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cancer. Stem cell identification in RCC and the uncovering of more specific markers could be useful for optimizing therapeutic strategies and for gaining prognostic and predictive information in RCC patients. 159 CASE REPORT: SALVAGE RADIOTHERAPY IN PROSTATE CANCER RECURRENCE AFTER HIGH-INTENSITY FOCUSED ULTRASOUND Barbara Bortolato, Francesco Bracco, Francesco Dionisi and Mauro Palazzi S.C. Radioterapia, A.O. Ospedale Niguarda Cà Granda, Milano, Italy Background: Although not validated and still controversial, high-intensity focused ultrasound (HIFU) has been used in recent years for the treatment of localized prostate cancer. Salvage radiotherapy after radical prostatectomy has been widely used for many years. We report a patient treated with salvage radiotherapy for a histologically proven local recurrence after HIFU treatment. Case Report: In November 2005, a 72-year-old man affected by Parkinson’s disease was bioptically diagnosed with a prostatic adenocarcinoma, Gleason pattern score 2+3 (1/6 cores positive; clinical stage 1c). Basal PSA was 3.74 ng/ml. No staging procedures were implemented. In May 2006, he was treated with HIFU, with control of the disease but with an associated complete incontinence. In March 2010, because of progressively increasing PSA (1.6 ng/ml), the patient underwent magnetic resonance imaging of the pelvis, showing abnormal solid tissue with contrast enhancement measuring 20×9 mm in the left posterior region with interruption of the prostatic capsule and extraprostatic fat infiltration. A bioptic sample histologically confirmed the cancer recurrence. The patient was initially treated with hormone therapy (bicalutamide 150 mg daily per os). We treated the patient with conformal radiotherapy (CRT) at a dose of 74 Gy in 37 fractions. The treatment was performed with periodic control of the treatment set-up by cone beam CT (image-guided radiotherapy). The treatment was well tolerated. Toxicity was measured using the RTOG scale (gastrointestinal toxicity of grade 1 and a genitourinary toxicity of grade 2). At the end of treatment, PSA was 0.57 ng/ml. Hormone therapy was continued during the treatment and interrupted six months after. After one year, the patient is free of recurrence and without evidence of late toxicity. Conclusion: Salvage radiotherapy after HIFU is feasible and safe, with a tolerable acute toxicity, while a longer followup is needed to define the impact on late sequelae and outcome. 1894 ANTICANCER RESEARCH 31: 1807-1956 (2011) 1 Blana A, Murat FJ, Walter B et al: First analysis of the longterm results with transrectal HIFU in patients with localized prostate cancer. Eur Urol 53: 1194-1203, 2008. 2 Pasticier G, Chapet O, Badet L et al: Salvage radiotherapy after high-intensity focused ultrasound for localized prostate cancer: early clinical results. Urology 72: 1305-1309, 2008. 3 Riviere J, Bernhard JC, Robert G et al: Salvage radiotherapy after high-intensity focused ultrasound for recurrent localized prostate cancer. Eur Urol 58(4): 567-573, 2010. 160 COMPARISON BETWEEN INCIDENCE OF COMPLICATIONS, STRATIFIED ACCORDING TO CLAVIEN SYSTEM IN OPEN VERSUS ROBOTIC PROSTATECTOMY Ottavio De Cobelli1 , Sara Melegari1 , Giancarlo Albo1 , Deliu-victor Matei1 , Gennaro Musi1 , Federica Mazzoleni1 , Luigi Santoro2 , Serena Detti1 and Fabrizio Verweij1 1Divisione di Urologia and 2Divisione di Epidemiologia e Biostatistica, Istituto Europeo di Oncologia, Milano, Italy Background: The introduction of PSA monitoring has assisted in the downstaging of prostate cancer and diagnosis in younger men, consequently meeting oncological goals and achieving a good quality of life in terms of continence, potency, hospitalization and morbidity. According to EAU 2010 guidelines, radical prostatectomy is considered the gold standard of treatment for prostate cancer. Robotic approaches have been developed to achieve these outcomes. In 1992 and 2004, Clavien (1) proposed a simple grading system for surgical complications, which was then used by Coehlo et al. (2) to classify robot-assisted radical prostatectomy. The aim of this study was to compare incidence of complications, stratified according to the Clavien system, in retropubic radical prostatectomy (RRP) vs. robot-assisted radical prostatectomy (RARP). Materials and Methods: From February 1999 to May 2008, we performed 953 RRP procedures and from November 1st 2006 to December 31st 2010, we performed 697 RARP procedures. To avoid population bias related to the learning curve, we selected the last 197 RRP procedures that were performed two years before the first RARP procedure, and 358 consecutive RARP procedures that were performed from February 2008 to February 2010. All RARP were performed according to Patels description, with rhabdosphincter reconstruction according to the Rocco-Patel technique; pelvic lymphadenectomy was performed for intermediate-risk patients according to the Kattan nomogram. At the preliminary analysis, RRP and RARP populations were comparable. We collected data regarding perioperative complications, defined according to Clavien and Dildo as any
Abstracts of the 21st Annual Meeting of the Italian Society of Uro-Oncology (SIUrO), 22-24 June, 2011, Naples, Italy deviation from the normal postoperative course. Results: A total of 115 overall complications were recorded in the RRP group vs. 87 in the robotic group (p-value=0.001). A total of 45.2% of patients who underwent RRP had one complication vs. 19.0% of patients in the robotic group. The following observations were made: inguinal hernia, 9 vs. 7 in the RRP vs. the RARP group, respectively; drained hematoma, one 1 vs. 4; acute urine retention, 5 vs. 9; perianastomotic leakage, 30 vs. 31; drained lymphocele, 6 vs. 2; balanitis, 10 vs. 0; pneumonia 0vs.2; needed blood transfusion 44 vs.19; and ureteral fistula, 1 vs. 0, respectively. A single patient in each group experienced an early anastomotic stenosis. A total of 7.9% vs.11.8% of the patients in the RRP vs. the RARP group, respectively, had Clavien I complication, 83.1% vs. 73.2% had Clavien II complication, 9% vs. 2.9% had Clavien IIIa complication and 0 vs. 11.8% had Clavien IIIb complication, respectively. Univariate and multivariate analyses of potential predictors for postsurgical complications showed that surgical technique, presurgical hemoglobin value and blood loss >500 ml were independent variables correlated with an increased risk. Discussion: Patel et al. reported complication rates of 5% in a series of 2500 patients. Higher complication rates were reported by Murphy et al., who showed a complication rate of 15.7%, with 5.2% being Clavien III complication, and by Novara et al., who showed an overall complication rate of 21%, with 3% being Clavien III and 0.2% being Clavien IV complications. As far as comparison between RRP and RARP is concerned, recently published studies reported comparable perioperative overall complication rates; Ficarra et al. showed only a nonstatistically significant trend in favor of RARP (2). Carlsson et al. (3), when comparing RRP and RALP, showed a lower incidence of overall and major complications with the robotic approach. Conclusion: RARP is a safe option for treatment of localized prostate cancer, presenting lower overall complication rates than open surgery. It seems that even if less frequent, adverse events can be more serious than when an open approach is used. 1 Dindo D, Demartines N and Clavien PA: Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2): 205-213, 2004. 2 Coelho RF, Palmer KJ, Rocco B, Moniz RR, Chauhan S, Orvieto MA, Coughlin G and Patel VR: Early complication rates in a single-surgeon series of 2500 robotic-assisted radical prostatectomies: report applying a standardized grading system. Eur Urol 57(6): 945-952, 2010. 3 Carlsson S, Nilsson AE, Schumacher MC, Jonsson MN, Volz DS, Steineck G and Wiklund PN: Surgery-related complications in 1253 Robot-assisted and 485 open retropubic radical prostatectomies at the Karolinska University Hospital, Sweden. Urology 75: 1092-1099, 2010. 161 ADJUVANT VS. SALVAGE RADIOTHERAPY AFTER RADICAL SURGERY FOR PROSTATE CANCER: EXPERIENCE AT THE NIGUARDA CA’ GRANDA HOSPITAL Barbara Bortolato1 , Francesco Bracco1 , Daniela Zanni2 , Francesco Dionisi1 and Mauro Palazzi1 1S.C. Radioterapia and 2Servizio di Fisica Sanitaria, A.O. Ospedale Niguarda Cà Granda, Milano, Italy Aim: The optimal role of radiotherapy (RT) in prostate cancer after radical prostatectomy is controversial. This retrospective review compares postoperative modalities of RT to investigate the optimal timing of RT. The aim of the study was to determine any advantage between the different modalities of treatment. Patients and Methods: Between 1994 and 2008 at the Niguarda Ca’ Granda Hospital in Milan, 338 patients were treated with external beam RT to the prostate bed after radical prostatectomy (pT2R+, pT3). These patients were divided into three groups: 137 patients (40.5%) who underwent RT within six months from surgery and whose post-prostatectomy PSA level was undetectable (group A); 98 patients (29%) treated with RT within six months, but with persistent PSA values (PSA >0.02 ng/ml) (group P); and 103 patients (30.5%) who underwent RT in the salvage setting, following a delayed rise in PSA or based on clinical evidence of relapse (group S). Adjuvant androgen ablation was given in 17/137 patients in group A, 27/98 patients in group P and 16/103 patients in group S. In group P, the mean value of PSA was 0.36 (range 0.02-7.7) ng/ml, while the mean PSA for group S was 0.78 (range 0.1-5.5) ng/ml. For the three groups, the median RT dose was 64.8 (range 59.4-72) Gy. The Kaplan–Meier method was used to estimate the probabilities of biochemical relapsefree survival (b-RFS) and overall survival (OS). The log-rank test was used to test the significance between the three groups with respect to selected endpoints. Results: For all groups, gastrointestinal and genitourinary toxicities were never higher than grade 2 according to RTOG classification. In group A, there were six deaths, four unrelated to prostate cancer and two due to metastatic disease; in group P, there were five deaths (three due to cancer and two due to other disease) and in group S there were six deaths (four related and two not related to prostate cancer). We evaluated biochemical relapse of disease according to ASTRO criteria. A total of 27/137 patients (19.7%) in group A, 35/98 patients (35.7%) in group P, and 64/103 patients (62.1%) in group S showed a biochemical relapse. The three groups showed a statistically significant difference in b-RFS (p
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255 ACCURACY OF ENDORECTAL MRI AND
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