Promising Oncological Outcomes Research Articles

MP18-10 ONCOLOGIC OUTCOMES AFTER HEMIABLATION THERAPY FOR LOCALIZED PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy1 Apr 2016MP18-10 ONCOLOGIC OUTCOMES AFTER HEMIABLATION THERAPY FOR LOCALIZED PROSTATE CANCER Estefania Linares Espinos, Jose I. Perez-Reggeti, Eric Barret, Arjun Sivaraman, Rafael Sanchez-Salas, Marc Galiano, François Rozet, Dominique Prapotnich, Nathalie Cathala, Annick Mombet, and Xavier Cathelineau Estefania Linares EspinosEstefania Linares Espinos More articles by this author , Jose I. Perez-ReggetiJose I. Perez-Reggeti More articles by this author , Eric BarretEric Barret More articles by this author , Arjun SivaramanArjun Sivaraman More articles by this author , Rafael Sanchez-SalasRafael Sanchez-Salas More articles by this author , Marc GalianoMarc Galiano More articles by this author , François RozetFrançois Rozet More articles by this author , Dominique PrapotnichDominique Prapotnich More articles by this author , Nathalie CathalaNathalie Cathala More articles by this author , Annick MombetAnnick Mombet More articles by this author , and Xavier CathelineauXavier Cathelineau More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2711AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Focal therapy was developed in order to limit side effects of conventional prostate cancer (PCa) treatments. We aimed to assess oncologic outcomes after focal thermal ablative primary treatment. METHODS Between January 2009 to August 2015, 277 patients underwent primary thermal hemiablation for localized PCa at our institution. Energy used was either cryotherapy or high intensity focused ultrasound (HIFU) or vascular-targeted photodynamic therapy (VTP). Inclusion criteria for hemiablation treatment were PSA<15ng/dl, Gleason ≤7, unilateral disease and index lesion <10mm and MRI prior to biopsy ≤T2b. We selected patients with post-treatment prostate biopsy and 12 months minimum follow-up. Patients were followed postoperatively with PSA, MRI-imaging and 12-core TRUS protocol biopsy, at 6-12 months. Failure was defined as any positive biopsy in the treated lobe. Cross-tabs applying chi-square were used to assess relationships among categorical variables. A p value <0.05 was considered statistically significant. Statistical analysis was performed using SPSS v21. RESULTS At one year follow-up, 229 patients had post-treatment control biopsy with 48 not available. Among them, 110, 89 and 30 patients underwent a hemiablation of the prostate using cryotherpy, HIFU and VTP respectively. A total of 55 patients had biopsy-proven cancer at follow-up. With a mean age of 65,5 ± 6,7 years, 43 were D'Amico Low risk and 12 Intermediate risk at diagnosis. Initial PSA was 7,44 ± 2,93 ng/dl, 47 Gleason 3+3 and 8 Gleason 3+4. Thirty (27%), 13 (17%) and 12 (40%) had biopsy proven cancer after primary focal cryotherapy, HIFU and VTP, respectively. Residual cancer in the treated side was present in 41 patients (15 bilateral), considered as failure to treatment (18%). De novo contralateral disease was diagnosed in 14 patients. Residual disease had a median core length of 4mm (3-13) and a median number of 2 (1-3) positive cores. No difference were observed in focal treatment failure between primary focal energy modalities (table 1). CONCLUSIONS Short-term data show promising oncologic outcomes in the focal therapy primary setting with 18% failure rate. Focal ablative therapy is an effective treatment option for the primary management of PCa, with no proven differences in failure rates between energy modalities. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e196 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Estefania Linares Espinos More articles by this author Jose I. Perez-Reggeti More articles by this author Eric Barret More articles by this author Arjun Sivaraman More articles by this author Rafael Sanchez-Salas More articles by this author Marc Galiano More articles by this author François Rozet More articles by this author Dominique Prapotnich More articles by this author Nathalie Cathala More articles by this author Annick Mombet More articles by this author Xavier Cathelineau More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

High-intensity focused ultrasound for the treatment of prostate cancer: A prospective trial with long-term follow-up

Objective. High-intensity focused ultrasound (HIFU) is a minimally invasive treatment for prostate cancer. Data from the literature show promising oncological outcomes with a favourable side-effect profile. The aim of this study was to re-evaluate and bring up to date the follow-up of a previously published, prospective trial on HIFU as the primary treatment for prostate cancer. Materials and methods. Between 2004 and 2007, 163 consecutive men with T1–T3N0M0 prostate cancer underwent HIFU with the Sonablate® 500. Follow-up included prostate-specific antigen (PSA) tests every 3 months after treatment and a random prostate biopsy at 6 months. Failure was defined according to positive findings at the 6 month biopsy and biochemical failure was defined according to the Phoenix criteria. Biochemical-free survival, metastasis-free survival and cancer-specific survival were calculated by Kaplan–Meier curves. Results. Median follow-up was 72.0 months. Of the 160 evaluable patients, 104 (65%) were biochemically disease free; in low- to intermediate-risk disease, on Kaplan–Meier analysis the 8 year biochemical-non-evidence of disease (bNED), metastasis-free survival and cancer-specific survival rates were 69.6%, 81.3%, 100% and 40.5%, 60.6%, 100%, respectively. A PSA nadir below 0.40 ng/ml and risk stratification have an independent predictive value for bNED and metastasis-free survival. Conclusions. A long-term favourable outcome of HIFU is associated with careful patient selection, with low- to intermediate-risk disease being the ideal case. A low postoperative PSA nadir is a predictor of long-term bNED.

Efficacy and long-term outcome of pre-emptive endoscopic resection and surgery for multiple synchronous gastric cancers.

In cases of synchronous gastric cancers (SGC) that include one for surgical indication and another for endoscopic resection (ER) in two different regions of the stomach, patients can avoid total gastrectomy and undergo subtotal gastrectomy following successful pre-emptive ER. The aim of this study was to evaluate the feasibility and efficacy of pre-emptive endoscopic resection and surgery (PRES) with curative intent for such SGCs. Between September 2002 and December 2012, 34 patients with SGCs (72 lesions) underwent PRES. Our institutional principals of PRES ensure the following: (1) treatment with curative intent, (2) multiple lesions indicated for ER and surgery, (3) evasion of TG following successful pre-emptive ER, (4) exclusion of type 4 and large type 3 (>80 mm) tumors, and (5) nonemergent cases such as hemorrhage, perforation, and obstruction. Clinicopathological characteristics and technical data were evaluated for all patients, and long-term outcomes were analyzed in patients who obtained curative ER and underwent subtotal gastrectomy. Curative ER was obtained in 31 patients (91.1 %), and subtotal gastrectomy was performed a median of 44 days after ER. Final stages were as follows: stage I, 25 patients (80.6 %); stage II, four patients (12.9 %); stage III, one patient (3.2 %); and stage IV, one patient (3.2 %). The 5-year overall and cause-specific survival rates were 96.3 % (95 % confidence interval 89.4-100 %) and 100 %, respectively. PRES was feasible and effective as the first treatment of choice for multiple SGCs. PRES enables minimally invasive surgery with promising oncological outcomes.

Transanal Endoscopic Microsurgery for Residual Rectal Cancer (ypT0-2) Following Neoadjuvant Chemoradiation Therapy

Significant tumor downstaging among patients with rectal cancer following neoadjuvant chemoradiation has raised the issue of offering patients with small residual cancers restricted to the bowel wall an alternative treatment strategy to total mesorectal excision. Transanal endoscopic microsurgery may allow proper primary tumor resection with promising oncological outcomes, less postoperative morbidity, and minimal long-term sexual, urinary, and fecal continence disorders in comparison with radical resection. The aim of this study was to determine the oncological outcomes of patients with residual rectal cancers restricted to the rectal wall (ypT0-2) following neoadjuvant chemoradiation and transanal endoscopic microsurgery. This study considered a prospective cohort of patients with residual rectal cancers following neoadjuvant chemoradiation treated by transanal endoscopic microsurgery and no additional systemic therapy. This study was a single-institution experience. Patients with adenocarcinoma of the rectum located no more than 7 cm from the anal verge and endorectal ultrasound- or magnetic resonance-staged cT2-4N0-2M0 treated by neoadjuvant chemoradiation (50.4-54 Gy and 5-fluorouracil-based chemotherapy) were eligible for the study. Patients with small residual tumors (≤3 cm) radiologically staged ycT0-2N0 were treated by transanal endoscopic microsurgery. Transanal endoscopic microsurgery was performed. The primary outcome measured was local recurrence. Of the 27 patients treated by transanal endoscopic microsurgery, 3 had ypT0, 6 had ypT1, and 18 had ypT2 cancers. All patients underwent R0 transanal endoscopic microsurgery excision. Local recurrence was observed in 4 (15%) patients after a median follow-up of 15 months. Only lymphovascular invasion was an independent predictive factor for local failure (p = 0.04). Tumor size, ypT status, T-status downstaging, lateral/radial margins, and tumor regression grade were not predictors of local failure. This study was limited by the small sample size and limited follow-up. A local failure rate of 15% after transanal endoscopic microsurgery for patients with residual rectal cancers restricted to the bowel wall (ypT0-2) may limit the indication of this procedure to highly selected patients as an alternative to standard radical total mesorectal excision.

Immediate breast reconstruction with prostheses after conservative treatment plus intraoperative radiotherapy. Long term esthetic and oncological outcomes

Electron intraoperative radiotherapy (ELIOT) has been introduced for breast conservative treatment (BCT) with promising oncological outcome. Thus, immediate breast reconstruction with prosthesis after BCT became possible due to minimal radiation effect on local tissue from ELIOT. We reported oncological and esthetical results of 29 BCT patients who had immediate implant reconstruction plus 21 Gy-ELIOT as the sole radiation treatment. All patients had prosthesis in ipsilateral breast and had simultaneous contralateral augmentation for symmetrical procedure. The average age was 52.3 years. There were stage Ia thirteen cases, stage Ib seven cases, stage IIa six cases and stage IIIb one case and two cases of intraepithelial neoplasia. From 54.2 (36–88) months follow up, the capsular contracture grading in the reconstructed breast from ELIOT-side is comparable with non-irradiated contralateral side. There was one patient who developed local recurrence (LR) and later on dead with breast related event (LR = 0.76% per year). There was no primary ipsilateral carcinomas and distant metastasis.

IJU this issue

This issue consists of two Perspectives in Urology, three Review Articles, five Original Articles, one Case Report, one Short Communication and two other reports. The content of this issue focuses on various interesting hot topics associated with clinical, as well as basic, aspects; therefore, I believe that this issue might help provide useful information for a wide variety of readers of IJU. This issue starts with Perspectives in Urology, a newly introduced category in IJU, which briefly presents a scientific view of several fields of urology by specialists. Two articles published in this issue describe the application of gasless single-port surgery to partial nephrectomy by Kihara (Tokyo, Japan) and controversial issues in the decontamination process for urological endoscopes by Yanaihara et al. (Saitama, Japan). This issue then includes three interesting Review Articles. Takenaka et al. (Tottori, Japan) summarized the recent progress in anatomical findings in relation to each basic step during robotic-assisted laparoscopic radical prostatectomy. They emphasized the important message that surgical anatomy should always be developing and changing with advances in surgical approaches. Matsumoto et al. (Asahikawa, Japan) described the pathophysiological relationship between metabolic syndrome and lower urinary tract symptoms (LUTS) with a special emphasis on bladder blood flow. They also proposed a novel therapeutic strategy for patients with LUTS from the viewpoint of bladder blood flow. Azuma et al. (Takatsuki, Japan) reviewed their experience of the development of novel bladder preservation approach for patients with locally advanced bladder cancer. They carried out combined therapy using balloon-occluded arterial infusion anticancer agents and hemodialysis with concurrent radiation, and presented promising oncological outcomes. Consequently, five excellent Original Articles are provided. Jensen et al. (Aarhus, Denmark) compared the prognostic significance between extended and limited lymph node dissection in patients with bladder cancer who underwent radical cystectomy. Although extended nodal dissection provided more accurate staging than limited dissection, recurrence patterns appeared to be similar between these two groups. Shigemura et al. (Kobe, Japan) compared Wallace direct ureteroileal anastomosis with the Le Duc anti-reflux procedure in modified Studer orthotopic neobladder reconstruction after radical cystectomy. The authors concluded that direct ureteroileal anastomosis using the Wallace method is effective for minimizing the stenosis of ureteroileal anastomosis. Bayraktar et al. (Istanbul, Turkey) assessed the effect of constipation on serum prostate-specific antigen (PSA) levels in men. In this study, serum PSA values in the constipated patients before treatment were shown to be significantly higher than those in the control group; therefore, the authors recommended the re-evaluation of PSA value in the constipated patients before carrying out the prostate biopsy. Ip et al. (Taichung, Taiwan) reported the apoptotic effects of bee venom on human bladder cancer cells and the signaling pathways involved in this event. This article clearly showed the induction of both caspase-dependent and caspase-independent apoptotic cell death in human bladder cancer cells by bee venom through the intracellular Ca2+-modulated intrinsic death pathway. Nakane et al. (Gifu, Japan) analyzed the role of cortactin and silent mating type information regulation 2 homolog 1 (SIRT1) in migration and invasion of human prostate cancer DU145 cells. Because knockdown of cortaction or SIRT1 expression resulted in the inhibition of both migration and invasion of DU145 cells, the authors suggest that this strategy could be a promising treatment for prostate cancer by regulating its metastatic spread. This issue also included an interesting Case Report and Short Communication. Fujisaki et al. (Shimotsuke-city, Japan) reported life-threatening anaphylaxis to leuprorelin acetate depot. Sugihara et al. (Iwata, Japan) reported the low incidence of admissions related to interstitial cystitis in Japan, which could possibly be explained by several factors, including racial difference, examination methods, lack of outpatient data and poor health-care coverage of this disease. None declared.

Percutaneous Ultrasound-Guided Radiofrequency Ablation of an Allograft Renal Cell Carcinoma: A Case Report

Background Renal cell carcinomas (RCCs) are rarely described in transplanted kidneys. Available therapeutic strategies range from allograft nephrectomy to nephron-sparing procedures such as partial nephrectomy or image-guided thermal ablation. Percutaneous radiofrequency ablation (RFA) is a minimally invasive technique which provides promising oncologic outcomes in small allograft RCCs while preserving allograft function. So far, only a few cases have been reported in the transplant setting. We describe a renal transplant RCC successfully approached by ultrasound-guided RFA. Methods A 42-year-old renal transplant recipient developed a small subcapsular allograft RCC at 11 years after transplantation. The decline in glomerular filtration rare prompted us to preserve as much parenchyma as possible. Ultrasound-guided RFA was performed under light sedation and local analgesia in a single session with a Starbust Talon needle. Results Postablation contrast-enhanced ultrasound displayed a 25×23 mm avascular area of complete necrosis. After 3 months gadolinium-enhanced magnetic resonance imaging confirmed the absence of viable tumor tissue and while the patient did not experience any graft function reduction (serum creatinine 2.6 mg/dL). Conclusions Image-guided RFA represents a promising therapeutic modality for small allograft RCCs in recipients with mild graft dysfunction and/or elevated surgical risk. It is associated with low morbidity and parenchymal preservation.

Repeat partial nephrectomy: surgical, functional and oncological outcomes.

The greater utilization of partial nephrectomy and ablative procedures has increased the incidence of patients presenting with local renal recurrence. The choice to either perform a partial or radical nephrectomy in these situations can be a challenging decision. Repeat and salvage partial nephrectomy, while challenging and potentially associated with increased complications, offers patients the ability to maintain excellent renal functional outcomes and promising oncologic outcomes at intermediate follow-up. Surgeons should be familiar with the surgical complications and the functional and oncologic outcomes of reoperative nephron-sparing surgery (NSS). Recent data and outcome analysis support utilization of these procedures in patients presenting with either local recurrence or de-novo lesions in the ipsilateral kidney.

Image-guided Percutaneous Ablation of Renal Tumors: Outcomes, Technique, and Application in Urologic Practice

The recent increase in detection of small (<or=4 cm) renal cortical neoplasms has engendered changes in the management of these incidental renal tumors. There is increased interest in new forms of minimally invasive therapies, including focal renal mass ablation with cryotherapy and radiofrequency ablation (RFA). Percutaneous cryoablation (PCA) and percutaneous RFA are among the newest approaches to minimally invasive renal surgery offering excellent patient recovery, lower rates of procedure-related complications, and promising oncologic outcomes. Ablative techniques were once considered a treatment option only in highly selected cases. However, with excellent efficacy of ablative technologies having been demonstrated with intermediate-term follow-up, renal ablation has expanded to a larger patient population. Percutaneous renal ablative procedures are optimized when performed in a combined fashion, with urologists and interventional radiologists collaborating to optimize the chance of success of the ablation. This article reviews the recent advances in PCA and percutaneous RFA and offers suggestions for patient selection in contemporary urologic practice.