient population to compare capsular contracture rates between ADM and mesh cohorts, as well as to assess for other potential risks that may increase the rate of capsular contracture in these patients. Methods/Technique A 15-year retrospective review of all implant-based breast reconstructions performed by the senior author was performed. All operations occurred between 2008 and 2023 in a hospital setting. Patient demographics were assessed including age, BMI, implant size, radiation history, location of malposition, and use of either ADM or mesh. Post-operative complications including incidence of capsular contracture were recorded. Patients who had documented capsular contracture prior to scaffold insertion were excluded from the study. Wilcoxon signed rank test, 2-sided t-test, and Fischer’s Exact test were used to compare baseline demographics and capsular contracture rates between the two groups, along with a multivariate logistic regression analysis to control for potential confounders. Results/Complications Fifty-two breasts underwent capsulorraphy, of which 25 (48.1%) used ADM and 27 (51.9%) used mesh. Average age was 50.6 years, average BMI was 27.7, average implant size was 541.8 cc, and eight breasts (15.4%) had been irradiated. Average follow-up time was seven years (mean = 85.4 months, range 22 – 149 months, SD = 35.9). Fourteen (26.9%) capsulorraphies were for inferior malposition, 13 (25.0%) for lateral malposition, and 25 (48.1%) were for inferolateral malposition. Patients in the ADM group had significantly more lateral malposition prior to insertion as compared to the mesh group which had more inferior malposition (p=0.0246). There was no significant difference between the two groups for any other recorded baseline demographic; these demographics included age, BMI, hypertension, diabetes, history of tobacco use, radiation, chemotherapy, implant volume, and implant surface texture. Capsular contracture occurred in 2 ADM breasts (8.0%) and 4 mesh breasts (14.8%) with no significant difference between the two groups (p=0.6695). Five of these capsular contractures had documented Baker grades with three grade II, one grade III, and one grade IV. None of the recorded baseline demographics significantly increased the risk for capsular contracture development. Conclusion ADM and synthetic mesh both function as effective tools for reducing the risk of developing capsular contracture after prosthetic breast reconstruction. The rate of capsular contracture with ADM was only 8.0% and the rate with mesh was only 14.8%. Both rates are lower than the 15-30% incidence that has been found in breast reconstruction patients without mesh. None of the patient demographics were significant risk factors for capsular contracture development, so these are unlikely to be confounders. There was no significant difference in rate of capsular contracture between the two groups, suggesting that ADM and mesh are similarly efficacious at preventing capsular contracture in reconstruction patients.

Clinical Manifestation, Risk Factors, and Immune Checkpoint Inhibitor Rechallenge of Checkpoint Inhibitor-Associated Pneumonitis in Patients With Lung Cancer.

Immune-related adverse effects can lead to damage to various systems of the body, checkpoint inhibitor-associated pneumonitis (CIP) is one of the potentially lethal immune-related adverse effects. However, evidence regarding the risk factors associated with CIP is limited. To timely and accurate identification and prompt treatment of CIP, understanding the risk factors for multimorbidity among diverse study populations becomes crucial. We retrospectively analyzed the clinical data of 1131 patients with lung cancer receiving immunotherapy to identify 110 patients with CIP, the clinical characteristics and radiographic features of patients with CIP were analyzed. A case-control study was subsequently performed to identify the risk factors of CIP. The median treatment cycle was 5 cycles and the median time to onset of CIP was 4.2 months. CIP was mainly grade I or II. Most cases improved after discontinuation of immune checkpoint inhibitors (ICIs) or hormone therapy. Severe CIP tended to occur earlier in comparison to mild to moderate cases. The recurrence rate was 20.6% in ICI-rechallenged patients, and patients with relapsed CIP were usually accompanied by higher-grade adverse events than at first onset. Among the 7 patients with relapse, ICI-associated deaths occurred in 2 patients (28.6%). For rechallenging with ICIs after recovery from CIP, caution should be practiced. Male [odds ratio (OR): 2.067; 95% CI: 1.194-3.579; P = 0.009], history of chest radiation (OR: 1.642; 95% CI: 1.002-2.689; P = 0.049) and underlying lung disease (OR: 2.347; 95% CI: 1.008-5.464; P =0.048) was associated with a higher risk of CIP.

Pompe and Circumstance: A Cautionary Tale of Anchoring Bias and Delayed Diagnosis of Late-onset Pompe Disease in a Patient with a History of Pelvic Radiation (P11-11.006)

Pompe and Circumstance: A Cautionary Tale of Anchoring Bias and Delayed Diagnosis of Late-onset Pompe Disease in a Patient with a History of Pelvic Radiation (P11-11.006)

Feasibility and safety of intracranial carotid implantation with covered stents for advanced head and neck squamous cell carcinoma involving the carotid artery: A preliminary investigation

AbstractObjectiveThe aim of this study was to assess the feasibility and safety of implanting covered stents in cases of advanced head and neck squamous cell carcinoma (ASCCHN) where the carotid artery was involved.MethodsA total of 30 patients (29 males and one female) were included in this study, with ages ranging from 40 to 79 years. Among these patients, 28 patients had received radiotherapy and 17 received subsequent adjuvant therapy, while one was receiving treatment for the first time. Eighteen were treated with covered stent implantation in conjunction with surgery, and the remaining 12 received stent implantation alone. The study evaluated and compared the stent implantation's success rate, overall survival (OS), and associated complications.ResultsSuccessful implantation of covered stents was achieved in all 30 cases. No instances of significant hemorrhage or thromboembolic cerebral infarction occurred during surgery. Of the patients in the salvage surgical group, 15 underwent complete tumor resection with a success rate of 83.3% (15/18), of which four experienced tumor recurrence with a local recurrence rate of 26.7% (4/15). The OS rates at 6 months for all patients, the salvage surgical group, the 15 patients with complete tumor resection, and the nonsurgical group were 64.0%, 66.8%, 75.5%, and 58.6%, respectively. At 12 months, the OS rates were 21.4%, 29.3%, 43.2%, and 11.8%, respectively. Notably, the OS of the 15 patients who underwent complete tumor resection was significantly higher than that of the 12 patients who received stent implantation alone (p = 0.044). All cerebrovascular accidents occurred in patients with radiotherapy history, and subsequent adjuvant therapy had no significant effect on the OS time in the salvage surgical and nonsurgical groups (p = 0.935; p = 0.526).ConclusionIn cases of ASCCHN involving the carotid artery, the implantation of covered stents is a safe and feasible procedure.

Predominance of MGMT promoter methylation among Pakistani glioblastoma patients.

Glioblastoma multiforme (GBM), the most prevalent subgroup of neuroepithelial tumors, is characterized by dismal overall survival (OS). Several studies have linked O6-methylguanine-DNA-methyltransferase (MGMT) promoter methylation to OS in GBM patients. However, MGMT methylation frequencies vary geographically and across ethnicities, with limited data for South Asian populations, including Pakistan. This study aimed to analyze MGMT promoter methylation in Pakistani GBM patients. Consecutive primary GBM patients diagnosed ≥ 18 years-of-age, with no prior chemotherapy or radiotherapy history, were retrospectively selected. DNA was isolated from formalin-fixed-paraffin-embedded tissues. MGMT promoter methylation was analyzed using methylation-specific PCR. Clinical, pathological, and treatment data were assessed using Fisher's exact/Chi-squared tests. OS was calculated using Kaplan-Meier analysis in SPSS 27.0.1. The study included 48 GBM patients, comprising 38 (79.2%) males and 10 (20.8%) females. The median diagnosis age was 49.5 years (range 18-70). MGMT methylation was observed in 87.5% (42/48) of all cases. Patients with MGMT methylation undergoing radiotherapy or radiotherapy plus chemotherapy exhibited significantly improved median OS of 7.2 months (95% CI, 3.7-10.7; P < 0.001) and 16.9 months (95% CI, 15.9-17.9; P < 0.001), respectively, compared to those undergoing surgical resection only (OS: 2.2 months, 95% CI, 0.8-3.6). This is the first comprehensive study highlighting a predominance of MGMT methylation in Pakistani GBM patients. Furthermore, our findings underscore the association of MGMT methylation with improved OS across diverse treatment modalities. Larger studies are imperative to validate our findings for better management of Pakistani GBM patients.

Abstract 1123: Genomic characterization of radiotherapy-associated bladder cancer

Abstract Background: Bladder cancer (BCa) is the 4th most common cancer diagnosed in men, with 82,290 new cases predicted in 2023. As BCa frequently occurs at an advanced patient age, its diagnosis may follow radiotherapy (RT) for the treatment of prostate cancer. Currently, data is limited regarding the influence of RT on the clinical course and genomic landscape of subsequent BCa, mainly due to a paucity of samples. From prior studies, pelvic radiation confers an increased risk of BCa, with resulting tumors that are largely genomically similar to non-RT tumors with the exception of an increase rate of genomic insertions. Our current study looks to expand on these findings by characterizing the genomes of the largest cohort of RT-associated bladder cancers to date. Methods: We identified BCa cases from patients with a prior history of pelvic radiation for prostate cancer, and tumor only targeted sequencing was performed using Foundation Medicine (FMI) on FFPE tissue (n=41). For control cases (CTRL), patients with no prior record of pelvic radiation and who had previously underwent standard of care FMI sequencing were included (n=41). Sequencing data were re-aligned to hg38 and mutation calling was performed on the newly aligned sequences. Results: CTRL and RT cohorts had similar distributions of patients based on race and smoking status. While cT stage was similar between the two cohorts, the CTRL cohort was biased toward higher cN and cM stages with no difference in overall survival (median OS: CTRL = 20m, RT = 23m), though the advanced stage of the CTRL cohort could mask a worse prognosis in the RT cohort. Latency specific analysis revealed short latency tumors (&amp;lt;10 years from RT) had a significantly shorter overall survival than long latency tumors (p&amp;lt;0.01, HR=5.59, CI=1.81-17.3), and a numerically, but not significantly, shorter survival than CTRL patients (p=0.17, HR=1.55, CI=0.82-2.94). Long latency tumor patients had a significantly longer overall survival than CTRL patients (p&amp;lt;0.01, HR = 0.22, CI=0.07-0.63). In line with prior studies, RT samples had increased numbers of insertions (p&amp;lt;0.01). In addition, we also detected an increase in SNVs in the RT samples (p&amp;lt;0.01). Of note, KDM6A alterations were enriched within the RT cohort (CTRL = 10/41, RT = 30/41, p&amp;lt;0.001), with series of splice site mutations exclusive to RT samples (p&amp;lt;0.001). Conclusion: Patients diagnosed with BCa within a short interval following pelvic radiation have a worse prognosis. Genomic analysis showed RT-associated tumors having an increased number of insertions, SNVs, and KDM6A splice site mutations compared to non-RT tumors. Overall, the spectrum of recurrent alterations within the cohorts were consistent with previous studies, with the exception of the KDM6A mutations. To our knowledge, this is the first report of a RT-associated alteration in a specific gene in bladder cancer and additional studies will be needed to validate and understand the consequences of this finding. Citation Format: N. Ari Wijetunga, Kathryn H. Gessner, Krishna Kanchi, Sara E. Wobker, David Corcoran, Matthew D. Galsky, Matthew I. Milowsky, William Y. Kim, Tracy L. Rose, Jeffrey S. Damrauer. Genomic characterization of radiotherapy-associated bladder cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1123.

Abstract 3432: Blood metabolomic profile of glioma risk: A pooled, multi-cohort analysis in COMETS

Abstract Although gliomas are relatively rare, they are among the most lethal malignancies. Yet, with the exception of ionizing radiation and family history, their etiologic factors remain largely unknown. We conducted an untargeted metabolomics investigation pooling nested case-control studies from 9 prospective cohorts (median age 63 years, 59% women) in the Consortium of Metabolomics Studies (COMETS). One cancer-free control was individually matched to each of the 803 glioma cases based on age, sex, self-identified race/ethnicity, and blood collection date. Using an ultrahigh-performance LC-MS/MS platform (Metabolon, Inc.), we identified 874 known metabolites in pre-diagnostic serum or plasma, and logistic regression models conditioned on the matching factors) estimated odds ratios (ORs) and 95% confidence intervals for the associations between 1-SD increases in circulating metabolites and glioma risk (Bonferroni corrected significance threshold P=5.7 × 10−5). A total of 58 metabolites were associated with glioma (P&amp;lt;0.05), with the top three being 3-methylglutarylcarnitine (OR=1.19; P=0.001), cholate (OR=0.85; P=0.001) and a sphingomyelin (SM) (d18:2/21:0, d16:2/23:0, OR=1.19; P=0.002). Analysis restricted to cases diagnosed &amp;gt;5 years after blood collection showed 51 metabolites associated with risk (P&amp;lt;0.05), including SM d18:2/23:1 (OR=1.32; P=5.2 × 10−5), and two other SMs (d18:2/21:0, d16:2/23:0 and d17:1/24:1(15Z)) (ORs=1.27 and 1.26, respectively; P&amp;lt;5.6 × 10−4). Our findings were not materially altered with further adjustment for smoking, BMI, height and diabetes. Analysis restricted to high-grade glioma cases (n=595) showed similar associations, whereas low-grade glioma (n=207) showed fewer metabolites related to risk (top signals of sphingosine, sphinganine and L-glutamic acid, each inversely associated). We did, however, observe that the 2-hydroxyglutarate/alpha-ketoglutarate ratio was significantly associated with low-grade disease (OR=2.9; P=0.0008), which was most pronounced among cases diagnosed &amp;gt;10 years following blood collection (OR=9.99; P=0.003). Glioblastoma (n=485) showed similar positive risk estimates including for 3-methylglutarylcarnitine which achieved Bonferroni significance (OR=1.35; P=3 × 10−5) and several SMs. In contrast, the top metabolite for astrocytoma risk (n=88) was tyrosine (OR=0.55; P=0.002). Gene-set and principal components analyses confirmed that the sub-pathways of SM, dihydro-SM, fatty acid, and dihydroceramide metabolism were significantly associated with overall glioma risk, and dihydro-SM, dihydroceramide, SM, lactosylceramide, glutathione, and purine metabolism were associated with high-grade glioma (all P values &amp;lt;0.05). These novel findings regarding altered metabolic pathways/dysregulation occurring years before glioma diagnoses may be related to etiologic factors or subclinical disease. Citation Format: Jiaqi Huang, Bin Zhao, Stephanie J. Weinstein, Marian L. Neuhouser, Steve C. Moore, Heather Eliassen, David J. Cote, Loic Le Marchand, Lorelei Mucci, Ying Yang, Victoria Stevens, Wei Zheng, Xiao-Ou Shu, Demetrius Albanes. Blood metabolomic profile of glioma risk: A pooled, multi-cohort analysis in COMETS [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3432.

Children with non-central nervous system tumors treated with platinum-based chemotherapy are at risk for hearing loss and cognitive impairments.

Childhood cancer survivors (CCS) with chemotherapy induced sensorineural hearing loss (SNHL) are at risk for neurocognitive impairments. The purpose of this study was to determine the relationship between SNHL and cognitive function among CCS. Inclusion: non-CNS solid tumor diagnosis; history of platinum chemotherapy (cisplatin and/or carboplatin); 8-17 years of age; off anti-cancer treatment for ≥6 months; and English speaking. Exclusion: history of intrathecal chemotherapy, cranial radiation, or baseline neurocognitive disorder. Participants completed the NIH Toolbox Cognition Battery at enrollment. T-tests were used to compare participants with normal hearing to those with hearing loss and the total sample with established Toolbox normative data (mean: 50; SD: 10). Fifty-seven individuals enrolled; 52 completed full cognitive testing. Participants were on average 12.2 years of age and 7.0 years since treatment completion. Twenty-one participants (40%) received cisplatin, 27 (52%) carboplatin, and 4 (8%) received both. Fifteen participants (29%) demonstrated SNHL based on the better ear. CCS, regardless of the presence or absence of SNHL, demonstrated significantly lower mean cognitive skills compared to the normative sample in attention, executive function, language- vocabulary and oral reading, processing speed, and fluid, crystallized and total composite scores (all p < 0.01). Participants with SNHL had significantly lower crystallized composite (vocabulary, oral reading) than those with normal hearing (41.9 vs. 47.2, p < 0.05, Cohen's d = 0.62). CCS at risk for platinum induced hearing loss but without cranial radiation or intrathecal chemotherapy exposure demonstrate impaired cognitive skills and those with SNHL demonstrate lower crystallized composite scores.

The Value of the Nutritional Indicators in Predicting Free Flap Failure From a Multicentre Database.

Nutritional and inflammatory statuses have been associated with complications in microvascular-free flaps during head and neck surgeries. This study aimed to evaluate the potential of nutritional indicators in predicting postoperative free flap complications. We conducted a 20-year retrospective, case-control study within a defined cohort. The study involved head and neck cancer patients from the Chang Gung Research Database who underwent simultaneous tumor ablation and free flap wound reconstruction between January 1, 2001, and December 31, 2019. We employed logistic regression and stratified analysis to assess the risk of free flap complications and the subsequent need for flap revision or redo in relation to nutritional indicators and other clinical variables. Of the 8066 patients analyzed, 687 (8.5%) experienced free flap complications. Among these, 197 (2.4%) had free flap failures necessitating a redo of either a free flap or a pedicled flap. Beyond comorbidities such as chronic obstructive pulmonary disease, end-stage renal disease, and a history of prior radiotherapy, every 10-unit decrease in the preoperative prognostic nutritional index (PNI) was consistently associated with an increased risk of both free flap complications and failure. The covariate-adjusted odds ratios were 1.90 (95% confidence interval [CI]: 1.42-2.54) and 1.89 (95% CI: 1.13-3.17), respectively. A lower preoperative PNI suggests a higher likelihood of microvascular free flap complications in head and neck surgeries. Further randomized controlled trial designs are required to establish causality.

Co2 LASER Therapy as an Option for Non-Healing Surgical Wounds after Radiation Therapy-A Retrospective Study.

Radiation has a huge impact on wound healing with progressive and irreversible impairment at the cellular level, making it very challenging for surgeons in terms of wound healing aftersalvagesurgeryin previously radiated patients. CO2 LASER helps in wound healing by its combined effect yielding a better result. Our study aims to retrospectively evaluate the healing outcome in a series of patients post-radiation, diagnosed with head and neck neoplasm recurrence, undergoing CO2 LASER treatment for non-healing surgicalwounds, post salvage surgeryhaving a previous history of radiotherapy in Head and Neck cancers. A total of seven patients from January 2018 to June 2021 who underwent CO2 LASER treatment in non-healing surgicalwounds, post salvage surgeryhaving a previous history of radiotherapy in Head and Neck cancerswere included in this study. Clinical assessment of healing in terms of complete healing, the appearance of the scar, and patient satisfaction, with a follow-up for 18months. This series included a total of seven patients, five men and two women, aged between 27 and 62years with a mean age of 47years. Three patients had a previous history of radiation, and four patients had a previous history of chemoradiation (CT + RT). Successful healing was noted in all the seven patients. Post-healing all patient's scars were soft, flat, and clinically acceptable. One patient presented with hypopigmentation. CO2 LASER therapy speeds up the healing process with minimal discomfort to the patient. CO2 LASER therapy can be used as an alternative for non-healingsurgical woundsafter salvage surgery in previously radiated patients with an unhealthy wound bed where split-thickness skin graft uptake is unpredictable.

Clinical features and prognostic analysis of checkpoint inhibitor pneumonitis in patients with non-small cell lung cancer

Objective: To describe the clinical characteristics of patients with non-small cell lung cancer (NSCLC) who developed checkpoint inhibitor pneumonitis (CIP) and to explore potential prognostic factors. Methods: NSCLC patients who were complicated with CIP after immune checkpoint inhibitors (ICIs) therapy in our institute were enrolled in this study from 1 July 2018 to 30 November 2022. Clinical data of NSCLC-CIP patients were collected, including clinical and radiological features and their outcomes. Results: Among the 70 enrolled NSCLC-CIP patients, there were 57 males (81%) and 13 females (19%). The mean age at the diagnosis of CIP was (65.2±6.3) years. There were 46 smokers (66%), 26 patients (37%) with emphysema, 19 patients (27%) with previous interstitial lung disease, and 26 patients (37%) with a history of thoracic radiation. The mean interval from the first application of checkpoint inhibitor to the onset of CIP was (122.7±106.9) days (range: 2-458 days). The main chest CT manifestations were coincided with non-specific interstitial pneumonia (NSIP) pattern and organizing pneumonia (OP) pattern. Most patients had grade 2 (21 cases) or grade 3 (34 cases) CIP. Seventeen patients had been concurrent with other immune-related adverse events such as rash, hepatitis, colitis, and thyroiditis. Half of the enrolled patients (36 patients/51%) had fever, and most patients had elevated C-reactive protein (52 patients/72%) and all patients had elevated erythrocyte sedimentation rate (70 patients/100%). Serum lactate dehydrogenase was elevated in 34 CIP patients. Prednisone≥1 mg·kg-1·d-1 (or equivalent) was the most commonly used initial treatment in CIP patients (50 patients/71.4%). Complications with pulmonary infections (OR=4.44, P=0.03), use of anti-fungal drugs (OR=5.10, P=0.03) or therapeutic dose of sulfamethoxazole (OR=4.86, P=0.04), longer duration of prednisone≥1 mg·kg-1·d-1 (or equivalent) (Z=-2.33, P=0.02) were probable potential risk factors for poor prognosis. Conclusions: Older males with smoking history might be predisposed to develop NSCLC-CIPs after ICIs therapy. NSIP pattern and OP pattern were common chest CT manifestations. Complications with pulmonary infections (especially fungal infection or Pneumocystis jirovecii pneumonia), longer duration, longer duration of high-dose corticosteroids were likely potential risk factors for poor prognosis.

(103) Prior Intracavernosal Injection Therapy and Prostate Cancer Treatment are Both Independently Associated with Increased Risks of Complications in Men Undergoing Inflatable Penile Prosthesis Placement

Abstract Introduction Intracavernosal injection (ICI) therapy for erectile dysfunction (ED) carries a risk of corporal fibrosis, potentially making placement of an inflatable penile prosthesis more difficult. Prostate cancer treatment may also induce corporal fibrosis. Objective To assess whether a history of ICI or prostate cancer treatment is associated with complications following IPP placement. Methods A retrospective cohort study of primary IPP cases from 2016–2021 across 16 institutions. Patients were stratified by history of ICI and between-group differences in risk factors were assessed. Multivariable logistic regression was used to assess for predictors of intraoperative complications, postoperative non-infectious complications and postoperative infection. Results A total of 2540 patients met inclusion criteria of which 781 (30.8%) had a history of ICI. Patients with a history of ICI tended to be older (mean 63 vs 64 years, p=0.002) and were more likely to have history of radical prostatectomy (21.0% vs. 32.1%, p&amp;lt;0.001) and/or radiation (5.51% vs 10.9%, p&amp;lt;0.001). On multivariable regression, a history of ICI, prostatectomy, and radiation were all significant predictors of intraoperative complications (OR 2.11, p=0.03; OR 2.27, p=0.03; OR 2.40, p=0.04, respectively). A history of ICI and patient age were predictors of non-infectious postoperative complications (OR 1.44, p=0.02, OR 1.02, p=0.004 respectively)). None of the variables were significant predictors of infection. Conclusions In men undergoing IPP placement, a history of ICI is associated with an increased risk of both intraoperative and postoperative, non-infectious complications. Prostate cancer treatment with radiation or surgery is independently associated with increased risk of intraoperative complications. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: D.O. has served as a consultant for Coloplast, Intuitive Surgical, and Fidelis. P.P. has served as a consultant for Coloplast, Boston Scientific, and Urofill. M.S. has served as a consultant for Boston Scientific and Coloplast. J.S. has served as a consultant for Boston Scientific and Coloplast. F.A.Y. has served as a consultant for Coloplast, Cynosure, Antares Pharma, Clarus Pharmaceuticals, and Acerus Pharma. M.S.G. has served as a consultant for Coloplast. The other authors disclose no conflicts.

(161) Is there a Difference in Inflatable Penile Prosthesis Mechanical Failure and Infections Rates in Relation to Prostate Cancer Treatment Modality (Radiation Therapy vs Radical Prostatectomy)

Abstract Introduction Inflatable Penile Prosthesis (IPP) implantation as a treatment for ED has high satisfaction rates in the general population; however, there is limited literature on quantification of complication rates as stratified by ED etiology. Objective Our aim was to compare mechanical failure and infection rates in patients undergoing IPP implantation for ED following Radical Prostatectomy (RP) versus radiation therapy (RT) for prostate cancer. Methods A retrospective chart review from our institutional database was conducted to identify 405 patients who underwent IPP placement at our institution from 2015–2019, then selecting for those whose etiology of ED was following RP or RT. To prevent crossover confounding; patients with history of pelvic radiation or salvage radiotherapy were excluded from the RP group and patients with history of RP were excluded from the RT group. Data was obtained from 75 patients who met criteria for inclusion: 44 patients in the RP group and 31 patients in the RT group. Mechanical failure, infection rates, mean EDITS scores and additional survey questions were compared between the radiation and RP groups. Results Patient demographic information and IPP complication and satisfaction rates are listed below in Table 1 and Figure 1. There was a statistically significant difference in number of patients experiencing IPP complications, 19.4% (n=6) of patients in the RT cohort and 4.5% (n=2) in the RP cohort, respectively. There was no statistically significant difference found in stratified complications- infection rates, device erosion rates, mechanical failure rates, or device removal and/or replacement rates between the two groups. The RP cohort had a significantly higher mean Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire score versus the RT cohort, 91.58 to 76.02, respectively. Conclusions These preliminary findings, while requiring large-scale follow up, suggest that there is a higher rate of IPP related complications in patients with device placement following RT for prostate cancer versus RP. Disclosure No.

(166) Surgical Excision and Grafting with Simultaneous Dorsal Plication for Ventral Plaque Accompanied by Urethral Tethering

Abstract Introduction Peyronie's disease, a condition characterized by penile curvature, approximately affects 9% of men. Surgical interventions are often employed to address this bothersome condition, and these can include techniques such as plication of the tunica albuginea, incision, or excision of the plaque with grafting procedures, and penile prosthesis implantation. The recommended treatment options vary depending on the specific constellation of symptoms and underlying conditions experienced by the patient. Objective We present a case of severe ventral curvature and penile shortening due to urethral tethering, resulting in residual curvature even after undergoing plaque excision and grafting. Methods The patient is a 65-year-old gentleman with a history of metastatic renal cell carcinoma, deep vein thrombosis status post inferior vena cava filter placement as well as anticoagulation with apixaban, and diabetes mellitus who presented with a complaint of progressive penile curvature over his past 12 months. His secondary complaints included difficulty and pain with intercourse. He noted a 90-degree ventral erection. He denies any history of penile trauma, surgery, or pelvic radiation, though he did report chest radiation for his metastatic kidney cancer. Penile doppler noted a large ventral mid penile plaque measuring 9.5x7.7x5 mm. Due to the severe, bothersome curvature, the patient was recommended excision and grafting (Tutoplast). Intraoperatively, a 2.5 cm x 3.0 cm plaque was excised and a Tutoplast pericardial allograft was used to cover the corporal defect. However, due to urethral tethering the patient still had residual curvature. We opted to perform a dorsal tunica albuginea plication using the Lue 16 dot technique. Results Penile plication remains a tool in the armamentarium of the reconstructive urologist and andrologist for penile curvature arising from Peyronie’s disease. However, in the setting of severe curvature, the penile length loss arising from plication alone can be prohibitive. Therefore incision, or excision with grafting has been implemented with significant sparing of penile length. On the other hand, there is a limit to which length can be maintained and occasionally the tethering of the corpus spongiosum can result in residual curvature. Contralateral tunical plication is therefore an option to be performed concomitantly with grafting procedures. This combination is uncommon but has been reported. In our approach, the patient’s severe curvature was improved with ventral plaque excision and grafting. However, his residual curvature at this stage was able to be corrected with minimal effect on his penile length by applying a dorsal plication technique with minimal additional risk. During the follow-up after the surgery, the patient reported a smooth recovery without any complications. There was no residual curvature, and the patient was able to achieve normal erections sufficient for intercourse without the need for additional measures. Conclusions The correction of severe ventral curvature deformity can be challenging, the surgeon should be prepared to perform additional correction procedures if penile straightening was limited by the tethering of the neurovascular bundle or urethra. Excision and grafting of ventral plaque with concomitant dorsal tunica plication for residual curvature in settings of urethral tethering is a safe viable and effective option with excellent functional results. Disclosure No.

(265) Self-Image after Breast Cancer

Abstract Introduction Breast cancer is currently the first cancer diagnosed among women. The impact of its local treatments such as surgery and radiation and its systemic treatments such as chemotherapy, hormone-suppressant therapies and targeted therapies on women's bodies anatomically and physiologically and on their body image and body esteem are the major factors altering their sexual health and the quality of their spousal relationships. Objective We aim to evaluate the qualitative impact of breast cancer on its survivors' body-image. Methods We ran a prospective qualitative study using semi-structured interviews until saturation of findings. The patients included were women diagnosed, treated for breast cancer, and followed up in our institution. All participants were sexually active and no older than 55. The study enrolled 20 participants over a 6-month period (February 2022-July 2022). Results All participants had a history of breast surgery either lumpectomy or mastectomy (70%) with (one case) or without reconstructive surgery. All patients reported a history of radiation and chemotherapy. 60% had received hormone therapy with medically induced menopause. The majority of participants explained how their bodies had changed not only physically and anatomically on the outside but also on the inside especially in relation to the adverse effects of chemotherapy and hormone therapy. They also reported body emotional changes. This required an adaptation to their new body for them and their partners and entourage. The main themes emerging from their discourse were: physical and emotional adaptation to breast cancer per se and its local and systematic treatments, fear of others judgment and comments on their physical changes and loss or gain of self-esteem. Breast reconstruction was also an important theme it the participants verbatim. Conclusions The words and themes that characterized the participants' speeches highlighted the impact of cancer diagnosis and oncological therapies on breast cancer survivors. Being part of a psychological intervention focused on self-compassion and body acceptance helps breast cancer survivors develop a better perception and acceptance of their new bodies. Disclosure No.

Reconstruction of Urethral Sphincter With Polyacrylamide Hydrogel.

Urethral bulking is an alternative to synthetic midurethral sling for the treatment of stress urinary incontinence (SUI) in women. Urethral bulking agents, which are injected in the submucosal tissues of the proximal urethra/bladder neck, have demonstrated less adverse effects with similar satisfaction rates but lower subjective and objective cure rates when compared with midurethral sling. Cystoscopic Reconstruction of External Sphincter Technique (CREST) is a novel technique, which reinforces the natural closure mechanism of the external urinary sphincter (EUS). The aim of the study was to provide safety and efficacy data for injecting polyacrylamide hydrogel (PAHG) in the components of the female EUS. This was a retrospective chart review of patients using CREST with PAHG as initial treatment for SUI by a single surgeon from January 2022 to October 2022. Exclusion criteria are as follows: younger than 18 years, prior SUI surgery, concomitant pelvic organ prolapse or reconstructive procedure, neurological conditions, or history of radiation. Subjective and objective cure rates were measured by patient-reported symptoms and cough stress test. Urinary retention, postoperative urinary infection, and de novo urinary urgency were assessed. One hundred and thirteen consecutive patients met inclusion criteria with median follow-up of 3 months. Eighty-five percent of participants reported subjective improvement, 69% reported subjective cure, and 69% demonstrated objective cure. Nine patients reported transient postoperative retention, 8 reported postoperative urinary tract infections, and 5 reported de novo urgency. There were no serious adverse events. CREST is a novel technique for injection of PAHG, into the EUS to treat SUI. Our data suggest that this technique could improve urethral injection outcomes with minimal complications.

Diagnostic advantages of transrectal ultrasound with gastrointestinal agent instillation for rectal adenoma and early-stage rectal cancer: comparison of conventional transrectal ultrasound techniques.

Despite being a major focus of medical research for decades, rectal cancer remains a major threat to human health. This study aimed to compare and analyze the diagnostic value of transrectal ultrasonography (TRUS) for rectal adenoma and early-stage rectal cancer before and after gastrointestinal agent instillation. In this prospective study, patients diagnosed with rectal adenomas and early-stage rectal cancer by ultrasound were randomly selected for inclusion. All patients underwent ultrasound examination at the Outpatient Department of the First Affiliated Hospital of China Medical University and underwent surgical treatment at the First Affiliated Hospital of China Medical University. Patients with a lesion located 13 cm or more from the edge of the anus, or history of surgery, and a history of radiation and chemotherapy were excluded. A gastrointestinal agent was directly instilled into the rectal cavity during conventional TRUS to compare and analyze the display of rectal lesions before and after such instillation and to evaluate the infiltration depth of rectal lesions. These findings were compared to the pathological findings to determine the diagnostic efficacy. Both the conventional TRUS and TRUS with gastrointestinal agent instillation were able to show the rectal wall structure and rectal lesions; the detection rate of rectal lesions of the former was 75.0%, and that of the latter was 97.1% (P<0.001). Of the 27 rectal adenomas, conventional TRUS detected 10, and TRUS with gastrointestinal agent instillation detected 25 lesions. The accuracy [90.54%; 95% confidence interval (CI): 81.48-96.11%; P=1.05E-08], specificity (87.88%; 95% CI: 71.80-96.60%; P=1.09E-05), and sensitivity (92.68%; 95% CI: 80.08-98.47%; P=1.05E-08) of TRUS in diagnosing early-stage rectal cancer were consistent with the pathological findings (P<0.001). The accuracy (95.95%, 95% CI: 88.61-99.16%; P=3.82E-11), specificity (93.94%, 95% CI: 79.77-99.26%; P=1.31E-07), and sensitivity (97.56%, 95% CI: 87.15-99.94%; P=3.82E-11) of TRUS after gastrointestinal agent infusion in diagnosing early-stage rectal cancer were consistent with the pathological findings (P<0.001). The specificity (87.88%; 95% CI: 71.80-96.60%; P=1.09E-05) of TRUS in diagnosing rectal adenomas was consistent with the pathological finding (P<0.001), but the accuracy (65%; 95% CI: 51.60-76.87%; P=0.25) and sensitivity (37.04%, 95% CI: 19.40-57.63%; P=0.25) were not (P>0.05). Meanwhile, the accuracy (93.33%; 95% CI: 83.80-98.15%; P=5.65E-06), specificity (93.94; 95% CI: 79.77-99.26%; P=1.31E-07), and sensitivity (92.59%; 95% CI: 75.71-99.09%; P=5.65E-06) of TRUS after gastrointestinal agent infusion in diagnosing rectal adenomas were consistent with the pathological findings (P<0.001). TRUS with gastrointestinal agent instillation had significantly improved accuracy in diagnosing early-stage rectal cancer and detecting intrarectal adenomatoid lesions.

Re-irradiation spine stereotactic body radiotherapy following high-dose conventional radiotherapy for metastatic epidural spinal cord compression: a retrospective study

Purpose We aimed to evaluate the efficacy and safety of re-irradiation stereotactic body radiation therapy (SBRT) in patients with metastatic epidural spinal cord compression (MESCC) following high-dose conventional radiotherapy.Materials and methods Twenty-one patients met the following eligibility criteria: with an irradiation history of 50 Gy2 equivalent dose in 2-Gy fractions (EQD2) or more, diagnosed MESCC in the cervical or thoracic spines, and treated with re-irradiation SBRT of 24 Gy in 2 fractions between April 2018 and March 2023. Prior treatment was radiotherapy alone, not including surgery. The primary endpoint was a 1-year local failure rate. Overall survival (OS) and treatment-related adverse events were assessed as the secondary endpoints. Since our cohort includes one treatment-related death (TRD) of esophageal perforation, the cumulative esophageal dose was evaluated to find the dose constraints related to severe toxicities.Results The median age was 68, and 14 males were included. The primary tumor sites (esophagus/lung/head and neck/others) were 6/6/7/2, and the median initial radiotherapy dose was 60 Gy2 EQD2 (range: 50–105 Gy2, 60–70/ > 70 Gy2 were 11/4). Ten patients underwent surgery followed by SBRT and 11 SBRT alone. At the median follow-up time of 10.4 months, 17 patients died of systemic disease progression including one TRD. No radiation-induced myelopathy or nerve root injuries occurred. Local failure occurred in six patients, with a 1-year local failure rate of 29.3% and a 1-year OS of 55.0%. Other toxicities included five cases of vertebral compression fractures (23.8%) and one radiation pneumonitis. The cumulative esophageal dose was recommended as follows: Dmax < 203, D0.035 cc < 187, and D1cc < 167 (Gy3 in biological effective dose).Conclusion Re-irradiation spine SBRT may be effective for selected patients with cervical or thoracic MESCC, even with high-dose irradiation histories. The cumulative dose assessment across the original and re-irradiated esophagus was recommended to decrease the risk of severe esophageal toxicities.

Epidemiology of and Risk Factors in Postoperative Complications from Robotically Assisted Laparoscopic Radical Prostatectomy in Contemporary National Surgical Quality Improvement Program Data.

Introduction: For localized clinically significant prostate cancer (csPCa), robotically assisted laparoscopic radical prostatectomy (RALP) is the gold standard surgical treatment. Despite low overall complication rate, continued quality assurance (QA) efforts to minimize complications of RALP are important, particularly given movement toward same-day discharge. In 2019, National Surgical Quality Improvement Program (NSQIP) began collecting RALP-specific data. In this study, we assessed pre- and perioperative factors associated with postoperative complications for RALP to further QA efforts. Materials and Methods: Surgical records of csPCa patients who underwent RALP were retrieved from the 2019 to 2021 NSQIP database, including new RALP-specific data. Multivariate logistic regression evaluated the association between risk factors and outcomes specific to RALP and pelvic lymph node dissection (PLND). Input variables included American Society of Anesthesiologists (ASA) class, age, operative time, and body mass index (BMI). Variables from the extended dataset with PLND information included number of nodes evaluated, perioperative antibiotics, postoperative venous thromboembolism (VTE) prophylaxis, history of prior pelvic surgery, and history of prior radiotherapy (RT). Outcomes of interest were any surgical complication, infection, pulmonary embolism, deep venous thrombosis, acute kidney injury, pneumonia, lymphocele, and urinary/anastomotic leak (UAL). Results: A total of 11,811 patients were included with 6.1% experiencing any complication. Prior RT, prior pelvic surgery, older age, higher BMI, lack of perioperative antibiotic therapy, longer operative time, PLND, and number of lymph nodes dissected were associated with higher risk of postoperative complications. Regarding procedure-specific complications, there were increased odds of UAL with prior RT, prior pelvic surgery, longer operative time, and higher BMI. Odds of developing lymphocele increased with prior pelvic surgery, performance of PLND, and increased number of nodes evaluated. Conclusion: In contemporary NSQIP data, RALP is associated with low complication rates; however, these rates have increased compared with historical studies. Attention to and counseling regarding risk factors for peri- and postoperative complications are important to set expectations and minimize risk of unplanned return to a health care setting after discharge.

Papillary Thyroid Carcinoma Synchronous with High-Grade Non-Hodgkin's Lymphoma: A Case Report

Papillary thyroid carcinoma (PTC) is the most common thyroid carcinoma, accounting for up to 90% of all thyroid malignancies. The association with a hematological malignancy is very rare, representing an incidence of only 7%. We present a case of synchronous papillary thyroid cancer and non-Hodgkin's lymphoma (NHL) and discuss possible dilemmas in diagnosis and treatment. A 60-year-old woman with no medical or radiation history presented with a hard, immobile left supraclavicular swelling. Cervical ultrasound showed the presence of a suspicious-looking supraclavicular adenopathy with two right lobar thyroid nodules classified EU-TIRADS 4. We performed a total thyroidectomy with right central latero-cervical functional left curage and excision of the left supraclavicular adenopathy. Pathological examination revealed papillary thyroid carcinoma synchronous with high-grade nonHodgkin's lymphoma. After a multidisciplinary consultation, the patient received six courses of chemotherapy before undergoing irratherapy. This article highlights the importance of a multidisciplinary approach in the absence of consensus, given the rarity of this case