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

Abstracts of the 21st Annual Meeting of the Italian Society of Uro-Oncology (SIUrO), 22-24 June, 2011, Naples, Italy
Aim: To evaluate acute urinary and rectal toxicities in patients
with prostate cancer submitted to image-guided radiotherapy
(IGRT). Patients and Methods: From June 2009 to March
2010, 29 patients (median age: 70 years, range: 48-82 years;
median Gleason score: 7, range: 5-10) underwent radical
radiotherapy and 12 patients (median age: 67 years, range: 54-
78 years; median Gleason score: 7, range: 5-9) underwent
adjuvant radiotherapy. All patients underwent simulation
computed tomography (CT) without contrast injection in
supine position. The CT scans were used to delineate the
organs at risk, namely bladder, rectum, coxo-femoral joints
and penis bulb. For patients receiving radical radiotherapy, the
seminal vesicles were excluded at an absorbed dose of 66 Gy.
For this group of patients, the total delivered dose was 74 Gy,
while for patients who underwent adjuvant radiotherapy, the
total delivered dose was 66 Gy. The planning target volume
(PTV) was obtained from the expansion of the clinical target
volume (CTV) by 8 mm anteriorly, laterally and caudally, 10
mm cranially and 5 mm posteriorly. The isocenter positioncheck
protocol was performed with the use of MV cone-beam
CT on the first, second and third day, successively, once a
week. Correct positioning was evaluated using the bone
structures of the pelvis as reference. Corrections of isocenter
position were made with a semi-automatic modality. Acute
urinary and rectal toxicities were evaluated administering IPSS
before radiotherapy, during the weekly clinical examinations
and at the end of the radiotherapy. At the same time, we used
the RTOG scale for acute and late adverse events to evaluate
toxicities. We also calculated the median error of isocenter
position indicated by virtual simulation and cone-beam
existing in the left-right (L-R), cranial-caudal (C-C) and
anterior-posterior (A-P) directions. Results: At the end of
IGRT, we found a median IPSS score of 8 (range: 0-14) for
the 12 patients treated with adjuvant radiotherapy; 50% of
patients had IPSS scores between 0-7. The worst scores
corresponded to the first, fourth and seventh questions. In
addition, we recorded prevalent G1 rectal toxicity and G2
urinary toxicity at end of treatment. In the group of patients
who underwent radical radiotherapy, the median IPSS score at
the end of treatment was 9 (range: 1-28) and 58.6% of patients
had IPSS scores between 0-7. The worst scores corresponded
to the second and seventh questions. There was prevalent G1
rectal toxicity and G2 urinary toxicity in 93.1% and 44.8% of
patients, respectively, at the end of treatment. At the last
follow-up (March 2010), in both groups, rectal and urinary
toxicities were G0, while IPSS scores between 0-7 were
observed in 82.6 and 100% of patients in the radical and
adjuvant radiotherapy groups, respectively. Median values of
L-R, C-C and A-P directions were 3, 2 and 3 mm,
respectively. In order to match precision and workload criteria,
thresholds for the standard deviation of the corrections were
set as: 2.96, 3.78 and 2.78 mm in the L-R, C-C and A-P
directions, respectively. Conclusion: Treatment was well
tolerated. We observed low toxicity rates and a high
compliance to treatment. IGRT, performed for first fractions,
may be helpful for eliminating gross systematic errors,
especially after virtual simulation.
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TOTAL INTRAVENOUS ANESTHESIA (TIVA),
TARGET-CONTROLLED INFUSION AND DA
VINCI ROBOT-ASSISTED PROSTATECTOMY
Ciro Visconti1 , Albertina Mastroluca2 , Giovanna Pavone2 ,
Giuseppe Melchionda2 , Latiano Costanzo3 and Antonio Cisternino3 1Urology, 2Department of Anesthesiology and Intensive
Care, 3Department of Urology, IRCCS, Casa Sollievo della
Sofferenza, Opera Padre Pio, San Giovanni Rotondo, Foggia,
Italy
Background: Robotic prostatectomy provides a prolonged
Trendelenburg position of about 40˚ and CO 2
pneumoperitoneum for surgical exposure with potential
significant changes in hemodynamic and respiratory
parameters for the patient, such as the rising of central venous
pressure (CVP) and pulmonary capillary wedge pressures.
CVP measures the filling pressure of the right ventricular
volume and gives an estimate of the intravascular volume
status and the interplay of the circulating blood volume
venous tone. Measuring CVP is widely considered a useful
aid in the management of a patient’s fluid status during
surgery. Target-controlled infusion (TCI) is a total intravenous
anesthesia (TIVA) technique that maintains constant plasma
and effect-site concentrations of anesthetic agents due to the
pharmacokinetic models incorporated in the TCI pump. The
precise dosing of the anesthetic drugs leads to superior
hemodynamic stability and fast recovery after surgery for
patients. The use of propofol/remifentanil TIVA-TCI in
combination tends to have a synergistic action and the rate of
equilibration between blood and effect-site depends on
cardiac output, central blood volume, cerebral blood flow,
lipid solubility and degree of ionization of drug. We evaluated
TIVA-TCI of propofol and remifentanil and hemodynamic
and respiratory parameters during Da Vinci robot-assisted
prostatectomy. Patients and Methods: In our retrospective
study, we evaluated 15 consecutive patients scheduled for
robot-assisted endoscopic radical prostatectomy in TIVA-TCI
with non-invasive monitoring of arterial blood pressure, heart
rate, pulse oximetry, end-tidal (ET) CO 2, peak and plateau
airway pressure and state entropy (SE), assessing anesthetic
depth and continuous invasive CVP on a S/5 Datex-Ohmeda
monitor. Accurate measurement of CVP was obtained with
cannulation of the internal jugular vein. The depth of
anesthesia was obtained with TIVA-TCI in propofol/
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