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Hanusz K, Domański P, Strojec K, Zapała P, Zapała Ł, Radziszewski P. Prostate Cancer in Transplant Receivers-A Narrative Review on Oncological Outcomes. Biomedicines 2023; 11:2941. [PMID: 38001942 PMCID: PMC10669184 DOI: 10.3390/biomedicines11112941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/19/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
Abstract
Prostate cancer (PCa) is a low tumor mutational burden (TMB) cancer with a poor response to immunotherapy. Nonetheless, immunotherapy can be useful, especially in metastatic castration-resistant PCa (mCRPC). Increased cytotoxic T lymphocytes (CTLs) density is correlated with a shorter overall survival (OS), an early biochemical relapse, and a generally poor PCa prognosis. An increased number of CCR4+ regulatory T cells (CCR4 + Tregs) relates to a higher Gleason score or earlier progression. The same therapeutic options are available for renal transplant recipients (RTRs) as for the population, with a comparable functional and oncological outcome. Radical retropubic prostatectomy (RRP) is the most common method of radical treatment in RTRs. Brachytherapy and robot-assisted radical prostatectomy (RARP) seem to be promising therapies. Further studies are needed to assess the need for prostatectomy in low-risk patients before transplantation. The rate of adverse pathological features in RTRs does not seem to differ from those observed in the non-transplant population and the achieved cancer control seems comparable. The association between PCa and transplantation is not entirely clear. Some researchers indicate a possible association between a more frequent occurrence of PCa and a worse prognosis in advanced or metastatic PCa. However, others claim that the risk and survival prognosis is comparable to the non-transplant population.
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Affiliation(s)
- Karolina Hanusz
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Poland Lindleya 4, 02-005 Warsaw, Poland
| | - Piotr Domański
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Poland Lindleya 4, 02-005 Warsaw, Poland
| | - Kacper Strojec
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Poland Lindleya 4, 02-005 Warsaw, Poland
| | - Piotr Zapała
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Poland Lindleya 4, 02-005 Warsaw, Poland
| | - Łukasz Zapała
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Poland Lindleya 4, 02-005 Warsaw, Poland
| | - Piotr Radziszewski
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Poland Lindleya 4, 02-005 Warsaw, Poland
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2
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Lancellotta V, D'Aviero A, Fionda B, Casà C, Esposito I, Preziosi F, Acampora A, Marazzi F, Kovács G, Jereczek-Fossa BA, Morganti AG, Valentini V, Gambacorta MA, Romagnoli J, Tagliaferri L. Immunosuppressive treatment and radiotherapy in kidney transplant patients: A systematic review. World J Radiol 2022; 14:60-69. [PMID: 35432777 PMCID: PMC8966497 DOI: 10.4329/wjr.v14.i3.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/20/2021] [Accepted: 03/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Immunosuppression (IS) therapy may contribute to cancer development. Some authors have proposed to reduce immunosuppression drugs dose in case of viral infections, in immunosuppression-related diseases, and in patients undergoing radiotherapy. The present analysis reports the results of a systematic review on kidney transplant recipients undergoing immunosuppression and radiotherapy.
AIM To define if it is necessary reduce immunosuppression drugs during radiotherapy.
METHODS The literature search was based on three electronic databases (Pubmed, Scopus, and Web of Science) using selected keywords linked through the "AND" and "OR" Boolean operators to build specific strings for each electronic search engine. Two researchers independently screened the citations, and disagreement was resolved by discussion or through the intervention of a third author. The review was conducted and reported according to the PRISMA statement. Extracted data were narratively synthesized, and, where possible, frequencies, percentages, and ranges were calculated.
RESULTS The literature search resulted in 147 citations. After abstracts screening, 21 records were selected for full-text evaluation. Fifteen of these were excluded, leaving six papers considered suitable for analysis. There is still no clear evidence that withdrawing antimetabolites and/or calcineurin inhibitors and/or mammalian target of rapamycin-inhibitors, as opposed to continuing maintenance IS, improves patient survival in kidney transplant recipients with cancer undergoing radiotherapy. Only few retrospective studies on small cancer patient cohorts are available in this setting, but without comparison of different immunosuppression treatments. Even where immunosuppression therapy was described, patient survival seemed to be correlated only with cancer stage and type.
CONCLUSION The results of this systematic review do not support the reduction of immunosuppression dose in patients undergoing radiotherapy.
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Affiliation(s)
- Valentina Lancellotta
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
| | - Andrea D'Aviero
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
| | - Bruno Fionda
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
| | - Calogero Casà
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
| | - Ilaria Esposito
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
| | - Francesco Preziosi
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
| | - Anna Acampora
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome 00168, Rome, Italy
| | - Fabio Marazzi
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
| | - György Kovács
- Università Cattolica del Sacro Cuore, Gemelli-INTERACTS, Rome, 00168 Rome, Italy
| | | | | | - Vincenzo Valentini
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
| | - Maria Antonietta Gambacorta
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
| | - Jacopo Romagnoli
- Renal Transplant Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
| | - Luca Tagliaferri
- Renal Transplant Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
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Keenan RA, Haroon U, Ryan P, Harrington B, Jones A, Aboelmagd M, Connolly S, O'Mally KJ, Galvin D, Hegarty N. Management of Urological Malignancy in Heart and Lung Transplant Recipients: An Irish National Cohort Study. EXP CLIN TRANSPLANT 2021; 19:1069-1075. [PMID: 34641776 DOI: 10.6002/ect.2021.0206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Following the first hearttransplantin Ireland in 1985, there have been almost 700 deceased donor heart and lung transplants carried out in Ireland at a single institution. In this retrospective study, our aim was to assess the incidence and management of urological malignancies arising in this national cohort. MATERIALS AND METHODS Our retrospective analysis included all heart and lung transplant recipients identified as having a urological malignancy. Primary outcome variables included incidence, management, and clinical outcomes following cancer diagnosis. RESULTS A total of 28 patients (4.1%) had radiologically or histologically confirmed urological malignancies. Fourteen patientswere diagnosedwith prostate cancer, with 13 who underwent radical treatment. Eight renal cell carcinomas were diagnosed in heart transplant recipients, with 5 who underwent nephrectomies. Two bladder cancers and 1 uppertract urothelial carcinoma were diagnosed and managed with endoscopic resection, radiotherapy, and nephroureterectomy, respectively. Two patients were diagnosed with penile squamous cell carcinoma and managed with radical surgery and lymph node dissection/sampling, with 1 patient receiving adjuvant chemoradiotherapy. CONCLUSIONS Urological malignancies are not common in heart and lung transplant recipients; however, standard management options can be safely used, including radical surgery. Prospective monitoring of these patients and potential considerations for screening should be maintained.
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Affiliation(s)
- Robert A Keenan
- >From the Department of Urology, Mater Misericordiae University Hospital, Dublin, Ireland
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Spatafora P, Sessa F, Caroassai Grisanti S, Bisegna C, Saieva C, Roviello G, Polverino P, Rivetti A, Verdelli L, Zanazzi M, Beatrice D, Vignolini G, Nesi G, Nicita G, Serni S, Villari D. Prostate Cancer Characteristics in Renal Transplant Recipients: A 25-Year Experience From a Single Centre. Front Surg 2021; 8:716861. [PMID: 34395512 PMCID: PMC8358676 DOI: 10.3389/fsurg.2021.716861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/05/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives: The incidence of prostate cancer in renal transplant recipients (RTRs) is increasing, but few data are available in the literature. In this study, we reviewed the 25-year experience in the management of prostate cancer after kidney transplantation at the Florence Transplant Centre. Methods: We retrospectively reviewed the data from 617 RTR male patients who underwent renal transplantation at our institute between July 1996 and September 2016. Data regarding demographics, renal transplantation, prostate cancer and immunosuppressive treatment were analyzed. The probability of death was estimated by using the Kaplan-Meier method and differences between patients' groups were assessed by the log-rank test. Results: From July 1991 to September 2016, 617 kidney transplantations of male patients were performed at our institute. Among these, 20 patients were subsequently diagnosed with prostate cancer accounting for a cumulative incidence of 3.24%. After a median follow-up of 59 months, 10 patients underwent radical prostatectomy whereas 10 patients underwent primary radiotherapy. A biochemical recurrence was identified in five (25%) patients while a fatal event occurred in 11 (55%) patients. Univariate Cox regression showed that the basal value of PSA >10 ng/ml was the only significant factor negatively affecting the survival of patients. Conclusions: Standard treatments can be proposed to RTR with satisfactory results on both post-operative and oncological outcomes. Further studies are needed to address the issue of prostate cancer screening based on PSA levels and the optimal management of prostate cancer in RTRs.
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Affiliation(s)
- Pietro Spatafora
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy
| | - Francesco Sessa
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Claudio Bisegna
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy
| | - Calogero Saieva
- Cancer Risk Factors and LifeStyle Epidemiology Unit, Cancer Research and Prevention Institute-Istituto per lo Studio e la Prevenzione Oncologica (ISPO), Florence, Italy
| | | | - Paolo Polverino
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy
| | - Anna Rivetti
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy
| | - Lorenzo Verdelli
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy
| | - Maria Zanazzi
- Department of Nephrology, Dialysis and Renal Transplantation, Careggi Hospital, Florence, Italy
| | - Detti Beatrice
- Department of Radiotherapy, Careggi Hospital, Florence, Italy
| | - Graziano Vignolini
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy
| | - Gabriella Nesi
- Division of Pathological Anatomy, University of Florence, Florence, Italy
| | - Giulio Nicita
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Donata Villari
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Romagnoli J, Tagliaferri L, Acampora A, Bianchi V, D'Ambrosio V, D'Aviero A, Esposito I, Hohaus S, Iezzi R, Lancellotta V, Maiolo E, Maiorano BA, Paoletti F, Peris K, Posa A, Preziosi F, Rossi E, Scaletta G, Schinzari G, Spagnoletti G, Tanzilli A, Scambia G, Tortora G, Valentini V, Maggiore U, Grandaliano G. Management of the kidney transplant patient with Cancer: Report from a Multidisciplinary Consensus Conference. Transplant Rev (Orlando) 2021; 35:100636. [PMID: 34237586 DOI: 10.1016/j.trre.2021.100636] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/11/2021] [Accepted: 06/11/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Cancer is the second most common cause of mortality and morbidity in Kidney Transplant Recipients (KTRs). Immunosuppression can influence the efficacy of cancer treatment and modification of the immunosuppressive regimen may restore anti-neoplastic immune responses improving oncologic prognosis. However, patients and transplant physicians are usually reluctant to modify immunosuppression, fearing rejection and potential graft loss. Due to the lack of extensive and recognised data supporting how to manage the immunosuppressive therapy in KTRs, in the context of immunotherapy, chemotherapy, radiotherapy and loco-regional treatments, a Consensus Conference was organised under the auspices of the European Society of Organ Transplantation and the Italian Society of Organ Transplantation. The conference involved a multidisciplinary group of transplant experts in the field across Europe. METHODS The overall process included a) the formulation of 12 specific questions based on the PICO methodology, b) systematic literature review and summary for experts for each question, c) a two-day conference celebration and the collection of experts' agreements. The conference was articulated in three sessions: "Immunosuppressive therapy and immunotherapy", "Systemic therapy", "Integrated Therapy", while the final experts' agreement was collected with a televoting procedure and defined according to the majority criterion. RESULTS Twenty-six European experts attended the conference and expressed their vote. A total of 14 statements were finally elaborated and voted. Strong agreement was found for ten statements, moderate agreement for two, moderate disagreement for one and uncertainty for the last one. CONCLUSIONS The consensus statements provide guidance to transplant physicians caring for kidney transplant recipients with cancer and indicate key aspects that need to be addressed by future clinical research.
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Affiliation(s)
- Jacopo Romagnoli
- Dipartimento di Scienze Mediche e Chirurgiche, U.O.C. Trapianti di Rene, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia; Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Luca Tagliaferri
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, U.O.C. Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
| | - Anna Acampora
- Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Valentina Bianchi
- Dipartimento di Scienze Mediche e Chirurgiche, U.O.C. Trapianti di Rene, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Viola D'Ambrosio
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma, Italy; Dipartimento di Scienze Mediche e Chirurgiche, U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Andrea D'Aviero
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, U.O.C. Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Ilaria Esposito
- Dipartimento di Scienze Mediche e Chirurgiche, U.O.C. di Dermatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Stefan Hohaus
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, U.O.C. Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Roberto Iezzi
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy; Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, U.O.C. di Radiologia diagnostica e interventistica generale, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Valentina Lancellotta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, U.O.C. Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Elena Maiolo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, U.O.C. Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Brigida A Maiorano
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma, Italy; Unità di Oncologia, Fondazione Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo (FG), Italy
| | - Filippo Paoletti
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Ketty Peris
- Dipartimento di Scienze Mediche e Chirurgiche, U.O.C. di Dermatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Dermatologia, Roma, Italy
| | - Alessandro Posa
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, U.O.C. di Radiologia diagnostica e interventistica generale, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Francesco Preziosi
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Ernesto Rossi
- Dipartimento di Scienze Mediche e Chirurgiche, U.O.C. Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Giuseppe Scaletta
- Dipartimento della Salute della Donna, del Bambino e di Sanità Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Giovanni Schinzari
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma, Italy; Dipartimento di Scienze Mediche e Chirurgiche, U.O.C. Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Gionata Spagnoletti
- Dipartimento di Scienze Mediche e Chirurgiche, U.O.C. Trapianti di Rene, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia; Dipartimento di Chirurgie Specialistiche, Ch. Epato-Bilio-Pancreatica e Dei Trapianti di Fegato e Rene, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - Alessandro Tanzilli
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giovanni Scambia
- Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italy; Dipartimento della Salute della Donna, del Bambino e di Sanità Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Giampaolo Tortora
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma, Italy; Dipartimento di Scienze Mediche e Chirurgiche, U.O.C. Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Vincenzo Valentini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, U.O.C. Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Umberto Maggiore
- Dipartimento di Medicina e Chirurgia, Università di Parma, UO Nefrologia, Azienda-Ospedaliero di Parma, Parma, Italy
| | - Giuseppe Grandaliano
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma, Italy; Dipartimento di Scienze Mediche e Chirurgiche, U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
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6
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Detti B, Stocchi G, Mariotti M, Sardaro A, Francolini G, Allegra AG, Roghi M, Maragna V, Teriaca MA, Livi L. Radiotherapy in prostate cancer after kidney transplant: review of the literature and report of 6 cases. TUMORI JOURNAL 2021; 108:371-375. [PMID: 34057383 DOI: 10.1177/03008916211013914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients who received a kidney transplant (KT) are described in literature as a group with a higher incidence of malignant neoplasms compared to the general population. Cancer development after KT has become a major issue, as a remarkable percentage of patients are diagnosed with cancer. Treatment of prostate cancer (PCa) in renal transplant recipients (RTRs) is a challenging issue that has been discussed by many authors over the years, but evidence is sparse and often includes conflicting reports. Among the therapeutic options for PCa in these patients, prostate irradiation represents a valuable alternative to surgery or other systemic therapies, as RTRs are often ineligible for these treatments. OBJECTIVE To report six cases treated at our institution between 1998 and 2017 and discuss the available literature. METHODS Patients' characteristics were reported along with biochemical status at diagnosis, type of immunosuppressive treatment, radiation therapy technique, and dose to transplanted kidney. RESULTS Overall, prostate irradiation was delivered respecting the dose constraints and patients showed good tolerance with no reports of acute or late transplanted kidney injury. CONCLUSIONS Our experience confirms that prostate radiotherapy for RTRs is feasible and effective and represents a valid option that should be considered by the multidisciplinary team.
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Affiliation(s)
- Beatrice Detti
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giulia Stocchi
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Matteo Mariotti
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Angela Sardaro
- Interdisciplinary Department of Medicine, Nuclear Medicine Unit and Section of Radiology and Radiation Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Giulio Francolini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Andrea G Allegra
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Manuele Roghi
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Virginia Maragna
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Maria A Teriaca
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio", Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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7
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The role of radiotherapy in patients with solid tumours after solid organ transplantation: a systematic review. Lancet Oncol 2021; 22:e93-e104. [PMID: 33662300 DOI: 10.1016/s1470-2045(20)30590-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/28/2020] [Accepted: 09/17/2020] [Indexed: 12/12/2022]
Abstract
For patients diagnosed with cancer who have previously received an organ transplant, radiotherapy represents a challenging clinical scenario without well established care algorithms. Immunosuppressive therapy can be a cause for concern among clinicians treating this category of patients. Potential immune modulation following irradiation could affect recipient organ tolerance and the outcomes of the transplantation itself. The main aim of this systematic review was to define the safety and effectiveness of radiotherapy in patients diagnosed with cancer who have previously received an organ transplant. We searched PubMed and Embase for articles published between Jan 1, 1995, and April 30, 2020 for studies in patients who had undergone radiotherapy for post-transplantation malignancies. The Review is framed by the PICO (population, intervention, control, and outcomes) criteria, and primarily focuses on modern treatment techniques.
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8
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Over-diagnosed prostate cancer in solid organ recipients: lessons from the last 3 decades. Int Urol Nephrol 2020; 53:241-248. [PMID: 32926314 DOI: 10.1007/s11255-020-02636-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/03/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Prostate cancer (PC) is the most common neoplasia in men. With aging of solid organ transplant recipients (SOTR), its incidence is likely to increase. The aim of this study was to analyze PC screening results retrospectively in renal transplant recipients (RTR), hepatic transplant recipients (HTR) and cardiac transplant recipients (CTR). PATIENTS AND METHODS A retrospective monocentric study of PC diagnosed in renal, hepatic or cardiac transplanted patients since 1989 was performed. All the patients were followed annually by digital rectal examination and prostate serum antigen (PSA) dosage. RESULTS 57 PC were diagnosed in 1565 SOTR male patients (3.6%): 35 RTR, 15 HTR, and 7 CTR. Standard incidence ratio (SIR) was 41.9. Mean age at the time of diagnosis was 64.5 (60.5-69.2). Mean time between transplantation and PC diagnosis was 95.7 (39.0-139.5) months. Median PSA rate was 7.0 (6.2-13) ng/mL. Clinical stages were T1, T2, and T3, respectively, for 29, 22 and 6 patients. Diagnosis was done by screening in 52 patients, after prostatitis in 1 and bone pain in another. Three PC were discovered on prostate chips after transurethral resection. Two patients were treated by active surveillance. 39 (68%) patients (25 RTR, 11 HTR and 3 CTR) were treated by radical prostatectomy. Histological results were 30 pT2 and 9 pT3 tumors, with 7 positive surgical margins. Gleason score was 5, 6, 7, 8 and 9 in, respectively, in 2, 24, 11, 1 and 1 patients. One patient with positive pelvic nodes was treated with hormonal therapy (HT). One had a biochemical relapse at 10 months and underwent salvage radiotherapy. Median follow-up was 85.2 months (46.1-115.0). 23 (40.4%) patients died. Two (3.6%) RTR and 1 (1.8%) CTR died from their PC. Standard incidence ratio were, respectively, 42.4, 48.2 and 39 in RTR, HTR and CTR. CONCLUSION Systematic screening in male SOTR after 50 years old could not be recommended. In the last 3 decades, we diagnosed too many low-risk prostate cancers strongly increasing the SIR but failing to decrease prostate cancer related mortality. SOTR should undergo individual screening with prior MRI when PSA rates are high. Management should not be different from that of the general population.
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Bratt O, Drevin L, Prütz KG, Carlsson S, Wennberg L, Stattin P. Prostate cancer in kidney transplant recipients - a nationwide register study. BJU Int 2020; 125:679-685. [DOI: 10.1111/bju.15002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Ola Bratt
- Department of Urology; Institute of Clinical Science; Sahlgrenska Academy; Gothenburg University; Gothenburg Sweden
- Department of Urology; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Linda Drevin
- Regional Cancer Centre, Uppsala-Örebro; Uppsala Sweden
| | | | - Stefan Carlsson
- Section of Urology; Department of Molecular Medicine and Surgery; Karolinska Institute; Stockholm Sweden
| | - Lars Wennberg
- Department of Transplantation Surgery; Karolinska University Hospital; Stockholm Sweden
| | - Pär Stattin
- Department of Surgical Sciences; Uppsala University; Uppsala Sweden
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