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

More documents

Recommendations

Info

mellitus and hypertension. The patient reported intermittent pain, fever, several episodes of gross hematuria and both irritative and obstructive urinary symptoms refractory to medical therapy. Physical examination revealed that the penis was worse, showing an increase in volume and consistent in its entirety, with a diffuse redness of the cutis. Four odorous purulent ulcerations involving the skin were present on the lateral surface. Inguinal lymph nodes could not be palpated on either side. The results of laboratory examinations were normal except for leucocytosis. A urinary catheter was therefore inserted and antibiotics were administered. We performed a wedge biopsy of the skin lesions previously described. The pathological examination revealed moderately differentiated squamous cell carcinoma with vascular invasion. Magnetic resonance of the lower abdomen and total body CT scan revealed the absence of distant metastases. After a negative sentinel node biopsy, a total penectomy with perineal urethrostomy was carried out. We decided to preserve both testicles. The affected area was corrected with a wellvascularized perineal skin flap. Results: The final histological examination confirmed the diagnosis of moderately differentiated squamous cell carcinoma. Extensive infiltration of the corpora cavernosa and urethra (pathological stage T3) were present with absence of lymphatic and vascular invasion with negative surgical margins. Furthermore, the patient underwent adjuvant chemotherapy with cisplatin. After 22 months, the patient is disease free. Discussion and Conclusion: Penile carcinoma is a rare malignancy in Western countries, with an incidence of 1,290 new cases and 290 deaths annually in the United States. In Europe, penile carcinoma represents fewer than 1% of all carcinomas. The five-year survival rate is approximately 80%. Pathological risk factors are perineural invasion, lymphovascular invasion, positive resection margins and urethral involvement. Despite severe implications for the quality of life, total penectomy (with wide surgical margins) with perineal urethrostomy is the standard surgical treatment for advanced disease (T3-T4). In T4 disease and in the presence of positive or relapsed nodes, adjuvant chemotherapy is strongly suggested. The presence of lymph node metastasis is probably the most important prognostic factor in squamous cell carcinoma of the penis; in fact, the disease-free survival at five years is less than 40% in node-positive patients but more than 80% in node-negative patients. 1 Barnholtz-Sloan JS, Maldonado JL, Pow-Sang J and Giuliano AR: Incidence trends in primary malignant penile cancer. Urol Oncol 25(5): 361-367, 2007. 2 Daling JR, Madeleine MM, Johnson LG, Schwartz SM, Shera KA, Wurscher MA, Carter JJ, Porter PL, Galloway DA, McDougall JK and Krieger JN: Penile cancer: importance of circumcision, human papillomavirus and smoking in in situ and invasive disease. Int J Cancer 116(4): 606-616, 2005. 1824 ANTICANCER RESEARCH 31: 1807-1956 (2011) 3 Barocas DA and Chang SS: Penile cancer: clinical presentation, diagnosis, and staging. Urol Clin North Am 37(3): 343-352, 2010. 4 Pizzocaro G, Algaba F, Horenblas S, Solsona E, Tana S, Van Der Poel H and Watkin NA: EAU penile cancer guidelines 2009. Eur Urol 57(6): 1002-1012, 2010 [Epub 2010 Feb 4]. 5 Pow-Sang MR, Ferreira U, Pow-Sang JM, Nardi AC and Destefano V: Epidemiology and natural history of penile cancer. Urology 76(2 Suppl 1): S2-6, 2010 27 PROLONGED RESPONSE TO CYTOREDUCTIVE SURGERY AND SUNITINIB IN AN ELDERLY PATIENT WITH SYNCHRONOUS MULTIPLE METASTASES FROM RENAL CELL CARCINOMA Matteo Maggioni1 , Guido Dormia1 , Stefano Dipierro1 , Fabio Bertana1 , Giovanni Longo1 , Augusto Maggioni2 , Cristina Locatelli3 and Pietro Tombolini1 1Urologia and 3Oncologia Medica, Ospedale San Carlo Borromeo, Milano, Italy; 2Clinica Urologica I, Milano Università Studi, Milano, Italy Renal cell carcinoma (RCC) is a cancer with a relatively low incidence, accounting for about 2-3% of all cancer cases. Multitargeted therapy of advanced RCC appears to be a better option than immunotherapy. Sunitinib is a multitarget tyrosine kinase inhibitor whose activity has been demonstrated in phase III and expanded-access studies. In the present paper, we report the case of an elderly patient with multiple metastases who attained a prolonged response to sunitinib. A 72-year-old woman with a Karnofsky performance status of 90, no significant medical history, and no comorbidities except hypertension treated with transdermal clonidine (TTS-1) was referred to our hospital in October 2006 complaining of flank pain and gross hematuria. At clinical examination, a mass in the right flank and a 2 cm subcutaneous nodule in the right breast were detected. Total-body computed tomography (CT) scan showed a right kidney neoplasm of 15 cm, a mass in the left adrenal gland, peripancreatic abnormal tissue, small lung nodules (three bilateral nodules of 1 cm) and extensive hilarmediastinal lymphadenopathies (maximum diameter 3.8 cm). At cranial CT evaluation, a sub-centimetric (0.4 cm) thalamic lesion of uncertain etiology was identified. Bone scintigraphy was normal. At blood chemistry assay, mild anemia (Hb 11.7 g/dl) was present; LDH and calcium were in the normal range. Surgical excision of the subcutaneous breast nodule revealed an adenocarcinoma of metastatic origin. The patient underwent a right radical nephrectomy and abdominal cytoreductive surgery, including left adrenalectomy and distal pancreatectomy. No residual intra-abdominal gross tumor remained after surgery. Final pathology documented a 15×10×8
Abstracts of the <strong>21st</strong> Annual Meeting of the Italian Society of Uro-Oncology (SIUrO), 22-24 June, 2011, Naples, Italy cm clear cell RCC, Fuhrman grade 2, pT3cN0M1, with pancreatic and contralateral adrenal involvement. After surgery, the patient recovered quickly and was placed on long-term corticosteroid treatment. Four weeks later (December 2006), she began subcutaneous interferon-alpha (IFN) 6 MU three times/weekly; higher doses were not tolerated. In February 2007, treatment was discontinued because of malaise and bone pain in the left hip. A CT scan of the pelvis revealed bone involvement of the left ischium. On CT and MRI, the thalamic lesion was found to have increased to 1 cm, with peripheral edema. The patient underwent stereotactic radiosurgery (Cyberknife) of the brain lesion. After cardiological assessment with ECG and echocardiography, in April 2007, she was placed on 50 mg sunitinib daily in a six-week cycle according to a 4/6 schedule (four weeks on treatment, two weeks off treatment. Up to June 2010, the patient was continuing sunitinib treatment and there was good control of arterial blood pressure with the three-drug combination, no electrocardiographic or echocardiographic alterations, normal thyroid function, grade 1 leukopenia and thrombocytopenia, and macrocytosis. The patient was in good performance status (Karnofsky 80) and was asymptomatic, but complaining of asthenia, especially during the four weeks of sunitinib administration, causing mild impairment of quality of life. The role of surgery in metastatic RCC is still debatable especially in this new era of targeted therapy. In conclusion, in the treatment of older people with targeted therapies, the following recommendations are made: assessment of the type and severity of co-morbidities; careful monitoring of cardiac, thyroid and metabolic dysfunctions, and assessment of the impact of every kind and grade of the developed toxicities on quality of life. 1 Flanigan RC, Mickisch GH, Sylvester R, Tangel C, Van Poppel H and Crawford ED: Cytoreductive nephrectomy in patients with metastatic renal cancer: a combined analysis. J Urol 171: 1071-1076, 2004. 2 Hofmann HS, Neef H, Krohe K, Andreev P and Silber RE: Prognostic factors and survival after pulmonary resection of metastatic renal cell carcinoma. Eur Urol 48: 77-81, 2005. 3 Karellas ME, Jang TL, Kagiwada MA, Kinnaman MD, Jarnagin WR and Russo P: Advanced-stage renal cell carcinoma treated by radical nephrectomy and adjacent organ or structure resection. BJU Int 103: 160-164, 2008. 29 QUALITY <strong>OF</strong> LIFE ISSUES IN URINARY DIVERSIONS: ORTHOTOPIC NEOBLADDER VERSUS ILEAL CONDUIT Paolo Destefanis, Milena Coppola, Mariateresa Carchedi, Andrea Buffardi, Francesco Travaglini, Antonino Battaglia, Alessandro Bisconti, Andrea Bosio, Beatrice Lillaz and Dario Fontana Divisione Universitaria di Urologia 2, Ospedale San Giovanni Battista Molinette, Ancona, Italy Background: During the last 20 years, the use of orthotopic neobladder has become the preferred choice for bladder replacement after radical cystectomy for muscle-invasive bladder cancer. The proportion of cystectomy patients receiving a neobladder has increased at medical centers to 30%-66%, while ileal conduit, once considered the gold standard, is now employed in 10%-64% of patients. It is generally believed that the use of an orthotopic neobladder might provide a better quality of life (QoL) because it should represent a true ‘restitutio ad integrum’ but many studies have failed to demonstrate a better QoL score. We report our experience with EORTC QoL questionnaires. Patients and Methods: A total of 53 patients were given the EORTC QLQ- C30 (version 3.0) and the QLQ-BLM30 questionnaires. All patients underwent radical cystectomy for muscle-invasive bladder cancer. Twenty-six patients received an ileal conduit (group A), while 27 a Y orthotopic neobladder (group B). The mean follow-up was 53.65±29.02 months. The QLQ-C30 incorporates five functional scales (physical, role, cognitive, emotional, and social), three symptom scales (fatigue, pain, and nausea and vomiting), a global health status/QoL scale, and a number of single items assessing additional symptoms commonly reported by cancer patients (dyspnea, loss of appetite, insomnia, constipation and diarrhea) and perceived financial impact of the disease. The QLQ-BLM30 is a phase- III module that specifically evaluates the impact of radical cystectomy and reconstructive surgery. The scores were linearly transformed (scale 0-100). A high score for a functional scale represents a high/healthy level of functioning, a high score for the global health status/QoL represents a high QoL, but a high score for a symptom scale/item represents a high level of symptomatology/problems. Results: All patients agreed to fill-in the questionnaires. As far as QLQ-C30 is concerned, all patients reported a good global health status/QoL (Group A: 60.58±21.42, group B: 68.21±23.69, p=0.22). No differences were recorded in physical, cognitive, emotional, and social functional scales. One of the questions of the role functioning scale recorded a statistically significant difference (group A: 50±27.08, group B: 66.67±29.24, p
Page 1 and 2: ANTICANCER RESEARCH 31: 1807-1956 (
Page 3 and 4: ANTICANCER RESEARCH 31: 1807-1956 (
Page 5 and 6: 1Department of Urology, Ospedale Sa
Page 7 and 8: Abstracts of the 21st Annual Meetin
Page 15: Abstracts of the 21st Annual Meetin
Page 67 and 68:
Abstracts of the 21st Annual Meetin
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Table II. Median value 3DCRT V40 V5
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
Page 137 and 138:
Page 139 and 140:
Page 141 and 142:
255 ACCURACY OF ENDORECTAL MRI AND
Page 143 and 144:
Page 145 and 146:
Page 147:
Nucciotti R, 35 Oderda M, 37, 38, 1
show all

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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?