Oncological outcomes following PSMA PET/CT-guided salvage whole-pelvis radiotherapy for recurrent prostate cancer.

Male sling implants are an acceptable treatment for post-prostatectomy stress urinary incontinence, but more long-term follow data is needed to assess clinical effectiveness. This study provides long-term continence and quality of life outcomes using complete 10-year follow up data from patients with AdVance™/AdVance XP™ Male Sling Systems. In an observational multicenter study, prospective data collection included preoperative patient characteristics, perioperative course, and postoperative outcomes. Continence was assessed using the 24 h pad weight test and patient-reported outcome measures (PROMs) were measured with the International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI SF). Follow-up over 10 years included re-intervention. Of 111 patients who underwent surgery between February 2008 and February 2012, 87 completed 10-year follow-up (median follow-up was 136.6 months (range:121.9-170.5). At 3-month follow-up, 59 patients (67.8%) were considered cured. Of the 59 patients initially cured, 17 patients (28.81%) lost continence during follow-up, 11 due to stress urinary incontinence recurrence (65%), four due to de novo urge incontinence (23%), and two due to salvage radiotherapy (12%). Of the 17 who lost continence, six received a second surgical treatment, with no reported intra or preoperative surgical problems due to the first surgery. In cured patients, surgery resulted in a reduction of the median ICIQ-SF score from 16.27 (SD 3.53) to 4.03 (SD 3.36) (p < 0.01). In the patients considered not cured, a reduction on the median ICIQ-SF score from 16.39 (SD 3.05) to 11.29 (SD 5.34) was observed (p < 0.01). Our findings suggest that long-term continence rates after sling implant are acceptable, especially in ideal patients with mild to moderate incontinence and naïve for prior pelvic irradiation or surgical treatment for urinary incontinence or urethral stricture disease.

The impact of urinary catheterization on urinary tract infection and renal function in elderly patients undergoing hip fracture surgery: A prospective randomized controlled trial.

Study Protocol of OLIGOPELVIS 2-GETUG P12: A Randomized Phase 3 Study Comparing Intermittent Androgen-deprivation Therapy with or Without Salvage High-dose Intensity-modulated Radiotherapy to Oligorecurrent Pelvic and Para-aortic Lymph Nodes in Patients with Biochemically Relapsing Prostate Cancer.

There is a dearth of data for artificial urinary sphincter (AUS) erosions after the introduction of InhibiZone-coated devices in 2008. We aim to identify common organisms associated with non-infected and infected AUS device erosions. We reviewed our prospectively collected, institutionally approved quality improvement database of AUS implantations, removals, or revisions performed our facility. Devices implanted after 2008 that subsequently eroded were included for review. Erosion was confirmed cystoscopically in all cases. Urine cultures and intraoperative cultures (tissue, aspirate, or swab) were reviewed. Descriptive analyses of clinical and culture data were performed. We performed 1,104 AUS cases between 2008 and 2022 and identified 80 (7.2%) erosions of InhibiZone-coated AUS devices in 67 patients. Median time to erosion was 10.5 months (IQR 3-29). 49 patients (73%) received prior pelvic radiation. Sixty-seven (84%) erosion cases had urine cultures and 36 (45%) had intraoperative cultures available for review. Of the 47 (70%) positive urine cultures, the most common results were mixed flora (36%), E. Coli (7%), and Klebsiella (7%). Top isolates from the 26 (72%) positive intraoperative cultures were Staphylococcus species (14%) and Pseudomonas (14%), followed by E. Coli (11%), Candida (11%), and Klebsiella (11%). Positive intraoperative cultures isolated more gram-negative organisms (47%) than gram-positive organisms (38%). InhibiZone-coated AUS devices erosions were associated with a wide variety of organisms, including gram-positive, gram-negative, and fungal species. This can help guide modern anti-microbial prophylaxis practices and empiric treatment pathways in the eroded patient.

Acute toxicity and quality of life in postoperative prostate cancer patients treated with ultra-hypofractionated pelvic radiation therapy

Sexual health following hyperbaric oxygen treatment in pelvic cancer survivors with radiation injuries: a longitudinal observational study.

To systematically compare the dosimetric performance and model-based radiobiological estimates of intensity-modulated proton therapy (IMPT), helical tomotherapy (TOMO), and volumetric modulated arc therapy (VMAT) for ovarian dose sparing in young cervical cancer patients after oophoropexy. Ten premenopausal cervical cancer patients who received postoperative pelvic radiotherapy following bilateral ovarian transposition were retrospectively enrolled. Three treatment plans (IMPT, TOMO, and VMAT) were designed for each patient with a uniform prescription of 45 Gy in 25 fractions. IMPT plans incorporated robust optimization accounting for setup uncertainty (5 mm) and range uncertainty (3.5%). Dosimetric parameters evaluated included target coverage ([Formula: see text]), homogeneity index (HI), ovarian mean dose ([Formula: see text]) and maximum dose ([Formula: see text]), and dose-volume metrics for organs at risk (OARs: rectum, bladder, small intestine, sigmoid, femoral heads). Radiobiological analyses included equivalent uniform dose (EUD), normal tissue complication probability (NTCP), and excess absolute risk (EAR) estimation for secondary malignancies using Schneider's mechanistic model. All three techniques achieved clinically acceptable target coverage. IMPT showed superior dose homogeneity and the most favorable planned ovarian dose-sparing profile, reducing ovarian [Formula: see text] by approximately 95% compared with photon-based techniques (0.11-0.35 Gy vs. 4.44-5.24 Gy, [Formula: see text]) and substantially lowering low-dose exposure ([Formula: see text] cc vs. 2.86-7.68 cc, [Formula: see text]). Both IMPT and TOMO achieved significantly lower [Formula: see text] to the rectum, bladder, and small intestine than VMAT ([Formula: see text]). IMPT also reduced small intestine [Formula: see text], mean bladder dose, and integral dose to normal tissue compared with both photon techniques ([Formula: see text]). Model-based NTCP analysis showed that IMPT yielded lower estimated complication probabilities for the small intestine, rectum, and bladder compared with TOMO and VMAT ([Formula: see text]), while femoral head estimates were comparable between IMPT and VMAT and lower than TOMO. EAR modeling suggested organ-specific and endpoint-dependent differences across pelvic OARs. VMAT had the shortest beam-on time (2.20 ± 0.05 min vs. TOMO 8.18 ± 0.99 min, [Formula: see text]). IMPT achieved the lowest ovarian radiation exposure and the most favorable overall dosimetric profile for ovarian dose sparing after ovarian transposition. TOMO provided competitive sparing for several high-dose pelvic OAR endpoints, whereas VMAT offered the shortest photon beam-on time. Overall, IMPT appears to be the most favorable dosimetric option for ovarian dose sparing when available, while VMAT and TOMO remain reasonable alternatives depending on clinical priorities and resource availability. These findings should be interpreted as dosimetric and model-based advantages rather than direct evidence of improved ovarian endocrine function or reduced clinical toxicity.

The 2023 update of the International Federation of Gynecology and Obstetrics (FIGO) staging system introduced significant changes in the classification of endometrial cancer by incorporating key pathological and molecular features. This study aimed to evaluate the impact of the revised FIGO 2023 staging system on stage distribution and adjuvant treatment decisions in patients undergoing surgical management of this malignancy. This retrospective study included 220 patients who underwent surgical staging for endometrial cancer between January 2018 and December 2025. All patients were initially staged using the FIGO 2009 classification. Cases were subsequently reclassified according to the FIGO 2023 staging criteria, using the algorithm proposed for settings in which routine molecular classification is unavailable. The McNemar test was used to compare stage categories between the two staging systems, and the Wilcoxon signed-rank test was applied to evaluate the impact of stage migration on adjuvant treatment recommendations. Stage migration occurred in 12.7% of patients (28/220) following the application of the FIGO 2023 criteria, predominantly due to upstaging. The most common factor associated with stage reclassification was substantial lymphovascular space invasion (LVSI). The proportion of patients managed with observation alone significantly decreased from 44.5% to 32.7% (p<0.001), while the use of pelvic radiotherapy increased from 19.1% to 28.2% (p=0.004). Similarly, the proportion of patients receiving combined chemoradiotherapy significantly increased from 11.8% to 17.3% (p=0.012). The implementation of the FIGO 2023 staging system has resulted in clinically meaningful stage migration and significantly impacted adjuvant treatment strategies. In particular, the recognition of substantial LVSI as a defining feature of stage IIC disease has led to more intensive adjuvant therapy in a subset of patients previously categorized as low risk.

Oncofertility outcomes in early-onset patients with non-breast solid malignancies: a systematic review

Background and PurposeRadiation-induced ovarian injury (RIOI) compromises the clinical utility of pelvic radiotherapy and reduces fertility in young female patients. Dimethyl sulfoxide (DMSO) exhibits antioxidant property. Hearin, we aimed to explore the protective effect and underlying mechanism of DMSO on RIOI.Materials and MethodsC57BL/6J female mice were treated with DMSO prior to undergoing lower abdominal radiation. Intragenerational and transgenerational fertility were assessed by mating experiment. Ovaries were harvested to evaluate follicle count and morphology. Granulosa cells were analyzed by immunohistochemical staining of TUNEL and Ki67. An ovary explant organ culture system was established to evaluate the effect of DMSO. Fluorescent probes were employed to evaluate mitochondrial mass and function. DNA double-strand breaks were detected by immunoblotting of γ-H2AX.ResultsDMSO preserved the fertility of irradiated mice and even safeguarded the reproductive capacity of their unirradiated female offspring. Histological analyses revealed that DMSO preserves the ovarian follicle reserve, including both primordial and developing follicles. Additionally, DMSO demonstrated radioprotective effects in ex vivo ovarian tissue. Moreover, DMSO reduced apoptosis and enhanced proliferation in granulosa cells. Mechanistically, DMSO alleviated radiation-induced oxidative stress and preserved mitochondrial function, as evidenced by increased mitochondrial mass, reduced oxidant levels, and enhanced mitochondrial membrane potential. Moreover, DMSO reduced the levels of DNA damage accumulation in vivo and in vitro.ConclusionOur data suggest that DMSO may offer a potential pharmacological treatment option for fertility impairment in women undergoing radiotherapy, which warrants further investigation in clinical settings.

e23262 Background: Pelvic radiotherapy (PRT) is an essential component of curative treatment for many gynaecological cancers. Still, it can also result in late side effects (SE) that impact long-term quality of life. SE include vaginal wall atrophy, bleeding, stenosis, and decreased vaginal length, which can lead to sexual dysfunction and difficulty with future pelvic exams. The late SEs are among the most distressing survivorship concerns for patients treated for gynaecological cancers. Vaginal dilator therapy (VDT) is commonly recommended following a course of PRT to prevent vaginal stenosis. However, many patients, especially older women, remain apprehensive about VDT, despite receiving counselling. The underlying reasons for non-use remain poorly understood. This study aimed to assess the barriers and facilitators to vaginal dilator use among women who receive PRT in Nigeria. Methods: Semi-structured telephone interviews were conducted with 16 women who had previously undergone PRT for gynaecological cancers at a tertiary cancer centre in Nigeria from 2024 to 2026. Interviews were analysed using inductive thematic analysis following Braun and Clarke’s methodology, followed by deductive mapping of identified factors onto the Consolidated Framework for Implementation Research (CFIR). Data collection and analysis were conducted concurrently until thematic saturation was reached. Results: Participants’ use of vaginal dilators was influenced by multiple factors across CFIR domains. At the individual level, perceptions of vaginal dilators as either medically necessary or sexually oriented influenced initiation and continued use. Pain/discomfort, bleeding, and vaginal discharge were commonly cited as reasons for discontinuation. Sociocultural and religious beliefs reportedly did not support the use of vaginal dilators but were overridden by perceived medical necessity. Family and spousal support facilitated adherence. Health system factors, including quality and timing-sensitive education, strongly influenced uptake, while inadequate follow-up limited sustained use. Conclusions: Barriers to vaginal dilator use after pelvic radiotherapy extend beyond individual patient factors and reflect broader sociocultural and health system influences. Implementation strategies that emphasise clear medical framing, patient-centred education delivered at appropriate time points, and follow-up may enhance sustained use.

Ovarian radiation injury and protection: Mechanisms, delivery-enabled interventions, and future directions.

Total neoadjuvant therapy for rectal cancer: Implications for subsequent liver metastases and chemotherapy-associated liver injury.

Penile prosthesis implantation (PPI) is an effective treatment for refractory erectile dysfunction (ED), but changes in penile length after surgery remain a major determinant of patient satisfaction. We aimed to identify patient- and surgery-related factors associated with final penile length, measured as total implanted device length. We analysed prospectively collected data from the PHOENIX registry, a multicenter cohort including consecutive PPI cases from 29 centers between November 2021 and August 2024 (ClinicalTrials.gov NCT03849586). Baseline demographics and surgical variables were recorded. Variables significant at p < 0.05 in univariate analysis and clinically relevant covariates were entered into a multivariate linear regression model. After exclusions, 1033 patients were included (mean age 60.9 ± 9.06 years). Mean total device length was 20.0 ± 2.36 cm (range 6-28). In multivariate analysis, shorter total device length was independently associated with diabetes mellitus (adjusted coefficient -0.59 cm; 95% CI -0.97 to -0.22; p = 0.002), history of radical prostatectomy (-0.45 cm; 95% CI -1.01 to -0.11; p = 0.04), prior pelvic radiotherapy (-1.42 cm; 95% CI -2.42 to -0.51; p = 0.002), Peyronie's disease (-0.83 cm; 95% CI -1.32 to -0.34; p < 0.001), previous intracavernosal injections (-0.68 cm; 95% CI -0.99 to -0.37; p < 0.001). Avoidance of sequential corporal dilation was associated with a modest increase in device length (+0.15 cm; 95% CI 0.01 to 0.50; p = 0.04). Loss of penile length is a well-established cause of patient and partner dissatisfaction following PPI. Pre-operative counselling and management of expectations is critical to the success of the procedure. In this large prospective multicenter cohort different factors were found to be associated with greater or lesser length. Among them, and following multivariate analysis, diabetes, radical prostatectomy, radiotherapy, Peyronie's disease and prior intracavernosal injections were associated with shorter implanted device length, whereas no corporal dilation was associated with longer device length. These findings can inform preoperative counselling and surgical planning.

Ilio-rectal fistula : A rare cause of lower gastrointestinal bleeding: case report and literature review

We report a case of high-risk prostate cancer (pT3bN1Gleason score 4＋5), in a 63-year-old male who underwent robot-assisted radical prostatectomy with extended pelvic lymph node dissection in May 2019, followed by adjuvant combined androgen blockade (CAB) therapy. In June 2022, the case progressed to castration-resistant prostate cancer (CRPC), and enzalutamide was initiated. Bone metastases to the sacrum and seventh thoracic vertebra were identified concurrently and treated with radiotherapy. In January 2024, the patient presented with lower back pain and left thigh pain. Computed tomography revealed a right iliac fracture and multiple fractures of the left sacroiliac joint, consistent with radiotherapy-related pelvic insufficiency fractures (PIFs). While PIFs are well-documented in patients with gynecologic malignancies, reports on prostate cancer patients remain limited. We analyzed cases of pelvic fractures following pelvic radiotherapy for prostate cancer at our institution, including the present case, and discussed them in the context of the existing literature.

IntroductionThe multi‐institutional HOPE trial (NCT04197141) compared conventional (25 fractions over 5 weeks) to ultra‐hypofractionated (5 fractions over 1.5 weeks) whole pelvis radiotherapy for unfavorable intermediate and high/very high‐risk prostate cancer patients treated with brachytherapy boost. Within this randomized controlled trial, we investigated setup errors for clinical target volumes corresponding to the prostate (CTVp) and nodes (CTVn).MethodsFifty‐four patients treated within a single institution were analyzed, with 28 treated on the ultra‐hypofractionated arm and 26 on the conventional fractionation arm. Prior to treatment, three fiducial markers were implanted into the prostate for daily cone‐beam computed tomography (CBCT) matching. All plans were delivered using volumetric modulated arc therapy with a uniform 6‐mm PTV margin. For all treatment fractions, average fiducial matching errors were measured for CTVp, while errors to CTVn were determined based on the difference between the treatment position and an automatic match to bone. Asymmetric PTV margins to account for prostatic and nodal setup errors were calculated using the van Herk formalism.ResultsMedian (interquartile range [IQR]) 3D errors for CTVp were 1.4 (0.8–2.5) mm for conventional versus 1.2 (0.7–1.9) mm for the ultra‐hypofractionatated arms (p = 0.013), while for CTVn they were 2.8 (1.6–4.2) mm and 2.9 (2.2–4.4) mm, respectively (p = 0.07). Between arms, statistically significant differences in setup errors were noted in all directions for CTVp and in the anterior‐posterior direction for CTVn (p < 0.05). To account for setup error, the required PTV margins in the anterior‐posterior/superior‐inferior/lateral directions were 2.8/3.8/0.8 and 2.7/3.0/1.0 mm for conventional and ultra‐hypofractionated treatments, respectively; for elective nodes, margins were 5.4/4.4/0.7 and 5.7/4.9/1.0 mm, respectively.ConclusionsThe 6‐mm PTV margin around the CTVn is appropriate to account for residual setup error while the margin around the CTVp could be reduced, assuming other sources of error are controlled. The residual 3D errors for the prostate were statistically significantly smaller in the ultra‐fractionated regimen, which was potentially due to longer image matching times and/or the higher percentage of patients treated with a 6‐DOF couch in that arm. However, this came at the expense of slightly larger nodal PTV margins in the ultra‐hypofractionated arm. These findings highlight the need for individual centers to independently quantify their treatment uncertainties, as measurable differences were observed between treatment arms despite identical image guidance protocols.

Haemorrhagic radiation cystitis (HRC) is a challenging complication of pelvic radiotherapy, often resistant to conventional treatments. To evaluate the clinical efficacy and safety of RADA16, a self-assembling peptide, in managing severe HRC. A preliminary feasibility case series of five consecutive patients treated at two UK hospitals. All patients had persistent haematuria despite standard interventions and received RADA16 via flexible or rigid cystoscopy. The findings from the cases suggest that all patients have experienced at least a partial or early resolution of haematuria and no adverse effects were reported. In most cases, two applications of RADA16 were sufficient. The longest patient followed up was still symptom free at 3years. This preliminary feasibility case series has demonstrated early efficacy for RADA16 in the management of HRC. RADA16 is a potentially promising minimally invasive treatment for refractory HRC. Further trials are warranted to confirm these findings.

A woman in her 60s with a prior history of cervical carcinoma treated with chemoradiation presented with a polypoidal vaginal lesion nearly 7 years after initial therapy. Histopathology confirmed osteosarcoma confined to the posterior vaginal wall, with imaging excluding metastases. Total vaginectomy was performed, and final diagnosis was radiation-induced vaginal osteosarcoma. Although adjuvant chemotherapy was recommended, the patient declined. 6 months later, local recurrence and lung metastases developed. This case highlights the rare occurrence of radiation-induced osteosarcoma at the vaginal vault, emphasising the importance of long-term surveillance following pelvic radiotherapy for gynaecological malignancies.