SBRT-SG-01: final results of a prospective multicenter study on stereotactic body radiotherapy for liver metastases

OBJECTIVE

This study aimed to assess the efficacy and tolerability of stereotactic body radiation therapy (SBRT) for the treatment of liver metastases.

METHODS

Patients with up to 5 liver metastases were enrolled in this prospective multicenter study and underwent SBRT. Efficacy outcomes included in-field local control (LC), progression-free survival (PFS), and overall survival (OS). Acute and late toxicities were evaluated using CTCAE v.4.0.

RESULTS

A total of 52 patients with 105 liver metastases were treated between 2015 and 2018. The most common primary tumor was colorectal cancer (72% of cases). Liver metastases were synchronous with the primary tumor diagnosis in 24 patients (46.2%), and 21 patients (40.4%) presented with other extrahepatic oligometastases. All patients underwent intensity-modulated radiation therapy (IMRT)/volumetric-modulated arc therapy (VMAT) with image-guided radiation therapy (IGRT) and respiratory gating, and a minimum biologically effective dose (BED10Gy) of 100 Gy was delivered to all lesions. With a median follow-up of 23.1 months (range: 13.4-30.9 months) since liver SBRT, the median actuarial local progression-free survival (local-PFS) was not reached. The actuarial in-field LC rates were 84.9% and 78.4% at 24 and 48 months, respectively. The median actuarial liver-PFS and distant-PFS were 11 and 10.8 months, respectively. The actuarial median overall survival (OS) was 27.7 months from SBRT and 52.5 months from metastases diagnosis. Patients with lesion diameter ≤ 5 cm had significantly better median liver-PFS (p = 0.006) and OS (p = 0.018). No acute or late toxicities of grade ≥ 3 were observed.

CONCLUSIONS

This prospective multicenter study confirms that liver SBRT is an effective alternative for the treatment of liver metastases, demonstrating high rates of local control and survival while maintaining a low toxicity profile.

Utility of CYP2D6 copy number variants as prognostic biomarker in localized anal squamous cell carcinoma

BACKGROUND

Anal squamous cell carcinoma (ASCC) is an infrequent tumor whose treatment has not changed since the 1970s. The aim of this study is the identification of biomarkers allowing personalized treatments and improvement of therapeutic outcomes.

METHODS

Forty-six paraffin tumor samples from ASCC patients were analyzed by whole-exome sequencing. Copy number variants (CNVs) were identified and their relation to disease-free survival (DFS) was studied and validated in an independent retrospective cohort of 101 ASCC patients from the Multidisciplinary Spanish Digestive Cancer Group (GEMCAD). GEMCAD cohort proteomics allowed assessing the biological features of these tumors.

RESULTS

On the discovery cohort, the median age was 61 years old, 50% were males, stages I/II/III: 3 (7%)/16 (35%)/27 (58%), respectively, median DFS was 33 months, and overall survival was 45 months. Twenty-nine genes whose duplication was related to DFS were identified. The most representative was duplications of the CYP2D locus, including CYP2D6, CYP2D7P, and CYP2D8P genes. Patients with CYP2D6 CNV had worse DFS at 5 years than those with two CYP2D6 copies (21% vs. 84%; p < .0002, hazard ratio [HR], 5.8; 95% confidence interval [CI], 2.7-24.9). In the GEMCAD validation cohort, patients with CYP2D6 CNV also had worse DFS at 5 years (56% vs. 87%; p = .02, HR = 3.6; 95% CI, 1.1-5.7). Mitochondria and mitochondrial cell-cycle proteins were overexpressed in patients with CYP2D6 CNV.

CONCLUSIONS

Tumor CYP2D6 CNV identified patients with a significantly worse DFS at 5 years among localized ASCC patients treated with 5-fluorouracil, mitomycin C, and radiotherapy. Proteomics pointed out mitochondria and mitochondrial cell-cycle genes as possible therapeutic targets for these high-risk patients.

PLAIN LANGUAGE SUMMARY

Anal squamous cell carcinoma is an infrequent tumor whose treatment has not been changed since the 1970s. However, disease-free survival in late staged tumors is between 40% and 70%. The presence of an alteration in the number of copies of CYP2D6 gene is a biomarker of worse disease-free survival. The analysis of the proteins in these high-risk patients pointed out mitochondria and mitochondrial cell-cycle genes as possible therapeutic targets. Therefore, the determination of the number of copies of CYP2D6 allows the identification of anal squamous carcinoma patients with a high-risk of relapse that could be redirected to a clinical trial. Additionally, this study may be useful to suggest new treatment strategies to increase current therapy efficacy.

Setting up regional diagnostic reference levels for pediatric interventional cardiology in Latin America and the Caribbean countries: preliminary results and identified challenges

The goal of the present study was to propose a set of preliminary regional diagnostic reference levels (DRLs) for pediatric interventional cardiology (IC) procedures in Latin America and the Caribbean countries, classified by age and weight groups. The study was conducted in the framework of the Optimization of Protection in Pediatric Interventional Radiology in Latin America and the Caribbean program coordinated by the World Health Organization and the Pan American Health Organization in cooperation with the International Atomic Energy Agency. The first step of the program was focused on pediatric IC. Dose data from diagnostic and therapeutic procedures were collected between December 2020 and December 2021. Regional DRLs were set as the third quartile of patient dose data (kerma area product) collected in 18 hospitals from 10 countries in an initial sample of 968 procedures. DRLs were set for four age bands and five weight ranges. The values obtained for the four age bands (<1 yr, 1 to <5 yr, 5 to <10 yr and 10 to <16 yr) were 2.9, 6.1, 8.8 and 14.4 Gy cm²for diagnostic procedures, and 4.0, 5.0, 10.0 and 38.1 Gy cm²for therapeutic procedures, respectively. The values obtained for the five weight bands (<5 kg, 5 to <15 kg, 15 to <30 kg, 30 to <50 kg and 50 to <80 kg) were 3.0, 4.5, 8.1, 9.2 and 26.8 Gy cm²for diagnostic procedures and 3.7, 4,3, 7.3, 16.1 and 53.4 Gy cm²for therapeutic procedures, respectively. While initial data were collected manually as patient dose management systems (DMSs) were not available in most of the hospitals involved in the program, a centralized automatic DMS for the collection and management of patient dose indicators has now been introduced and is envisaged to increase the sample size. The possibility of alerting on high dose values and introducing corrective actions will help in optimization.

Analyzing Spanish-Language Public Sentiment in the Context of a Pandemic and Social Unrest: The Panama Case

Over the past decade, an increase in global connectivity and social media users has changed the way in which opinions and sentiments are shared. Platforms such as Twitter can act as public forums for expressing opinions on non-personal matters, but often also as an outlet for individuals to share their feelings and personal thoughts. This becomes especially evident during times of crisis, such as a massive civil disorder or a pandemic. This study proposes the estimation and analysis of sentiments expressed by Twitter users of the Republic of Panama during the years 2019 and 2020. The proposed workflow is comprised of the extraction, quantification, processing and analysis of Spanish-language Twitter data based on Sentiment Analysis. This case of study highlights the importance of developing natural language processing resources explicitly devised for supporting opinion mining applications in Latin American countries, where language regionalisms can drastically change the lexicon on each country. A comparative analysis performed between popular machine learning algorithms demonstrated that a version of a distributed gradient boosting algorithm could infer sentiment polarity contained in Spanish text in an accurate and time-effective manner. This algorithm is the tool used to analyze over 20 million tweets produced between the years of 2019 and 2020 by residents of the Republic of Panama, accurately displaying strong sentiment responses to events occurred in the country over the two years that the analysis performed spanned. The obtained results highlight the potential that methodologies such as the one proposed in this study could have for transparent government monitoring of responses to public policies on a population scale.

Understanding colorectal twitter: A comparison of its highest and lowest rank influencers

The distribution of content related to colorectal surgery in social media is steadily increasing. Social media influencers possess large audiences and are frequently viewed as authority; however, their credibility is often unchecked. In our commentary we present our analysis and comparison of the most and least influential accounts on Twitter within the field of colorectal surgery. Additionally, we discuss the current literature, role and importance of social media for the modern surgeon.

Impact of the COVID-19 pandemic during Spain's state of emergency on the diagnosis of colorectal cancer

INTRODUCTION

We evaluate the impact of COVID-epidemic in colorectal cancer (CRC) diagnosis during Spain's state of emergency.

METHODS

We compared newly diagnosed patients with patients diagnosed in the same period of 2019.

RESULTS

A new diagnosis of CRC decreased 48% with a higher rate of patients diagnosed in the emergency setting (12.1% vs. 3.6%; p = .048) and a lower rate diagnosed in the screening program (5.2% vs. 33.3%; p = .000).

CONCLUSIONS

Fewer patients have been diagnosed with CRC, with a higher rate of patients diagnosed in an emergency setting.

Stereotactic body radiation therapy for liver metastasis from colorectal cancer: size matters

PURPOSE

We analysed our initial experience with SBRT in liver metastasis from colorectal cancer at our institution.

MATERIALS AND METHODS

Between January/2014 and December/2017, 22 patients with 31 LMCCR were treated. Local control (LC) was assessed using the Kaplan-Meier and log-rank tests. We analysed potential prognostic factors for LC: sex, PTV size, number of LM and the radiation scheme.

RESULTS

Median age: 69 years. Prior chemotherapy or local liver treatments: 81.8% and 63.6% of patients, respectively. SBRT consisted of 3 × 20 Gy (42.9%) and 3 × 15 Gy (31.4%). There were 88.5% responses (57.1% CR and 31.4% PR). Median follow-up was 30 months. LC per lesion at 12 and 24 months was 85.3% and 61.8%, respectively. Tumour volumes > 30 cc correlated with worsened 2-year-control rates (90% vs 34.5%) (p = 0.005). There was only a patient with CTC-grade 3 toxicity.

CONCLUSIONS

Liver SBRT is a safe and effective treatment that achieves high local control rates. We found a significant correlation between larger LMCRC and worse local control.

High-pressure homogenization and high hydrostatic pressure processing of human milk: Preservation of immunological components for human milk banks

Human milk (HM) constitutes the first immunological barrier and the main source of nutrients and bioactive components for newborns. Immune factors comprise up to 10% of the protein content in HM, where antibodies are the major components (mainly IgA, IgG, and IgM). In addition, antibacterial enzymes such as lysozyme and immunoregulatory factors such as soluble cluster of differentiation 14 (sCD14) and transforming growth factor β2 (TGF-β2) are also present and play important roles in the protection of the infant's health. Donor milk processed in HM banks by Holder pasteurization (HoP; 62.5°C, 30 min) is a safe and valuable resource for preterm newborns that are hospitalized, but is reduced in major immunological components due to thermal inactivation. We hypothesized that high hydrostatic pressure (HHP) and high-pressure homogenization (HPH) are 2 processes that can be used on HM to reduce total bacteria counts while retaining immunological components. We studied the effects of HHP (400, 450, and 500 MPa for 5 min applied at 20°C) and HPH (200, 250, and 300 MPa, milk inlet temperature of 20°C) applied to mature HM, on microbiological and immunological markers (IgA, IgG, IgM, sCD14, and TGF-β2), and compared them with those of traditional HoP in HM samples from healthy donors. The HHP processing between 400 and 500 MPa at 20°C reduced counts of coliform and total aerobic bacteria to undetectable levels (<1.0 log cfu/mL) while achieving approximately 100% of immunological component retention. In particular, comparing median percentages of retention of immunological components for 450 MPa versus HoP, we found 101.5 versus 50.5% for IgA, 89.5 versus 26.0% for IgM, 104.5 versus 75.5% for IgG, 125.0 versus 72.5% for lysozyme, 50.6 versus 0.1% for sCD14, and 88.5 versus 61.1% for TGF-β2, respectively. Regarding HPH processing, at a pressure of 250 MPa and inlet temperature of 20°C, the process showed good potential to reduce coliforms to undetectable levels and total aerobic bacteria to levels slightly above those obtained by HoP. The median percentages of retention of immunological markers for HPH versus HoP were 71.5 versus 52.0%, 71.0 versus 27.0%, 104.0 versus 66.5%, and 30.9 versus 0.2%, for IgA, IgM, IgG, and sCD14, respectively; results did not significantly differ for lysozyme and TGF-β2. The HPH at 300 MPa produced higher inactivation of immunological components, similar to values achieved with HoP.

The blind men and the elephant: Systematic review of systematic reviews of cannabis use related health harms

Cannabis is the third most used psychoactive substance worldwide. The legal status of cannabis is changing in many Western countries, while we have very limited knowledge of the public health impact of cannabis-related harms. There is a need for a summary of the evidence of harms and risks attributed to cannabis use, in order to inform the definition of cannabis risky use. We have conducted a systematic review of systematic reviews, aiming to define cannabis-related harms. We included systematic reviews published until July 2018 from six different databases and following the PRISMA guidelines. To assess study quality we applied the AMSTAR 2 tool. A total of 44 systematic reviews, including 1,053 different studies, were eligible for inclusion. Harm was categorized in three dimensions: mental health, somatic harm and physical injury (including mortality). Evidence shows a clear association between cannabis use and psychosis, affective disorders, anxiety, sleep disorders, cognitive failures, respiratory adverse events, cancer, cardiovascular outcomes, and gastrointestinal disorders. Moreover, cannabis use is a risk factor for motor vehicle collision, suicidal behavior and partner and child violence. Cannabis use is a risk factor for several medical conditions and negative social consequences. There is still little data on the dose-dependency of these effects; evidence that is essential in order to define, from a public health perspective, what can be considered risky use of cannabis. This definition should be based on quantitative and qualitative criteria that informs and permits the evaluation of current approaches to a regulated cannabis market.

A Giant Childhood Mesenteric Lipoblastoma With Extensive Maturation

Abdominal lipoblastomas are uncommon soft tissue tumors in children and rarely arise from the mesentery. Due to intraabdominal location and slow growth, these masses can go unnoticed for long periods of time and often found on surgical exploration. We present a case of a 12-year-old male with years of abdominal distension accompanied by new onset early satiety that was found to have an intra-abdominal mass. He underwent an exploratory laparotomy revealing a large 33 x 27 x 15 cm rubbery mesenteric mass displacing the entire intra-abdominal contents, connected by a single vascular pedicle and encasing a loop of small intestine. The mass was resected and the patient did well without signs of recurrence. Histology confirmed the presence of mature adipocytes but on further cytogenetic analysis, a translocation between chromosomes 2 and 8 at the 12q arm was detected, which is often associated with lipoblastomas. This case represents the one of the largest mesenteric lipoblastomas that matured extensively to lipoma-like histology at the time of surgical resection.

[Re-irradiation with SBRT (Stereotactic Body Radiation Therapy) for locoregional unresectable relapse of head and neck cancer: a case report]

Patients with an unresectable recurrence of head and neck carcinoma (HNC) have a poor prognosis, with limited treatment options. Recent technical advances allow radiotherapy (RT) to be handled with great precision, making it possible to re-irradiate recurrent tumors by means of stereotactic body radiotherapy (SBRT) with high doses of RT while protecting healthy tissues near the tumor. Although this technique has been used to irradiate different primary tumors and their metastases, SBRT in HNC has had a much slower evolution than in the mentioned locations. This is due to the difficulties in re-irradiating the HNC, because of the expected toxicity as it is a relatively small area with dense vascularization and innervation, and where several senses are located. We present the first case of a HNC re-irradiated with SBRT in the Complejo Hospitalario de Navarra; the patient showed a complete response and continues to be disease-free sixteen months after the irradiation.

Free Neurocognitive Screening Initiative: An Opportunity to Address Health Disparities and Promote Cultural Competence in Northcentral Florida

Objective

The risk for cognitive impairment is greater in individuals with low SES and limited education. In rural areas, distance and economic concerns preclude individuals from accessing care. In Alachua County, 23% of residents live below poverty and 16% are uninsured. The Neurocognitive Screening Initiative (NSI) attempts to reduce disparities in Alachua by offering free neurocognitive screening. NSI also aspires to promote cultural competence through unique training opportunities for clinical neuropsychology doctoral students.

Method

Patients learned about NSI through flyers, word of mouth, or referrals. Appointments include a clinical interview, cognitive testing, and mood questionnaires. Patients receive feedback, brain health recommendations, and referrals to community resources. Phase 1 began in November 2017 and involved selection of appropriate cognitive measures, development and dissemination of advertising materials, identification of resources, and trainee recruitment. From February 2018 to August 2018, phase 2 involved administration of cognitive screeners. Phase 3 involved continued provision of clinical services, expansion of the NSI team and increased culturally relevant outreach.

Outcomes

NSI’s greatest challenge is recruitment of the appropriate demographic. Since phase 2, we have evaluated 10 patients with diverse racial, socioeconomic, and clinical characteristics. NSI has recruited an ethnoracially diverse cohort of trainees comprised of 4 graduate students and 2 postdoctoral fellows supervised by a clinical neuropsychologist.

Discussion

Efforts to provide services to marginalized individuals have uncovered challenges in attracting patients who might benefit from these services. NSI is forging community partnerships with churches, libraries, and local organizations to reach the targeted audience. Via weekly meetings, participation in community events/outreach, and clinical work, NSI provides unique training for emerging neuropsychologists.

Does Literacy Moderate the Relationship between Age of Migration and Cognitive Change: Results from the Washington Heights-Inwood Community Aging Project (WHICAP)

Objective

The “healthy immigrant effect” pertains to findings that Hispanics/Latinos born outside of the US tend to be physically and emotionally healthier than individuals born in the US. However, immigrant Latino groups residing in the US have higher incidences of dementia (Tang et al., 2001). Sex/gender and years of education have been found to moderate the relationship between age of migration and cognitive functioning among immigrants born in Mexico (Garcia et al., 2017; Hill et al., 2012). While years of education has been the focus of many studies, literacy (ability to read/write) has been less frequently explored as a moderator of age of migration and cognitive change. We investigated the effect of age of migration on cognitive trajectory in a diverse Latino population and explored whether literacy influences the association between age of immigration and cognitive change. We hypothesize that literacy (ability to read/write) will buffer the effects of age of migration on cognitive (memory, language, motor speed, visuospatial) trajectory.

Participants and Method

Age at baseline, English fluency, country of birth, sex/gender, and years of education were included as time-invariant covariates and literacy was tested as a moderator via multiple group modeling.

Results

Results show that age of migration is marginally and inversely associated with baseline cognitive performance (p &lt; .01). Thus, individuals who immigrated at an older age had lower baseline cognitive scores than their counterparts. Age of migration was not associated with cognitive change. Independent of covariates, literacy did not buffer the negative effects of later age at migration on cognitive function.

Conclusions

Results suggest that literacy confers a small advantage in premorbid cognition, but does not protect against cognitive decline over time. These findings also suggest that adults who immigrate at an older age present with lower cognitive scores at baseline, but do not experience faster rates of cognitive change.

References

Tang, M. X., Cross, P., Andrews, H., Jacobs, D. M., Small, S., Bell, K., ... & Mayeux, R. (2001). Incidence of AD in African-Americans, Caribbean Hispanics, and Caucasians in northern Manhattan. Neurology, 56, 49-56. Garcia, M. A., Reyes, A. M., Downer, B., Saenz, J. L., Samper-Ternent, R. A., & Raji, M. (2018). Age of migration and the incidence of cognitive impairment: A cohort study of elder Mexican-Americans. Innovation in aging, 1, igx037. https://doi.org/10.1093/geroni/igx037. Hill, T. D., Angel, J. L., Balistreri, K. S., & Herrera, A. P. (2012). Immigrant Status and Cognitive Functioning in Late Life: An Examination of Gender Variations in the Healthy Immigrant Effect. Social Science & Medicine (1982), 75, 2076–2084. http://doi.org/10.1016/j.socscimed.2012.04.005.

The Role of Quality of Education in Neurocognitive Functioning in a Diverse Sample with Chronic Opioid Use Disorder

Objective

Literacy is a proxy for quality of education (QoE) and mediates ethnicity-related differences in neurocognitive (NC) performance in some populations (Manly et al., 2002; Rivera Mindt et al., 2008). However, it is unknown whether this relationship exists in the context of chronic opioid use disorder (OUD). This study examined the role of ethnicity, QoE, opioid use severity, and depression in predicting NC performance in a diverse sample of persons with OUD.

Participants and Method

This cross-sectional study included 74 adults with OUD (Age M = 40.3 [SD = 10.5]; Education M = 11.3 [2.5]; 24% female; 68% Latinx and 32% Non-Latinx White [NLW]). All participants completed comprehensive NC testing and psychiatric/substance use questionnaires. Variables included ethnicity (Latinx vs. Non-Latinx White), years of education, QoE (Wide Range Achievement Test, Third Edition; WRAT-3 Reading Standard Scores), opioid use severity (high vs. low OAT dose), current depression (Beck Depression Inventory, Second Edition; BDI-II Total Score), and demographically-corrected NC T-scores were computed and used for average domain T-scores (e.g., learning, memory, verbal fluency, executive function). Bivariate and ANCOVA analyses were used to compare ethnic groups.

Results

There were no significant group differences on opioid use severity or current depression (p’s &gt; .05). However, compared to the NLW group, the Latinx group had lower years of education (M = 10.9 [SD = 1.7] vs. M = 12.2 [SD = 3.5]; t[72)] = 2.1, p &lt; .05), QoE (M = 83.1 [SD = 13.6] vs. M = 94.8 [SD = 9.4]; t[72] = 3.8, p &lt; .001), executive functioning (M = 42.0 [SD = 6.5] vs. M = 45.8 [SD = 8.5]; t[72) = 2.1, p &lt; .05), and learning (M = 32.2 [SD = 8.2] vs. M = 37.8 [SD = 8.7]; t[72)] = 2.7, p &lt; .05), with medium to large effect sizes (Cohen’s d &gt; .50). The overall effect of ethnicity became non-significant for executive functioning after accounting for QoE (F[2,70] = 10.0, p = .002) and years of education (F[2,70)] = 16.8, p &lt; .001).

Conclusions

The current study found that accounting for years of education and QoE attenuates some differences in NC performance between Latinx and Non-Latinx participants.

References

Manly, J. J., Jacobs, D. M., Touradji, P., Small, S. A., & Stern, Y. (2002). Reading level attenuates differences in neuropsychological test performance between African American and White elders. Journal of the International Neuropsychological Society, 8(3), 341-348. Mindt, M. R., Arentoft, A., Germano, K. K., D’Aquila, E., Scheiner, D., Pizzirusso, M., ... & Gollan, T. H. (2008). Neuropsychological, cognitive, and theoretical considerations for evaluation of bilingual individuals. Neuropsychology review, 18(3), 255-268.

Radiopotentiation of enzalutamide over human prostate cancer cells as assessed by real-time cell monitoring

Aim

To evaluate the radiopotentiation of enzalutamide in human prostate cancer cells.

Background

While radiotherapy is the first line of treatment for prostate cancer, androgen blockade therapies are demonstrating significant survival benefit as monotherapies. As androgen blockade can cause cell death by apoptosis, it is likely that androgen blockade will potentiate the cytotoxic activities of radiotherapy.

Materials and methods

Here, we tested the potential synergistic effects of these two treatments over two human metastatic prostate cancer cells by real-time cell analysis (RTCA), androgen-sensitive LNCaP cells (Lymph Node Carcinoma of the Prostate) and androgen-independent PC-3. Both cell lines were highly resistant to high doses of radiotherapy.

Results

A pre-treatment of LNCaP cells with IC50 concentrations of enzalutamide significantly sensitized them to radiotherapy through enhanced apoptosis. In contrast, enzalutamide resistant PC-3 cells were not sensitized to radiotherapy by androgen blockade.

Conclusions

These results provide evidence that the enzalutamide/radiotherapy combination could maximize therapeutic responses in patients with enzalutamide-sensitive prostate cancer.

MOLECULAR TYPING OF MYCOBACTERIUM KANSASII — A GLOBAL PERSPECTIVE

.

Urological approach for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in a clinical care center

BACKGROUND

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is associated with significant manipulation of the urinary tract (UT). We aim to describe the urological events and their management in patients who underwent CRS-HIPEC.

METHODS

Clinical records of patients who underwent treatment between 2007 and 2015 were reviewed. Urological events and their multidisciplinary management were analyzed. Descriptive statistics were calculated.

RESULTS

A total of 103 patients were included. Mean age was 51 years (SD ± 11.8). Mean peritoneal cancer index (PCI) was 20.4 (SD ± 10.1). Primary tumors included appendicular (64%), gynecological (16%), colorectal (10%), and peritoneal mesotheliomas (9%). Ninety-three percent of patients had bilateral ureteral catheters inserted prior to surgery, without complications. Intraoperative UT injuries occurred in 7% of patients. In 5% of patients, tumor invasion of the bladder was evident at surgery and partial resection and primary repair of the bladder wall was performed. Urological complications included urinary tract infection (UTI) (21%) acute post-renal failure (4%), urinary fistulae (4%), and acute urinary retention (AUR) (1%).

CONCLUSIONS

In our study, intraoperative UT events and postoperative complications, although not neglectable, were infrequent. Due to the high complexity of these cases, a multidisciplinary approach is mandatory. However, randomized clinical trials are necessary to clarify current data on the need and efficacy of prophylactic ureteral catheterization in patients undergoing CRS-HIPEC.

GEORCC recommendations on target volumes in radiotherapy for Head Neck Cancer of Unkown Primary

Head Neck Cancer of Unknown Primary (HNCUP) is a rare condition, representing approximately 5-10% of all head neck cancers. Radiotherapy, adjuvant or radical, is usually employed in the treatment of those patients. To date, no specific guidelines for the optimal definition of the target volume to be irradiated have been published. In recent years, there have been advances in the knowledge of the molecular biology of HNCUP, its diagnostic imaging and the implementation of sophisticated radiotherapy techniques with enhanced precision in target localization and treatment delivery. These progresses have provided valuable information about the natural history of HNCUP that will allow for establishment of the best treatment for each patient, including standardized, consistent and reproducible target volumes definitions. Several recommendations regarding how to choose volumes when contouring HNCUP in clinical practice are reported, in order to achieve a high rate of loco-regional control while avoiding unnecessary toxicity.

Effects of adjuvant oxaliplatin on anal function in locally advanced rectal cancer treated with preoperative chemoradiotherapy and low anterior resection

718

Background: The main purpose of the present study was to determine if the addition of adjuvant oxaliplatin (OXA) could have some influence on sphincter function in patients with locally advanced rectal cancer (LARC) treated with preoperative capecitabine/radiotherapy followed by lower anterior resection (LAR). Methods: Those patients with LARC treated at our center with LAR and without two-years loco-regional relapse were retrospectively analyzed independent of the type of adjuvant treatment received. Anal sphincter function was assessed by Wexner´s incontinence score (0 to 20 points, being punctuation inversely proportional to sphincter function). All questionnaires were completed between January 2010 and December 2012. Comparisons of sphincter function measured with the Wexner test between patients with and without OX were conducted with the Mann-Whitney test. Statistical analyses were conducted using IBM SPSS Statistics, version 20. Results: From 2006, 92 consecutive patients were included in our study. Mean time from LAR to fecal function assessment was 58 months (25 to 96 months). Wexner test median values did not differ significantly (p=0.450) between patients with and without adjuvant OXA. The median (IQR) for the group without adjuvant OXA was 6.0 (1.0-11.25), being for group that received adjuvant OXA of 5.0 (1.0-10.0). Conclusions: Based on our findings, OXA could be used as adjuvant treatment in LARC, due to its absent of deleterious influence over the sphincter anal function. Because of the retrospective nature of our study, prospective studies should be warranted in similar scenarios. This study has been supported by a grant of “Mutua Madrileña Fundation.”

Current Status of Radiotherapy for the Management of Regional Nodes in Breast Cancer

Worldwide, breast cancer is the most common invasive cancer in women. Breast cancer constitutes about 23% of invasive cancers in women. The management of breast cancer depends on various factors, including the cancer stage and patient age. Breast cancer is usually treated with surgery, which can be followed by chemotherapy or radiation therapy, or both. Until recently, the standard procedure for axillary study was axillary dissection. Sentinel lymph node biopsy has been validated as a less-aggressive axillary treatment without an impact on survival. In the present report, we review the current management of the axillary lymph nodes, especially from the viewpoint of an oncology radiotherapist.

Contrast-enhanced ultrasound (CEUS): an excellent tool in the follow-up of small renal masses treated with cryoablation

Strict imaging follow-up is mandatory after cryoablation of small renal masses (SRMs). Although it uses ionizing radiation and nephrotoxic iodinated contrast, computed tomography (CT) is still the gold standard test. Contrast-enhanced ultrasound (CEUS) is a novel technique that informs in real time about renal perfusion avoiding radiation and nephrotoxicity. The objective of this study is to compare outcomes between CEUS and CT in the follow-up of SRMs treated with cryoablation, as well as to assess degree of agreement between them. This is a prospective observational study (May 2012 to December 2013) comparing CEUS and CT in 16 patients with SRMs cryoablated. The on-going protocol of the study includes a CT and CEUS 3 months after treatment and then every 6 months during 5 years. Local relapse was defined as the presence of contrast enhancement in the mass. All the CEUS were performed by a single experienced observer (E.S.). Degree of agreement was measured with kappa index. CEUS detected contrast enhancement in three patients (3/16, 18.8%) and CT in two patients (2/16, 12.5%). Degree of agreement between CEUS and CT, according to Landis-Koch classification, was 0.76 (CI 0.33-1.19; p = 0.0165), which is excellent and higher than expected by random. Sensitivity of the test is 93.75% (15/16). Median time of follow-up after cryoablation is 22 months (15.5-36.5). CEUS has an excellent agreement with CT and a high sensitivity in the follow-up of SRMs treated with cryosurgery, demonstrating its usefulness. Due to these encouraging results, it could become a reference test in the near future for monitoring SRMs after ablative treatment.