Development of therapeutic strategies for non-muscle-invasive bladder cancer (NMIBC) that failed intravesical Bacillus Calmette - Guerin (BCG) therapy remains an urgent priority for clinicians. Currently, radical cystectomy is the recommended standard of care treatment options for these patients. Intravesical chemotherapy using gemcitabine and docetaxel are regarded as the most effective treatment options for unresponsive NMIBC, however, these options are ineffective in the control of bladder cancer. In this review, we present the definition of BCG unresponsive NMIBC and discuss about the recent management options that include immunotherapy, intravesical chemotherapy, gene therapy, and targeted individualized therapy. Notably, immunotherapy is the most recent strategy utilizing the PD-1/PD-L1 and other immune checkpoint inhibitors (ICIs). Pembrolizumab (KEYNOTE-057), Atezolizumab (SWOG S1605) and Nivolumab were developed and are efficacious in BCG –unresponsive NMIBC. In summary, ICIs are considered as the most promising agent for BCG unresponsive NMIBC in the future.
{"title":"Novel Therapeutic Strategies for BCG-unresponsive Non-muscle Invasive Bladder Cancer","authors":"Peng Zhang, Yi Ding","doi":"10.32948/auo.2022.11.27","DOIUrl":"https://doi.org/10.32948/auo.2022.11.27","url":null,"abstract":"Development of therapeutic strategies for non-muscle-invasive bladder cancer (NMIBC) that failed intravesical Bacillus Calmette - Guerin (BCG) therapy remains an urgent priority for clinicians. Currently, radical cystectomy is the recommended standard of care treatment options for these patients. Intravesical chemotherapy using gemcitabine and docetaxel are regarded as the most effective treatment options for unresponsive NMIBC, however, these options are ineffective in the control of bladder cancer. In this review, we present the definition of BCG unresponsive NMIBC and discuss about the recent management options that include immunotherapy, intravesical chemotherapy, gene therapy, and targeted individualized therapy. Notably, immunotherapy is the most recent strategy utilizing the PD-1/PD-L1 and other immune checkpoint inhibitors (ICIs). Pembrolizumab (KEYNOTE-057), Atezolizumab (SWOG S1605) and Nivolumab were developed and are efficacious in BCG –unresponsive NMIBC. In summary, ICIs are considered as the most promising agent for BCG unresponsive NMIBC in the future.","PeriodicalId":33190,"journal":{"name":"Annals of Urologic Oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42323308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Vigna-Taglianti, A. Boriano, A. Merlotti, S. Martini, Gianello Luca, S. Solla, Spinelli Lavinia, F. Olivero, F. Bergesio, A. De Maggi, A. Reali, E. Grazioso Russi
Background The development of new metabolic diagnostic imaging PET is changing the history of metastatic prostate cancer (pCa), identifying situations of progression with a low disease burden; radiation treatment of metabolically active oligometastatic sites has been shown to be effective to prolong patient survival. In the scenario of oligometastatic disease to pelvic lymph nodes there is no uniform consensus on treatment volumes and radiotherapy doses to use. Methods We retrospectively assessed a series of 50 patients treated from 2015 to 2021 at our center who presented with recurrent pelvic lymph node pCa disease with 1-3 lymph-nodes lateralized to one side of the pelvis. Patients were treated with intensity modulated Rapid Arc radiotherapy (IMRT), limiting the treatment volume to the chain of the affected side only. During the follow-up, the patients who presented a biochemical recurrence of the disease were evaluated by PET. Results The biochemical progression-free survival and the metastatic progression-free survival were respectively 36% and 49% at 5 years. 22/50 patients presented a documented recurrence on PET. Only one patient presented a relapse within the irradiated volume and no patient presented a relapse on the contralateral pelvic lymph node chain. No patient had gastrointestinal toxicity > grade 1 RTOG. Conclusion Treatment of patients with oligorecurrent (1-3 lesions) pelvic pCa, limiting the volume of irradiation to only one side of the affected lymph node chain, results in good biochemical disease control and presents a low risk of neoplastic contralateral progression.
{"title":"Long Term Results of Elective Nodal Salvage Radiotherapy in Oligometastatic Prostate Cancer : A Mono-Institutional Series","authors":"R. Vigna-Taglianti, A. Boriano, A. Merlotti, S. Martini, Gianello Luca, S. Solla, Spinelli Lavinia, F. Olivero, F. Bergesio, A. De Maggi, A. Reali, E. Grazioso Russi","doi":"10.32948/auo.2022.09.30","DOIUrl":"https://doi.org/10.32948/auo.2022.09.30","url":null,"abstract":"Background The development of new metabolic diagnostic imaging PET is changing the history of metastatic prostate cancer (pCa), identifying situations of progression with a low disease burden; radiation treatment of metabolically active oligometastatic sites has been shown to be effective to prolong patient survival. In the scenario of oligometastatic disease to pelvic lymph nodes there is no uniform consensus on treatment volumes and radiotherapy doses to use.\u0000Methods We retrospectively assessed a series of 50 patients treated from 2015 to 2021 at our center who presented with recurrent pelvic lymph node pCa disease with 1-3 lymph-nodes lateralized to one side of the pelvis. Patients were treated with intensity modulated Rapid Arc radiotherapy (IMRT), limiting the treatment volume to the chain of the affected side only. During the follow-up, the patients who presented a biochemical recurrence of the disease were evaluated by PET.\u0000Results The biochemical progression-free survival and the metastatic progression-free survival were respectively 36% and 49% at 5 years. 22/50 patients presented a documented recurrence on PET. Only one patient presented a relapse within the irradiated volume and no patient presented a relapse on the contralateral pelvic lymph node chain. No patient had gastrointestinal toxicity > grade 1 RTOG.\u0000Conclusion Treatment of patients with oligorecurrent (1-3 lesions) pelvic pCa, limiting the volume of irradiation to only one side of the affected lymph node chain, results in good biochemical disease control and presents a low risk of neoplastic contralateral progression.","PeriodicalId":33190,"journal":{"name":"Annals of Urologic Oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45076138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Varma, Seema Jindal, B. Sharda, K. Malukani, Shilpi Dosi, Pooja Kesharwani
Background Prostate cancer (PCa) is the second most frequent malignancy (after lung cancer) in men worldwide .In prostate cancer, immunohistochemistry (IHC) has an important role in the diagnostic confirmation. Gleason score, tumour volume, surgical margins and Ki-67 index are the most significant prognostic factors. The value of different biomarkers like p53, Ki-67, PSMA, androgen receptor mutations, IGF, E-cadherin remains to be applied in clinical practice. In the present study we studied the expression of PSMA and Ki 67 IHC marker in prostatic carcinoma cases and its relation with Gleason score and Gleason grade group of tumour. Method A total of 52 cases of prostate carcinoma diagnosed on histopathology as adenocarcinoma in the Department of surgical pathology within 2.5 years duration were further studied immunohistochemically by PSMA and Ki 67 antibodies. Results At the time of presentation most of the cases have serum PSA level 11-50 ng/ml and with increasing Gleason score it can be ≥100ng/ml. Majority of cases have Gleason score 7 and the most common Gleason grade group is 2. PSMA and Ki 67 IHC marker is significantly correlated with Gleason score and Gleason grade group. PSMA expression is significantly correlated with perineural invasion and Ki 67 with bone metastasis. Conclusion PSMA and Ki 67 IHC marker can be used in conjunction with or as a substitute to Gleason scoring system for proper risk.
{"title":"Study of Immunohistochemical Marker Psma and Ki 67 Expression and Its Relation with Grading in Prostate Carcinoma","authors":"A. Varma, Seema Jindal, B. Sharda, K. Malukani, Shilpi Dosi, Pooja Kesharwani","doi":"10.32948/auo.2022.08.29","DOIUrl":"https://doi.org/10.32948/auo.2022.08.29","url":null,"abstract":"Background Prostate cancer (PCa) is the second most frequent malignancy (after lung cancer) in men worldwide .In prostate cancer, immunohistochemistry (IHC) has an important role in the diagnostic confirmation. Gleason score, tumour volume, surgical margins and Ki-67 index are the most significant prognostic factors. The value of different biomarkers like p53, Ki-67, PSMA, androgen receptor mutations, IGF, E-cadherin remains to be applied in clinical practice. In the present study we studied the expression of PSMA and Ki 67 IHC marker in prostatic carcinoma cases and its relation with Gleason score and Gleason grade group of tumour.\u0000Method A total of 52 cases of prostate carcinoma diagnosed on histopathology as adenocarcinoma in the Department of surgical pathology within 2.5 years duration were further studied immunohistochemically by PSMA and Ki 67 antibodies.\u0000Results At the time of presentation most of the cases have serum PSA level 11-50 ng/ml and with increasing Gleason score it can be ≥100ng/ml. Majority of cases have Gleason score 7 and the most common Gleason grade group is 2. PSMA and Ki 67 IHC marker is significantly correlated with Gleason score and Gleason grade group. PSMA expression is significantly correlated with perineural invasion and Ki 67 with bone metastasis.\u0000Conclusion PSMA and Ki 67 IHC marker can be used in conjunction with or as a substitute to Gleason scoring system for proper risk.","PeriodicalId":33190,"journal":{"name":"Annals of Urologic Oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46896116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Context Radical cystectomy (RCX) is the most difficult urologic procedure. It is usually performed in patients with morbidities and associated with a high rate of complications. So, every effort must be done to improve the outcome of this surgery. Objective This systematic review tries to put an up to date analysis of the literature on how to improve the outcome of RCX. Evidence acquisition A systematic literature search in the PubMed and Cochrane databases was performed from 1990 to July 2022 in English language using the keywords ‘‘radical cystectomy’, ‘Enhanced recovery’ and ‘Improved outcome’. Prospective studies were preferred; however, retrospective studies were used when no prospective studies were available. Evidence synthesis In all, 237 relevant articles were identified and 46 articles were included in this systematic review. RCX may be associated by complications that may reach 70%. Preoperative patient preparation, optimization and counseling are critical. Enhanced recovery after surgery protocols should be adopted. The radicality of surgery is affected by the use of neo-adjuvant and/or adjuvant therapy, timing of surgery, the presence of a well-organized team and the surgeon experience. Ureteral dissection, urethral stump preparation and nerve sparing are three important steps during RCX greatly affecting the function of the following reconstructive step. Close follow up after RCX especially in the first two years is critical. Conclusions Multiple factors should be followed to achieve good RCX. Regular skilled operative team, high volume surgeon, well equipped operative theater, excellent postoperative care are keys of success.
{"title":"Update on How to Improve the Outcome of Radical Cystectomy: A Systematic Review","authors":"A. Moeen, Hassan A Aboul-Ella","doi":"10.32948/auo.2022.05.10","DOIUrl":"https://doi.org/10.32948/auo.2022.05.10","url":null,"abstract":"Context Radical cystectomy (RCX) is the most difficult urologic procedure. It is usually performed in patients with morbidities and associated with a high rate of complications. So, every effort must be done to improve the outcome of this surgery.\u0000Objective This systematic review tries to put an up to date analysis of the literature on how to improve the outcome of RCX.\u0000Evidence acquisition A systematic literature search in the PubMed and Cochrane databases was performed from 1990 to July 2022 in English language using the keywords ‘‘radical cystectomy’, ‘Enhanced recovery’ and ‘Improved outcome’. Prospective studies were preferred; however, retrospective studies were used when no prospective studies were available.\u0000Evidence synthesis In all, 237 relevant articles were identified and 46 articles were included in this systematic review. RCX may be associated by complications that may reach 70%. Preoperative patient preparation, optimization and counseling are critical. Enhanced recovery after surgery protocols should be adopted. The radicality of surgery is affected by the use of neo-adjuvant and/or adjuvant therapy, timing of surgery, the presence of a well-organized team and the surgeon experience. Ureteral dissection, urethral stump preparation and nerve sparing are three important steps during RCX greatly affecting the function of the following reconstructive step. Close follow up after RCX especially in the first two years is critical.\u0000Conclusions Multiple factors should be followed to achieve good RCX. Regular skilled operative team, high volume surgeon, well equipped operative theater, excellent postoperative care are keys of success.","PeriodicalId":33190,"journal":{"name":"Annals of Urologic Oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44788238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Choudhary, Shams Tabrej Asgarali Ansari, E. Galeti, S. Shahab
Background Robotic surgery has now evolved as an emerging tool for better and easy operative techniques. The quest for trifecta comprising warm ischemia time less than 25 minutes, negative surgical margins and no perioperative complications seems to be better accomplished by robotic partial nephrectomy, which is likely to become the new standard for minimally invasive partial nephrectomy. Materials & Methods It is a prospective observational study over 18 months in patients aged more > 18 years with a renal tumour of clinical stage T1 coming for robotic partial nephrectomy. A total of 40 patients were included in the study who underwent robotic-assisted partial nephrectomy for renal tumours less than 7 cm in size. The duration of the study was from July- 2018 to December-2019 and their follow up period was 3 months post-surgery. Results Of the 40 patients, the mean age was 52.3 ± 11.91 years. 28 (70%) patients were males and remaining 12 (30%) were females. 11 (27.5%) tumours were situated in the anterior upper pole, 9 (22.5%) in the anterior lower pole, 8 (20%) in the posterior upper pole, 7 (17.5%) in the posterior lower pole and interpolar tumours were 5 in number (12.5%). 24 (60%) tumors were ≥ 50% exophytic, 11 (27.5%) were < 50% exophytic and 5 (12.5%) were purely endophytic in nature. Maximum nephrometry score was 5a amounting to 10 (25%) patients and 5p tumours were the second most common amounting to 7 (17.5%) patients. The mean console time was noted to be 84.40± 12.05 mins. The mean total operative time was noted to be 167.00 ± 21.116 minutes. Mean Warm Ischemia Time (WIT) was recorded to be 27.28 ± 5.923 minutes. The mean blood loss was 145.75±61.075 ml. The mean length of hospital stay was 4.27 ± 0.78 days. None of the cases was converted to open partial/radical nephrectomy and none had positive surgical margins in the histopathology reports. Conclusion Our study shows that Robotic Assisted Partial Nephrectomy (RAPN) is an efficacious and safe surgery in stage T1 renal tumours (tumour size <7 cm) to achieve complete oncological clearance by minimal access technique.
{"title":"Is Robotic-assisted partial nephrectomy an efficacious and safe procedure for removal of stage T1 renal tumors?","authors":"D. Choudhary, Shams Tabrej Asgarali Ansari, E. Galeti, S. Shahab","doi":"10.32948/auo.2022.03.23","DOIUrl":"https://doi.org/10.32948/auo.2022.03.23","url":null,"abstract":"Background Robotic surgery has now evolved as an emerging tool for better and easy operative techniques. The quest for trifecta comprising warm ischemia time less than 25 minutes, negative surgical margins and no perioperative complications seems to be better accomplished by robotic partial nephrectomy, which is likely to become the new standard for minimally invasive partial nephrectomy.\u0000Materials & Methods It is a prospective observational study over 18 months in patients aged more > 18 years with a renal tumour of clinical stage T1 coming for robotic partial nephrectomy. A total of 40 patients were included in the study who underwent robotic-assisted partial nephrectomy for renal tumours less than 7 cm in size. The duration of the study was from July- 2018 to December-2019 and their follow up period was 3 months post-surgery.\u0000Results Of the 40 patients, the mean age was 52.3 ± 11.91 years. 28 (70%) patients were males and remaining 12 (30%) were females. 11 (27.5%) tumours were situated in the anterior upper pole, 9 (22.5%) in the anterior lower pole, 8 (20%) in the posterior upper pole, 7 (17.5%) in the posterior lower pole and interpolar tumours were 5 in number (12.5%). 24 (60%) tumors were ≥ 50% exophytic, 11 (27.5%) were < 50% exophytic and 5 (12.5%) were purely endophytic in nature. Maximum nephrometry score was 5a amounting to 10 (25%) patients and 5p tumours were the second most common amounting to 7 (17.5%) patients. The mean console time was noted to be 84.40± 12.05 mins. The mean total operative time was noted to be 167.00 ± 21.116 minutes. Mean Warm Ischemia Time (WIT) was recorded to be 27.28 ± 5.923 minutes. The mean blood loss was 145.75±61.075 ml. The mean length of hospital stay was 4.27 ± 0.78 days. None of the cases was converted to open partial/radical nephrectomy and none had positive surgical margins in the histopathology reports.\u0000Conclusion Our study shows that Robotic Assisted Partial Nephrectomy (RAPN) is an efficacious and safe surgery in stage T1 renal tumours (tumour size <7 cm) to achieve complete oncological clearance by minimal access technique.","PeriodicalId":33190,"journal":{"name":"Annals of Urologic Oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48895961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Evan Austin, D. Mobley, Jamaka C. Tarajkowski, D. Lamm
Introduction To evaluate the response of patients with high-risk bacillus Calmette-Guerin (BCG)–unresponsive non-muscle invasive bladder cancer (NMIBC) who we treated with intravesical CG0070, a conditionally replicating granulocyte macrophage colony-stimulating factor (GM-CSF) containing an RB promoter. Methods 15 patients with residual high grade BCG-unresponsive CIS +/- Ta/T1/T2 bladder cancer received one or more 6-week instillations of intravesical CG0070 and were retrospectively reviewed. Overall response including the number, location, grade and stage of recurrences, were recorded. Side effects of intravesical instillation of CG0070 were also investigated. 11 of the 15 patients had at least 2.5 years of follow up both before and after treatment, permitting statistical chi-square analysis for the 2.5 year pre- and post-CG0070 periods. Results Of the 15 patients, 5 had Ta + Cis, 4 had T1 + CIS, 4 had CIS alone, and 2 had T2 + CIS prior to CG0070 instillation. Complete response of CIS was seen in 60% at 6 months, 47% at 12 months, and 40% at 24 months. Overall, 40% of patients remained tumor free and none progressed. For the 11 patients amenable to statistical analysis, 32 recurrences were noted within 2.5 years before therapy and 13 2.5 years after (p <0.01). 40% of patients experienced no adverse events as a result of treatment. Most common side effects were hematuria (33.3%), malaise/fatigue (33.3%), and urgency/frequency (26.7%). Discussion Treatment with intravesical CG0070 for high-risk BCG-unresponsive bladder cancer appears to be a promising salvage regimen worthy of further investigation.
{"title":"Oncolytic and Immunotherapeutic CG0070 Adenovirus for High-risk Bacillus Calmette-Guerin Unresponsive Bladder Cancer","authors":"Evan Austin, D. Mobley, Jamaka C. Tarajkowski, D. Lamm","doi":"10.32948/auo.2021.12.22","DOIUrl":"https://doi.org/10.32948/auo.2021.12.22","url":null,"abstract":"Introduction To evaluate the response of patients with high-risk bacillus Calmette-Guerin (BCG)–unresponsive non-muscle invasive bladder cancer (NMIBC) who we treated with intravesical CG0070, a conditionally replicating granulocyte macrophage colony-stimulating factor (GM-CSF) containing an RB promoter.\u0000Methods 15 patients with residual high grade BCG-unresponsive CIS +/- Ta/T1/T2 bladder cancer received one or more 6-week instillations of intravesical CG0070 and were retrospectively reviewed. Overall response including the number, location, grade and stage of recurrences, were recorded. Side effects of intravesical instillation of CG0070 were also investigated. 11 of the 15 patients had at least 2.5 years of follow up both before and after treatment, permitting statistical chi-square analysis for the 2.5 year pre- and post-CG0070 periods.\u0000Results Of the 15 patients, 5 had Ta + Cis, 4 had T1 + CIS, 4 had CIS alone, and 2 had T2 + CIS prior to CG0070 instillation. Complete response of CIS was seen in 60% at 6 months, 47% at 12 months, and 40% at 24 months. Overall, 40% of patients remained tumor free and none progressed. For the 11 patients amenable to statistical analysis, 32 recurrences were noted within 2.5 years before therapy and 13 2.5 years after (p <0.01). 40% of patients experienced no adverse events as a result of treatment. Most common side effects were hematuria (33.3%), malaise/fatigue (33.3%), and urgency/frequency (26.7%).\u0000Discussion Treatment with intravesical CG0070 for high-risk BCG-unresponsive bladder cancer appears to be a promising salvage regimen worthy of further investigation.","PeriodicalId":33190,"journal":{"name":"Annals of Urologic Oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46255503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Karthikesh Omkaram, Mallikarjuna Reddy Nalabolu, E. Galeti, V. Reddy, B. Reddy, Ayesha Galeti
In contrast to proctitis, vaginitis and acute radiation cystitis, late urological complications after pelvic irradiation are rarer, more serious and irreversible. The main disadvantage of radiotherapy is the fact that it affects both cancer and healthy cells located in the tumour area. As a consequence, different complications develop. A large proportion of cancers treated with radiotherapy are located in the lower abdomen and pelvis, which is why complications often involve the urinary tract. Due to the anatomy of these areas, urological complications occur not only after radiological treatment of urological cancers, but also after treatment of malignancies of the reproductive or digestive system. The most common radiation-induced complications include haemorrhagic cystitis, urethral and ureteral strictures, urinary fistulae, and secondary primary malignancies. Because of impaired tissue healing, the treatment of radiation urological complications is a challenge for urologists and often requires complicated reconstruction techniques. We hereby described an elderly woman who is a known case of carcinoma of cervix with post radical hysterectomy and post pelvic radiotherapy status presented with fever, pain abdomen, vomiting, obstipation, voiding difficulties with dysuria on admission, which was diagnosed as acute intestinal obstruction with post radiation bladder necrosis with acute kidney injury. This case is a rare example of high-grade late adverse events which occurred 8 yrs after radiation therapy in a known case of carcinoma of cervix.
{"title":"A rare case of post radiation urinary bladder necrosis in a patient with carcinoma cervix","authors":"Karthikesh Omkaram, Mallikarjuna Reddy Nalabolu, E. Galeti, V. Reddy, B. Reddy, Ayesha Galeti","doi":"10.32948/auo.2021.12.31","DOIUrl":"https://doi.org/10.32948/auo.2021.12.31","url":null,"abstract":"In contrast to proctitis, vaginitis and acute radiation cystitis, late urological complications after pelvic irradiation are rarer, more serious and irreversible. The main disadvantage of radiotherapy is the fact that it affects both cancer and healthy cells located in the tumour area. As a consequence, different complications develop. A large proportion of cancers treated with radiotherapy are located in the lower abdomen and pelvis, which is why complications often involve the urinary tract. Due to the anatomy of these areas, urological complications occur not only after radiological treatment of urological cancers, but also after treatment of malignancies of the reproductive or digestive system. The most common radiation-induced complications include haemorrhagic cystitis, urethral and ureteral strictures, urinary fistulae, and secondary primary malignancies. Because of impaired tissue healing, the treatment of radiation urological complications is a challenge for urologists and often requires complicated reconstruction techniques. We hereby described an elderly woman who is a known case of carcinoma of cervix with post radical hysterectomy and post pelvic radiotherapy status presented with fever, pain abdomen, vomiting, obstipation, voiding difficulties with dysuria on admission, which was diagnosed as acute intestinal obstruction with post radiation bladder necrosis with acute kidney injury. This case is a rare example of high-grade late adverse events which occurred 8 yrs after radiation therapy in a known case of carcinoma of cervix.","PeriodicalId":33190,"journal":{"name":"Annals of Urologic Oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48724159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Veda Murthy Reddy Pogula, E. Galeti, Kashinath V. Thakare, Venkatesh Velivela, S. Reddy, Abhiram Verma, Ayesha Galeti
Adrenal myelolipoma is inevitably a benign neoplasm of the adrenal gland. It is the second most common primary adrenal incidentaloma after adrenocortical adenomas. Adrenal myelolipoma is a rare, benign and non-functional neoplasm, composed of mature adipose and hematopoietic tissue which closely resembles bone marrow. Most of these lesions are small, unilateral and asymptomatic, discovered incidentally at autopsy or on imaging studies performed for other reasons. We report a case of this rare tumour in a 46-year-old obese male who had presented with vague abdominal pain on the right side past 6 months without any other significant history. Ultrasound and subsequently CECT scan abdomen showed a large well-circumscribed mass arising from the right adrenal gland, measuring 11×10cm. Laparoscopic right adrenalectomy was performed.
{"title":"Giant adrenal myelolipoma treated by laparoscopic excision: A case report and review of literature","authors":"Veda Murthy Reddy Pogula, E. Galeti, Kashinath V. Thakare, Venkatesh Velivela, S. Reddy, Abhiram Verma, Ayesha Galeti","doi":"10.32948/auo.2021.12.29","DOIUrl":"https://doi.org/10.32948/auo.2021.12.29","url":null,"abstract":"Adrenal myelolipoma is inevitably a benign neoplasm of the adrenal gland. It is the second most common primary adrenal incidentaloma after adrenocortical adenomas. Adrenal myelolipoma is a rare, benign and non-functional neoplasm, composed of mature adipose and hematopoietic tissue which closely resembles bone marrow. Most of these lesions are small, unilateral and asymptomatic, discovered incidentally at autopsy or on imaging studies performed for other reasons. We report a case of this rare tumour in a 46-year-old obese male who had presented with vague abdominal pain on the right side past 6 months without any other significant history. Ultrasound and subsequently CECT scan abdomen showed a large well-circumscribed mass arising from the right adrenal gland, measuring 11×10cm. Laparoscopic right adrenalectomy was performed.","PeriodicalId":33190,"journal":{"name":"Annals of Urologic Oncology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42316158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Gupta, D. Omil-Lima, Lin Chen, W. Muncey, Irma J. Lengu, K. Scarberry
Introduction and Objective Micropapillary urothelial carcinoma (MPUC) is a rare and aggressive histologic variant of bladder cancer. Treatment guidelines recommend forgoing Bacillus Calmette-Guérin (BCG) therapy in favor of early radical cystectomy for non-muscle invasive (NMI)-MPUC due to high rates of disease progression. We aimed to evaluate its management in patients with immediate cystectomy and BCG across various centers. Methods Patients with MPUC were identified from the National Cancer Database (2004-2017). Treatment trends and rates of pathological upstaging were identified. Bivariate and multivariate analyses were performed to assess differences in outcomes by treatment approach. Results 1,685 patients were diagnosed with MPUC during the study period with 531 identified with localized Ta, T1, or Tis disease. BCG was administered as an initial therapy in 24.1% of NMI-MPBC patients and in 16.3% of NMI-non-MPUC patients (p<0.001). Cystectomy was performed as primary therapy for NMI disease in 29.9% of MPUC and in 2.7% of non-MPUC patients (p<0.001). Of the patients who underwent primary cystectomy, upstaging from NMI-MPUC to T2-T4 disease was seen in 46.5% of the MPUC patients compared to 37.3% in patients with non-MPUC (p=0.025). Upstaging to pathologic N1-3 disease was observed in 33.1% of MPUC patients compared to 11.9% non-MPUC patients (p<0.001). Cox regression analysis, adjusting for patient age, sex, race, comorbidities, and disease stage, care at academic cancer centers were associated with increased odds of having cystectomy as primary therapy compared to community cancer centers (OR = 4.29, 95% CI 2.73-6.76). Conclusion The current study lends evidence to current practice guidelines by reporting treatment patterns for patients with micropapillary bladder cancer across a broad spectrum of clinical practice. NMI-MPUC patients treated at academic cancer centers were more likely to receive radical surgery as primary treatment compared to patients at the community cancer centers.
{"title":"Non-muscle invasive micropapillary urothelial carcinoma of the bladder: Variable use of initial cystectomy versus intravesical bacillus calmette-guérin","authors":"K. Gupta, D. Omil-Lima, Lin Chen, W. Muncey, Irma J. Lengu, K. Scarberry","doi":"10.32948/auo.2022.12.28","DOIUrl":"https://doi.org/10.32948/auo.2022.12.28","url":null,"abstract":"Introduction and Objective Micropapillary urothelial carcinoma (MPUC) is a rare and aggressive histologic variant of bladder cancer. Treatment guidelines recommend forgoing Bacillus Calmette-Guérin (BCG) therapy in favor of early radical cystectomy for non-muscle invasive (NMI)-MPUC due to high rates of disease progression. We aimed to evaluate its management in patients with immediate cystectomy and BCG across various centers.\u0000Methods Patients with MPUC were identified from the National Cancer Database (2004-2017). Treatment trends and rates of pathological upstaging were identified. Bivariate and multivariate analyses were performed to assess differences in outcomes by treatment approach.\u0000Results 1,685 patients were diagnosed with MPUC during the study period with 531 identified with localized Ta, T1, or Tis disease. BCG was administered as an initial therapy in 24.1% of NMI-MPBC patients and in 16.3% of NMI-non-MPUC patients (p<0.001). Cystectomy was performed as primary therapy for NMI disease in 29.9% of MPUC and in 2.7% of non-MPUC patients (p<0.001). Of the patients who underwent primary cystectomy, upstaging from NMI-MPUC to T2-T4 disease was seen in 46.5% of the MPUC patients compared to 37.3% in patients with non-MPUC (p=0.025). Upstaging to pathologic N1-3 disease was observed in 33.1% of MPUC patients compared to 11.9% non-MPUC patients (p<0.001). Cox regression analysis, adjusting for patient age, sex, race, comorbidities, and disease stage, care at academic cancer centers were associated with increased odds of having cystectomy as primary therapy compared to community cancer centers (OR = 4.29, 95% CI 2.73-6.76).\u0000Conclusion The current study lends evidence to current practice guidelines by reporting treatment patterns for patients with micropapillary bladder cancer across a broad spectrum of clinical practice. NMI-MPUC patients treated at academic cancer centers were more likely to receive radical surgery as primary treatment compared to patients at the community cancer centers.","PeriodicalId":33190,"journal":{"name":"Annals of Urologic Oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44498509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hereditary renal cancer syndromes represent approximately 5% of renal malignancies and have distinctive clinical, histopathologic, and genetic features. Next-generation sequencing and other molecular testing methods have uncovered several hereditary renal cancer syndromes. Several autosomal dominant hereditary renal cell carcinoma (RCC) syndromes, including those related to germline pathogenic variants in VHL, BAP1, MITF, MET, FH, TSC1/TSC2, FLCN, SDH, and CDC73 have been confirmed. FH- and BAP1-related RCCs are associated with more aggressive disease. Identifying the clinical and pathological features in these hereditary RCC syndromes is important as, relative to familial cohorts, these patients require early screening and intervention and regular surveillance to improve their clinical prognosis and long-term outcomes. More importantly, identification of these syndromes plays a vital role in personalized management and systemic treatment selection in this modern era of precision medicine. Ongoing studies have demonstrated that treatment based on genetic pathway targeting is a promising approach for hereditary renal cancer management. This review describes updates in the diagnostic criteria for and management of familial kidney cancer syndromes.
{"title":"Hereditary renal cell tumors: Clinicopathologic importance","authors":"Harmanjot Singh, M. Divatia, Donghwa Baek, J. Ro","doi":"10.32948/auo.2021.10.15","DOIUrl":"https://doi.org/10.32948/auo.2021.10.15","url":null,"abstract":"Hereditary renal cancer syndromes represent approximately 5% of renal malignancies and have distinctive clinical, histopathologic, and genetic features. Next-generation sequencing and other molecular testing methods have uncovered several hereditary renal cancer syndromes. Several autosomal dominant hereditary renal cell carcinoma (RCC) syndromes, including those related to germline pathogenic variants in VHL, BAP1, MITF, MET, FH, TSC1/TSC2, FLCN, SDH, and CDC73 have been confirmed. FH- and BAP1-related RCCs are associated with more aggressive disease. Identifying the clinical and pathological features in these hereditary RCC syndromes is important as, relative to familial cohorts, these patients require early screening and intervention and regular surveillance to improve their clinical prognosis and long-term outcomes. More importantly, identification of these syndromes plays a vital role in personalized management and systemic treatment selection in this modern era of precision medicine. Ongoing studies have demonstrated that treatment based on genetic pathway targeting is a promising approach for hereditary renal cancer management. This review describes updates in the diagnostic criteria for and management of familial kidney cancer syndromes.","PeriodicalId":33190,"journal":{"name":"Annals of Urologic Oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49366682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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