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

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The correct gold marker positions were verified by fluoroscopy. The planning computed tomography (CTsim) was acquired (1 mm axial slices) five days after implantation, when stability of the markers had been achieved. Polyurethane foam was individually tailored to immobilize the legs and to ensure a stable positioning of the patient’s pelvis; the patients were asked to keep a full bladder and an empty rectum in order to reduce inter-fraction organ-filling variability. The prostate without the seminal vesicles as clinical target volume (CTV) was delineated by the same expert physician (GM). An initial 3D conformal RT plan (pre-planning) was performed, prescribing 78 Gy (2 Gy per fraction) to the planning target volume (PTV) and using a standard CTV-to-PTV margin of 1 cm except for 0.5 cm on the posterior edge. A daily match of marker positions between CBCT and CTsim was performed in order to correct inter-fraction prostate motion. After the first week of treatment, a new treatment plan was performed for each patient where the first five CBCTs were used to create a patient personalized PTV , as a merged volume, including the 5-day prostate position variability (plus 2 mm due to operator and Linac mechanical inaccuracy). Patient symptoms were monitored regularly (at least each 3-4 months up to the time of writing). The observed toxicity was recorded and classified according to the RTOG score. Results: The applied adaptive on-line protocol with scheduled re-planning to compensate for the anterior prostate tilt (incorrigible with a linear shift) allowed us to reduce CTV-PTV margin in the majority of patients: the median CTV-PTV margin in the pre-planning phase was 98.82±25.70 cc (range 29.73-134.14 cc), while the median CTV-PTV margin in the re-planning phase was 20.38±12.56 cc (range 4.79-56.09 cc), with a median advantage of 78.44±21.67 cc (range 24.94-117.57 cc). The reduction of re-planning margin allowed a reduction of the dose to the rectum and bladder, and resulted in low acute and late toxicity. Late rectal toxicity was recorded only in three patients (one G1, one G2 and one G3 patient) and late bladder toxicity in 13 patients (eight G1, four G2 and one G3 patients); all the patients, except one, presented sexual impotence, mainly as worsening of pre-radiotherapy impotence due to hormonal therapy; only one patient showed true radiotherapy-related impotence. Conclusion: Image-guided radiation therapy is helpful to personalize and reduce the CTV-PTV margin. Consequently, toxicities were very low, with few cases of G1- G2 acute and late bladder and rectal effects, and only two cases of G3 toxicity. 153 INTRAOPERATIVE RADIO<strong>THE</strong>RAPY DURING RADICAL RETROPUBIC PROSTATECTOMY Silvestro Parziani 1 , Carlo Vivacqua 1 , Marco Paolucci 2 , Roberto Di Lorenzo 3 and Franco Checcaglini 4 1890 ANTICANCER RESEARCH 31: 1807-1956 (2011) 1Urologia, and 2Fisica Sanitaria, ASL3 Umbria Ospedale Foligno, Perugia, Italy; 3Radiologia, ASL3 Umbria Ospedale Foligno, Perugia, Italy; 4Radioterapia Oncologica, ASL1 Umbria Ospedale C., Castello, Italy Aim: To evaluate the efficacy, complications and outcome of intraoperative radiotherapy (IORT) during retropubic prostatectomy (RRP). Patients and Methods: From January 2009 to February 2010, twelve patients were submitted to RRP, obturatory lymphadenectomy and IORT. At clinical staging, six tumors were T2c, three presented with perineural infiltration, two showed seminal vesicle infiltration and one extracapsular disease. Mean preoperative PSA value was 14 (range 11-23) ng/ml and the Gleason score at biopsy was 7-9. None of the patients presented preoperative incontinence. Vesico-urethral anastomosis was performed with 6-8 stitches. IORT was administered with linear electron accelerator and administration of energy of 12 MeV. Results: The time surplus for IORT administration was 45 minutes (±30-60 minutes according to the difficulty in finding the correct position of the probe underneath the pubic bone),with the entire procedural time being 200 (±30) minutes. Bleeding was less than 500 cc, without need for transfusions. Three tumors were pT2c, three were pT3a, one was pT3b, one was pT2cN1 and four patients presented R+. Perioperative complications were not observed. Bladder catheter was removed after ten days. At three months follow-up, five patients presented stress-incontinence (three pads/day); at six months, one patient still presented the same problem. Erectile dysfunction was reported by all patients. PSA failure was not present at mean follow-up of 16 (range 13-23) months. Discussion: IORT during RRP can be used safely in the treatment of prostate cancer with locally advanced disease or with high Gleason score. Oncologic follow-up was too short and the number of patients was too low in our series to lead to conclusions on the outcome, but the absence of PSA failure is encouraging. The use of a linear electron accelerator with maximum energy administration of 12 MeV does not seem to expose the patients to significant adverse effects. Conclusion: Selected patients affected by prostate cancer can benefit from radical surgery associated with a supplementary treatment as IORT, without evidence of significant adverse side-effects. 154 RARE NON-GERM CELL TESTICULAR TUMOURS: LEIOMYOSARCOMA AND ADULT TYPE GRANULOSA CELL TUMOUR Daniele Tiscione, Tommaso Cai and Gianni Malossini Urologia, Ospedale S. Chiara, Trento, Italy
Abstracts of the <strong>21st</strong> Annual Meeting of the Italian Society of Uro-Oncology (SIUrO), 22-24 June, 2011, Naples, Italy Background: Non-germ cell tumors of the testicle include the sex cord/gonadal stromal tumors (Leydig cell, Sertoli cell and granulosa cell) and non-specific stromal tumors (leiomyosarcoma). These tumors are very rare and account for only 2-4% of adult testicular tumors. Primary testicular leiomyosarcomas are soft-tissue tumors, arising from the undifferentiated smooth muscle cells of mesenchymal origin. Risk factors are reported to be high-doses of anabolic steroids, chronic inflammation, radiotherapy, or an association with testicular germ cell tumors. Testicular granulosa cell tumors are divided into two histological types: adult and juvenile. Adult type tumors arise from epithelial tissue of the gonads. The average age at presentation is 44 years and the tumors are usually >7 cm diameter. Case Report A: A 65-year-old man presented at our clinic with a six-month history of left testicular pain and swelling. His past medical history was significant for a left testicular trauma that had occurred several years before. Scrotal ultrasound showed an intratesticular mass (4×4 cm), while whole-body computed tomography (CT) scans and tumor markers were normal. The patient underwent left radical orchiectomy and histopathological examination of the excised mass was consistent with highgrade leiomyosarcoma. There was no evidence of recurrence or metastasis 16 months postoperatively. Case Report B: A 26-year-old man presented at our clinic with a two-month history of left testicular pain. Ultrasound showed left sex cord and testicular inflammation and a small nodule (7 mm) of the left testis. The pain resolved after medical therapy and two months afterwards an ultrasound examination confirmed the presence of the nodule. The patient underwent surgical resection of the nodule. The histological picture was consistent with adult type granulosa cell tumor. There was no evidence of recurrence or metastasis ten months postoperatively. Discussion: Granulosa cell tumors and leiomyosarcoma of the testis are uncommon neoplasms and, to date and our knowledge, only 17 cases of leiomyosarcoma and only 25 cases of adult type granulosa cell tumors have been reported in the literature. All leiomyosarcomas and 20% of the adult type granulosa cell tumors are malignant. In both cases, distant metastases are relatively rare. The standard treatment is orchiectomy. Adjuvant treatments, such as chemotherapy, radiotherapy or retroperitoneal lymph-node dissection, do not seem able to improve prognosis, which remains good in cases of localized tumors. Conclusion: In our opinion, scrotal trauma, associated with chronic inflammation, should be considered as a risk factor for testicular cancer. In cases of small testicular nodules (
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1Department of Urology, Ospedale Sa
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255 ACCURACY OF ENDORECTAL MRI AND
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Nucciotti R, 35 Oderda M, 37, 38, 1
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