ABSTRACTS OF THE 21st ANNUAL MEETING OF THE ITALIAN ...

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prostate patients, 1 sexologist or andrologist, 1 geriatrician and ≥1 clinical trial coordinator. All core team members should attend weekly MDM to discuss at least 90% of the cases referred to PCU. Decisions should be documented in patient charts. The PCU should offer all treatment options (radical prostatectomy, external radiotherapy, brachytherapy, observational strategies, hormonal therapy, chemotherapy, novel therapeutics, psychological support and palliative care) and ensure the patient’s right to information and selfdetermination. Patients should be provided with a detailed written record of the treatment and follow-up plan. PC patients should have access to a weekly multidisciplinary clinic with a urologist, a radiation oncologist and a medical oncologist, synchronously or in rapid succession. If possible, a psychologist should participate. PC patients should be offered follow-up supervised by one core member responsible for the treatment. Patients with advanced, recurrent or metastatic PC should be offered clinic access every two weeks. The PCU should possess or have access to all the technological equipment for imaging, radiotherapy, pathology. Establishing a PCU will require the re-organization of current PC services, workflow and attitudes but it should have a favorable economic impact and avoid multiple consultations and inappropriate treatments. Certification of a PCU should be considered the necessary step forward to ensure optimal treatment and care of men with PC. 248 MULTIDISCIPLINARY CLINIC FOR PROSTATE CANCER AT ISTITUTO NAZIONALE TUMORI, MILAN: 6 YEARS’ EXPERIENCE Tiziana Magnani1 , Riccardo Valdagni2 , Roberto Salvioni3 , Sergio Villa4 , Simona Donegani5 , Barbara Avuzzi4 , Nice Bedini4 , Lara Bellardita5 , Rosella Bellomira5 , Davide Biasoni3 , Augusto Caraceni6 , Silvia Catania7 , Mario Catanzaro3 , Maurizio Colecchia8 , Giardino Felicetta9 , Caterina Magnani5 , Cristina Marenghi10 , Nicola Nicolai3 , Giuseppe Procopio10 , Biagio Paolini8 , Tiziana Rancati11 , Carla Ripamonti6 , Silvia Stagni3 , Tullio Torelli3 , Annalisa Villa5 , Daniela Villani5 , Ernesto Zecca6 and Nadia Zaffaroni12 1Project Manager, 2Direttore Programma Prostata, Direttore Radioterapia Oncologica 1, 3Urologia, 4Radioterapia, 5Psicologia, 6Terapie Palliative, 7Data Manager, 8Anatomia Patologica, 9Nurse, 10Oncologia, 11Fisica Medica and 12Ricerca di Base, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy Background: The Istituto Nazionale Tumori started the multidisciplinary (MD) translational prostate program in 2004, re-arranging and activating experimental and clinical 1946 ANTICANCER RESEARCH 31: 1807-1956 (2011) research on prostate cancer (PC) within a disease-focused frame. Priorities in clinical activity were sharing diagnostic, therapeutic, and observational guidelines as a working methodology to manage PC patients and setting up a MD clinic for PC patients. Patients and Methods: After determining institutional guidelines, the following MD clinics started in March 2005: (i) a clinic for newly diagnosed, untreated patients and for patients in all states of disease who seek a second opinion: a urologist, radiation oncologist, medical oncologist and psychologist simultaneously meet ten patients once a week; after recording the anamnesis, digital rectal examination and evaluating co-morbidities, possible therapeutic, observational, and follow-up strategies or research protocols are proposed if the case is univocally interpreted, if the case is complex and no shared decision is reached, it is referred to the multidisciplinary case discussion; patients may request psychological support for the decisionmaking and individual, couple, family or group counseling, with supportive, rehabilitation and palliative care given on demand; (ii) a follow-up clinic for patients on active surveillance (AS) and watchful waiting: a urologist and radiation oncologist meet eight and 6 patients once a week, respectively; (iii) a case discussion (once a week, CME activity): specialists working in the MD and the prostate program (urologists, radiation oncologists, medical oncologists, psychologists, uropathologists, radiologists, experimental researchers, and prostate program administrative personnel) discuss cases seen multidisciplinarily plus complex cases examined monodisciplinarily, share decisions taken in the clinic, tailor strategies to individual patients whenever possible, include patients in trials and check adherence to institutional guidelines and quality assurance. Results: From March 2005 to December 2010, 2150 MD clinics were run. The disease distribution was analyzed from 2006, when an electronic chart was introduced. While the number of patients with high-risk and metastatic PC decreased, the number of patients with low-risk PC increased constantly, with a peak in 2009 (61%). This is probably due to the anticipation of diagnosis and to the fact our Institute is one of the few Italian centers where AS is routinely proposed within a research protocol (PRIAS study). Considering the distribution of therapies in a low-risk group population, while in 2006, only 44% of low-risk patients accepted AS, this increased to 81% in 2009. This is probably due to the change in patients’ attitudes towards observational strategy and the credit of our Institute as a reference center for AS. Considering the small number of patients with metastatic, advanced and recurrent disease (5.5%) and of no shows, a nurse coordinator was introduced in September 2010 to collect basic information on the cases to be seen and reorganize the clinic lists according to the state of disease, thus optimizing human resources and having the medical oncologist on call for selected patients. A total of 98.4%
Abstracts of the 21st Annual Meeting of the Italian Society of Uro-Oncology (SIUrO), 22-24 June, 2011, Naples, Italy patients seen multidisciplinarily were discussed in the case discussion meetings. It was possible to check adherence to guidelines, evaluate the quality of the multidisciplinary team’s activity and modify the work-flow to adapt to changing situations. Treatment plans prescribed by physicians working outside our institute were changed for 236/2150 patients (11%). Indications formulated in the clinics were changed in the case discussion for 129/2150 patients (6%) after checking adherence to our institutional guidelines. Conclusion: Our MD clinic is proving efficient in the management of PC patients. The synchronous presence of different specialists enables all possible therapeutic and observational options to be proposed. Case discussion meetings allow agreement on the strategies offered to patients, multidisciplinary management of complex cases, performance of quality checks, stimulation of interdisciplinary working and facilitation of team building. 251 BRAIN METASTASES INCIDENCE IN PATIENTS RECEIVING TARGET THERAPIES FOR ADVANCED RENAL CELL CARCINOMA Antonia Cricca1 , Piergiorgio Di Tullio2 , Daniela Rubino3 , Raffaella Morabito3 and Andrea Angelo Martoni2 1Oncologia Medica, Oncologia Medica Martoni, S.Orsola- Malpighi, Bologna, Italy 2Oncologia and 3Radiologia, S.Orsola-Malpighi, Bologna, Italy Background: Treatment of metastatic renal cell carcinoma has changed significantly in recent years thanks to targeted therapies. In the literature, brain metastases are reported to occur in 2-17% of patients with metastatic renal cell carcinoma. The aim of this study was to analyze the incidence and characteristics of patients with brain metastases from RCC treated with targeted therapy. Patients and Methods: From March 2007 to October 2010, 43 consecutive patients affected by metastatic renal cell carcinoma without brain metastasis were analyzed. Patient characteristics were: 35 males (81.3%) and 8 females (18.7%), with a median age of 54 (range 35- 76) years, KPS 100 (range 60-100). A clear renal cell histology was observed in 41 patients (95.3%) and other histology in 2 patients (4.7%). Thirty-eight patients (88.3%) underwent surgery and 31 patients (72%) patients were treated as first-line, and 12 (28%) were pre-treated. Results: With a median follow-up of 32 (range 1-43) months, 6 patients (13.9%) progressed with brain metastases. Median time of treatment was 10 (range 5-27) months. The median age was 55 (range 46-70) years, KPS 100 (range 60-100), clear renal cell histology was observed in 5 patients (83.3%), other histology in 1 patient (16.7%). Of this group, two patients (33.3%) experienced relapse in an extra cerebral site. No difference was observed in the two groups as regard site of metastasis and no patients changed ongoing treatment because of onset of brain metastasis. In 3 patients (50%), brain metastases were symptomatic. Three patients (50%) underwent gamma-knife treatment, one patient (16.7%) external radiotherapy and two patients (33.3%) anti-edema therapy. Conclusion: The occurrence of brain metastases in the course of treatment with targeted therapy is a significant event. The assessment of these patients requires systematic evaluation of the brain with CT scans and specific local treatments. This aspect should be investigated with a broadening of the series through a multicenter study. 252 VARIANTS OF ADRENOCORTICAL CARCINOMA: MORPHOLOGICAL, PHENOTYPICAL AND MOLECULAR FINDINGS AND CLINICO- PATHOLOGICAL CORRELATIONS Enrico Bollito, Eleonora Duregon, Marco Volante, Susanna Cappia and Mauro Papotti SCDU Anatomia Patologica, AOU San Luigi Gonzaga, Università di Torino, Italy Adrenocortical carcinoma (ACC) diagnostic criteria (>3/9 Weiss parameters) do not apply well with special variants, including oncocytic (OACC) and myxoid tumors. A review of 194 ACCs showed that the oncocytic variant (20 patients: 14 pure OACCs with oncocytes >90% of the tumor; 6 mixed, with clear cell component ranging from 10 to 50%) can hardly be classified using the Weiss system since cytoplasmic eosinophilia, atypia and diffuse growth are intrinsically present (thus requiring a higher diagnostic threshold). The mitochondrial DNA profile of OACCs was analyzed by means of real-time PCR and FISH, detecting in 5/20 cases the socalled ‘4977 bp common deletion’, which was previously identified in many oncocytic tumors of other organs (e.g. kidney, thyroid and salivary gland). Myxoid tumors (17 patients: 14 pure myxoid, of which 1 borderline and 13 malignant tumors; 3 with focal myxoid changes in otherwise conventional ACCs) are characterized by cords or nests of medium-size scanty atypical cells in a myxoid background, with a peculiar neurofilament expression. The Weiss system might be inadequate to reliably detect malignancy in myxoid ACCs because a few criteria are hard to assess or are poorly represented in myxoid areas (such as small vessel invasion, diffuse growth pattern and nuclear atypia). The prognosis of patients with these ACC variants seems more comparable to conventional ACCs regarding the myxoid, and more favorable as compared to pure oncocytic ACCs, whereas this does not hold true for ACCs having an oncocytic component. 1947
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