Background: The treatment of low-risk prostate cancer is still open to debate in the published literature and several options can be proposed to patients. In our institute, patients with low-risk prostate cancer are usually treated with retropubic prostatectomy (RRP), brachytherapy (BT) or robotic prostatectomy (RALP), depending on the patient’s characteristics and preference. The aim of this study was to assess the predictive value of the main preoperative criteria for the diagnosis of low-risk prostate cancer, by comparison with the definitive pathological parameters assessed after RRP and RALP, in order to revise critically the role of BT in this group of patients. Patients and Methods: In the period between 1996 and 2010, 748 open or laparoscopic radical prostatectomies were carried in our institute. Among them, 215 procedures were due to low-risk prostate cancer according to AUA criteria, namely PSA ≤10 ng/ml, clinical stage T1c or T2a and Gleason score
Abstracts of the <strong>21st</strong> Annual Meeting of the Italian Society of Uro-Oncology (SIUrO), 22-24 June, 2011, Naples, Italy 195 ROBOT-ASSISTED RENAL TUMORECTOMY FOR A SMALL RENAL CELL CANCER Claudio Giberti, Fabrizio Gallo, Maurizio Schenone and Pierluigi Cortese Dipartimento di Chirurgia, Divisione di Urologia, Ospedale San Paolo, Savona, Italy Aim: To demonstrate the method for performing a robotassisted renal tumorectomy for a small left renal cell cancer. Case Report: A 66-year-old female patient, affected by a small (3 cm) exophytic tumor, localized in the medium part of the left kidney, underwent robot-assisted renal tumorectomy in our institute using the Da Vinci surgical robot. The patient was placed in the flank position. The access was controlled by a 12-mm camera port, 2 cm from the umbilicus on the left pararectal line and two 8-mm robotic trocars, introduced on the left midaxillary line in a C configuration. A fourth trocar was introduced during the procedure. After incision of the left paracolic gutter and exposure of the renal lodge, the left renal vein and artery were isolated. Gerota’s fascia was then incised, with complete isolation of the tumor, and the renal capsule was scored in order to design the margin of tumor dissection. The renal artery was clamped with a bull-dog clamp and cold dissection of the tumor was performed during warm ischemia. After removing any blood clots, an absorbable fibrin sealant patch (Tachosil) was put into the inner defect and then renorrhaphy was performed using Vycril 2/0 sliding clips. The bull-dog clamp was removed after 13 min of warm ischemia and Gerota’s fascia was sutured. The specimen was retrieved into the endobag through the camera port. The operative time was 120 min. Blood loss was minimal. Results: No peri- or postoperative complications occurred. The patient was discharged on the fourth day after surgery. Pathological examination reported pTaG1 renal cell cancer. Follow-up was regular. Conclusion: The Da Vinci surgical robot significantly helps the surgeon during the tumor dissection and the suture of renal parenchyma, shortening the warm ischemia time and providing easier reproducibility of this laparoscopic technique. 1 Benway BM, Bhayani S, Rogers C et al: Robot-assisted partial nephrectomy: an international experience. Eur Urol 57: 815-820, 2010. 2 Petros FG, Patel MN, Kheterpal E et al: Robotic partial nephrectomy in the setting of prior abdominal surgery. BJU Int, 2010. 3 Rogers C, Sukumar S and Gill IS: Robotic partial nephrectomy: the real benefit. Curr Opin Urol 21: 60-64, 2011. 197 COMPARISON <strong>OF</strong> DOSIMETRIC RESULTS AND TOXICITY PATTERNS BETWEEN SIB-IMRT AND HIGH-DOSE 3D-CRT IN PROSTATE CANCER Donatella Russo1 , Antonella Papaleo1 , Angela Leone1 , Giuseppe Di Paola1 , Elisa Cavalera1 , Maria Giovanna Natali2 , Gabriella Pastore2 and Mario Santantonio1 1Radioterapia Oncologica, 2Fisica Sanitaria, Ospedale V. Fazzi, Lecce, Italy Aim: To evaluate the risk of rectal and bladder toxicity in intensity-modulated radiation therapy (IMRT) of the prostate compared to 3D conformal radiation therapy (3D-CRT) in localized prostate cancer patients, based on the dose coverage of the planning and clinical target volumes and the frequency of the acute and late adverse events. Patients and Methods: Between November 2007 and December 2009, 29 patients with localized prostate cancer were selected for this comparative study at the Operative Unit of Radiotherapy of V. Fazzi Hospital of Lecce, during the implementation of dynamic-arc-IMRT with NomoStat System ® for serial tomotherapy. Clinical target volume (CTV) 1, CTV-1, included the prostate and the seminal vesicles, while CTV-2 included the prostate and the base of the seminal vesicles. To obtain planning target volume (PTV) 1, PTV-1, the CTV-1 was expanded with a 10-mm margin in all directions except for the posterior direction, where the margin was limited to 6-7 mm. A 3D margin of 6 mm was added to the CTV-2 resulting in the PTV-2. Thirteen patients were treated with standard 3D- CRT to 60 Gy to PTV-1, plus a 16-Gy sequential boost to PTV-2 with conventional fractionation (2 Gy/fraction in 38 fractions). In sixteen patients, IMRT treatment plans were designed to deliver 66.5 Gy (1.9 Gy/fraction) to the seminal vesicles while simultaneously delivering 78.5 Gy (2.24 Gy/fraction) to the prostate in 35 fractions, using simultaneous integrated boost (SIB) technique. The bladder, rectum and femoral heads were delineated as organs at risk (OAR). OAR dosimetry evaluation was based on dose-volume histograms. Association of these dose parameters with acute and late toxicity was performed. Side-effects were classified according to the RTOG scale for acute and late gastrointestinal (GI) and genitourinary (GU) toxicity. Additional symptoms, such as rectal blood loss, urgency, incontinence and erectile dysfunction were investigated. Results: Average values of the volume that received at least 95% of the prescription dose (V95), target volume coverage by 100% of the prescription dose (V100%) and conformity index within the PTV were: 99.3%, 97.8% and 0.9 in SIB-IMRT and 95%, 68.8% and 0.65 in 3D-CRT, respectively. The mean dose to the bladder was 38.8 (range, 34-55) Gy and 26.8 (range, 22-35) Gy with 3D- CRT and IMRT, respectively, with an applied dose limit of 1915
Change language