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Fonteyne V, Berghen C, Van Praet C, Vanderstraeten B, Verbeke S, Villeirs G, Colman R, Vanneste B, Ost P, De Meerleer G, Lumen N. Moderate hypofractionated radiotherapy for prostate cancer: 3-year toxicity results of a multicentre randomized phase 3, non-inferiority trial. Radiother Oncol 2024; 193:110089. [PMID: 38278333 DOI: 10.1016/j.radonc.2024.110089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND AND PURPOSE Moderate hypofractionated radiotherapy (HFRT) is a standard treatment for prostate cancer patients. We compared 2 moderate HFRT regimens, with a biologically equivalent dose of 80 Gy in 2 Gy fractions, with a modest simultaneous integrated boost to the dominant intraprostatic lesion. MATERIAL AND METHODS This is a multicenter, non-inferiority, randomized phase 3 trial with acute toxicity as the primary endpoint, comparing: 56 Gy in 4 weeks (16x3.5 Gy, 4 days/week, Arm A) with 67 Gy in 5 weeks (25x2.68 Gy, 5 days/week, Arm B). The H0 hypothesis is that both regimens are equivalent in terms of acute grade ≥ 2 gastro-intestinal toxicity, defined as a difference in acute grade ≥ 2 gastro-intestinal toxicity of ≤ 10 %. Here we report on acute and late toxicity. RESULTS We included 170 patients in Arm A and 172 patients in Arm B. The median follow-up time for all patients was 42 months. Acute grade ≥ 2 gastrointestinal toxicity was reported by 24 % of patients in both groups. Acute grade 2 and 3 urinary toxicity was observed in 52 % and 9 % of patients in Arm A and 53 % and 7 % in Arm B. Late grade 2 and grade ≥ 3 gastrointestinal toxicity occurred in 19 % and 4 % of patients in Arm A compared with 15 % and 4 % in Arm B. Late grade 2 and grade ≥ 3 urinary toxicity was observed in 37 % and 10 % of patients in Arm A and 36 % and 6 % in Arm B. CONCLUSION This analysis confirms that both HFRT regimens are safe and equivalent in terms of acute grade ≥ 2 gastrointestinal toxicity.
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Affiliation(s)
- V Fonteyne
- Department of Radiotherapy Oncology, Ghent University Hospital, Ghent, Belgium; Department Human Structure and Repair, Ghent University, Ghent, Belgium.
| | - C Berghen
- Department of Radiotherapy and Oncology, Leuven University Hospitals, Louvain, Belgium
| | - C Van Praet
- Department of Urology, ERN Accredited Centre, Ghent University Hospital, Ghent, Belgium
| | - B Vanderstraeten
- Department of Radiotherapy Oncology, Ghent University Hospital, Ghent, Belgium; Department Human Structure and Repair, Ghent University, Ghent, Belgium
| | - S Verbeke
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - G Villeirs
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - R Colman
- Biostatistics Unit, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - B Vanneste
- Department of Radiotherapy Oncology, Ghent University Hospital, Ghent, Belgium; Department Human Structure and Repair, Ghent University, Ghent, Belgium
| | - P Ost
- Department Human Structure and Repair, Ghent University, Ghent, Belgium
| | - G De Meerleer
- Department of Radiotherapy and Oncology, Leuven University Hospitals, Louvain, Belgium
| | - N Lumen
- Department of Urology, ERN Accredited Centre, Ghent University Hospital, Ghent, Belgium
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Sutera PA, Shetty AC, Hakansson A, Van der Eecken K, Song Y, Liu Y, Chang J, Fonteyne V, Mendes AA, Lumen N, Delrue L, Verbeke S, De Man K, Rana Z, Hodges T, Hamid A, Roberts N, Song DY, Pienta K, Ross AE, Feng F, Joniau S, Spratt D, Gillessen S, Attard G, James ND, Lotan T, Davicioni E, Sweeney C, Tran PT, Deek MP, Ost P. Transcriptomic and clinical heterogeneity of metastatic disease timing within metastatic castration-sensitive prostate cancer. Ann Oncol 2023; 34:605-614. [PMID: 37164128 PMCID: PMC10330666 DOI: 10.1016/j.annonc.2023.04.515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Metastatic castration-sensitive prostate cancer (mCSPC) is commonly classified into high- and low-volume subgroups which have demonstrated differential biology, prognosis, and response to therapy. Timing of metastasis has similarly demonstrated differences in clinical outcomes; however, less is known about any underlying biologic differences between these disease states. Herein, we aim to compare transcriptomic differences between synchronous and metachronous mCSPC and identify any differential responses to therapy. PATIENTS AND METHODS We performed an international multi-institutional retrospective review of men with mCSPC who completed RNA expression profiling evaluation of their primary tumor. Patients were stratified according to disease timing (synchronous versus metachronous). The primary endpoint was to identify differences in transcriptomic profiles between disease timing. The median transcriptomic scores between groups were compared with the Mann-Whitney U test. Secondary analyses included determining clinical and transcriptomic variables associated with overall survival (OS) from the time of metastasis. Survival analysis was carried out with the Kaplan-Meier method and multivariable Cox regression. RESULTS A total of 252 patients were included with a median follow-up of 39.6 months. Patients with synchronous disease experienced worse 5-year OS (39% versus 79%; P < 0.01) and demonstrated lower median androgen receptor (AR) activity (11.78 versus 12.64; P < 0.01) and hallmark androgen response (HAR; 3.15 versus 3.32; P < 0.01). Multivariable Cox regression identified only high-volume disease [hazard ratio (HR) = 4.97, 95% confidence interval (CI) 2.71-9.10; P < 0.01] and HAR score (HR = 0.51, 95% CI 0.28-0.88; P = 0.02) significantly associated with OS. Finally, patients with synchronous (HR = 0.47, 95% CI 0.30-0.72; P < 0.01) but not metachronous (HR = 1.37, 95% CI 0.50-3.92; P = 0.56) disease were found to have better OS with AR and non-AR combination therapy as compared with monotherapy (P value for interaction = 0.05). CONCLUSIONS We have demonstrated a potential biologic difference between metastatic timing of mCSPC. Specifically, for patients with low-volume disease, those with metachronous low-volume disease have a more hormone-dependent transcriptional profile and exhibit a better prognosis than synchronous low-volume disease.
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Affiliation(s)
- P A Sutera
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| | - A C Shetty
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, USA; Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, USA
| | | | - K Van der Eecken
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Y Song
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, USA; Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, USA
| | | | - J Chang
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, USA
| | - V Fonteyne
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - A A Mendes
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - N Lumen
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - L Delrue
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - S Verbeke
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - K De Man
- Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Z Rana
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, USA
| | - T Hodges
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, USA; Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, USA
| | - A Hamid
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - N Roberts
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, USA
| | - D Y Song
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, USA; Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, USA; James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, USA
| | - K Pienta
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, USA; James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, USA
| | - A E Ross
- Department of Urology, Northwestern University, Chicago, USA
| | - F Feng
- Department of Medicine, UCSF, San Francisco, USA; Department of Urology, UCSF, San Francisco, USA; Department of Radiation Oncology, UCSF, San Francisco, USA
| | - S Joniau
- Department of Urology, Catholic University Leuven, Leuven, Belgium
| | - D Spratt
- Department of Radiation Oncology, University Hospitals, Cleveland, USA
| | - S Gillessen
- Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - G Attard
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - N D James
- The Royal Marsden Hospital NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - T Lotan
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, USA
| | | | - C Sweeney
- South Australian Immunogenomics Cancer Institute, University of Adelaide, Adelaide, Australia
| | - P T Tran
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, USA; Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, USA
| | - M P Deek
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, USA.
| | - P Ost
- Department of Radiation Oncology, Iridium Network, Antwerp, Belgium; Department of Human Structure and Repair, Ghent University, Ghent, Belgium.
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Verla W, Barratt R, Chan G, Campos-Juanatey F, Esperto F, Greenwell T, Lumen N, Martins F, Osman N, Ploumidis A, Riechardt S, Waterloos M, Dimitropoulos K. Is a course of Intermittent Self-Dilatation (ISD) with topical corticosteroids superior at stabilising urethral stricture disease in men and improving functional outcomes over a course of ISD alone? A systematic review and meta-analysis. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01051-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Fede Spicchiale C, Yang T, De Man K, Verbeke S, Lumen N. The role of diagnostic PSMA-PET and PSMA scores in prostate cancer preoperative assessment: Results from a single center study. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01022-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Lambert E, Allaeys C, Berquin C, Verbeke S, Devisschere P, Van Praet C, Lumen N. Is it safe to change from a standard anterior approach to a Retzius-sparing approach in robot-assisted radical prostatectomy? Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01142-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Verla W, Barratt R, Chan G, Campos-Juanatey F, Esperto F, Greenwell T, Lumen N, Martins F, Osman N, Ploumidis A, Riechardt S, Waterloos M, Dimitropoulos K. Is a course of Intermittent Self-Dilatation (ISD) with topical corticosteroids superior at stabilising urethral stricture disease in men and improving functional outcomes over a course of ISD alone? A systematic review and meta-analysis. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02051-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Murtha A, Warner E, van der Eecken K, Kwan E, Herberts C, Sipola J, Ng S, Chen E, Fonseca N, Schönlau E, Bernales C, Donnellan G, Verbeke S, Lumen N, van Dorpe J, De Laere B, Annala M, Vandekerkhove G, Ost P, Wyatt A. 4MO Multi-focal genomic dissection of synchronous primary and metastatic tissue from de novo metastatic prostate cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Tran P, Sutera P, Deek M, Van der Eecken K, Hakansson A, Liu S, Chang J, Fonteyne V, Mendes A, Lumen N, Delrue L, Verbeke S, De Man K, Song D, Paller C, Davicioni E, Joniau S, De Meerleer G, Lotan T, Ost P. 1381P A transcriptomic signature of AR activity prognosticates development of castration-resistance following metastasis-directed therapy in oligometastatic castration-sensitive prostate cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Lumen N, Lambert E, Fonteyne V, De Maeseneer D, Van Praet C. The changing landscape of systemic therapy in the treatment of newly-diagnosed metastatic prostate cancer. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00599-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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MacLennan S, Azevedo N, Briganti A, Duncan E, Dunsmore J, Fullwood L, Lumen N, Plass K, Ribal M, Roobol M, Schouten N, Smith E, Skolarus T, N'Dow J. Mapping EAU guideline practice variations across Europe: An audit of ADT before surgery in locally advanced and high-risk prostate cancer in 6315 cases across 31 European countries. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01034-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lambert E, Hollebosch S, van Praet C, Van Bruwaene S, Duck L, De Roock W, van Wambeke S, Ghysel C, Ameye F, Schatteman P, Vandenbroucke F, Sautois B, Baekelandt F, Ost D, Fransis K, Filleul B, Remondo C, Wynendaele W, Bamelis B, Logghe P, Vergauwe E, Denies E, Joniau S, Lumen N. Treatment of patients with newly diagnosed metastatic hormone sensitive prostate cancer (mHSPC) in Belgium: a real world data analysis. Acta Clin Belg 2021; 77:897-905. [PMID: 34789066 DOI: 10.1080/17843286.2021.2001999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Abiraterone acetate + prednisone (AAP) and docetaxel have proven their efficacy in the treatment of patients with newly diagnosed metastatic hormone-sensitive prostate cancer (mHSPC) in clinical trials. However, real-world data are scarce. The goal of this study is to evaluate real-world data on the efficacy and safety of these therapies in mHSPC patients. PATIENTS AND METHODS Records of 93 patients from 21 different centres were retrospectively reviewed. Primary and secondary endpoints were radiographic and PSA progression-free survival (RPFS - PSA-PFS) and cancer specific and overall survival (CSS - OS), respectively. Adverse events (AEs) were evaluated according to the Common Terminology Criteria for Adverse Events version 5.0. Differences in oncological outcome and AEs were evaluated between three treatment groups: ADT only (N=26) - ADT + AAP (N=48) - ADT + docetaxel (N=19). Survival analysis was performed using Kaplan-Meier statistics. RESULTS Median RPFS was 13 months (95% confidence interval [CI]: 9-17) for ADT only, 21 months (95% CI: 19-23) for ADT + AAP and 12 months (95% CI: 11-14) for ADT + docetaxel (p = 0.004). The 1-year PSA-PFS, CSS and OS were 73.5%, 90.7% and 88.7%, respectively, with no significant differences between the three groups. Adverse events of grade 3 or higher were not observed more frequently. CONCLUSION Retrospective real-world data show a significantly longer RPFS for mHSPC patients treated with ADT + AAP compared to ADT only or ADT + docetaxel at short-term follow-up. This can aid in counselling of mHSPC patients in daily clinical practice.
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Affiliation(s)
- E Lambert
- Uz Gent, Department of Urology Ghent, Belgium
| | | | - C van Praet
- Uz Gent, Department of Urology Ghent, Belgium
| | | | - L Duck
- Clinique Saint-Pierre Ottignies, Department of Medical Oncology
| | - W De Roock
- Ziekenhuis Oost-Limburg, Department of Medical Oncology and Limburgs Oncologisch Centrum, Genk, Belgium
| | - S van Wambeke
- Zna Jan Palfijn Merksem, Department of Medical Oncology
| | - C Ghysel
- Department of Urology, Az Sint-Jan Brugge
| | - F Ameye
- Department of Urology, Az Maria Middelares, Ghent, Belgium
| | | | | | - B Sautois
- Department of Medical Oncology, Chu de Liège
| | | | - D Ost
- Department of Urology, Az Sint-Blasius Dendermonde
| | | | - B Filleul
- Department of Medical Oncology, Ch Jolimont
| | - C Remondo
- Department of Medical Oncology, Hôpitaux Iris Sud, Brussels, Belgium
| | - W Wynendaele
- Department of Medical Oncology, Imelda Ziekenhuis Bonheiden
| | - B Bamelis
- Department of Urology, Jan Yperman Ziekenhuis Ieper
| | - P Logghe
- Department of Urology, Olv van Lourdes Ziekenhuis Waregem
| | | | - E Denies
- Department of Urology, Az Jan Portaels Vilvoorde
| | - S Joniau
- Department of Urology, Uz Leuven
| | - N Lumen
- Uz Gent, Department of Urology Ghent, Belgium
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Falcone M, Preto M, Timpano M, Peretti F, Ferro I, Verla W, Spinoit A, Lumen N, Goedertier W, Hoebeke P, Gontero P. A multicenter cohort analysis of the surgical outcomes after ZSI 475 ftm erectile deviceimplantation in transmen. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00768-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Timpano M, Falcone M, Preto M, De Rooij F, Pigot G, Lumen N, Verla W, Hoebeke P, Spinoit A, Peretti F, Ferro I, Gontero P. Surgical outcomes after treatment of urethral complications following metoidioplasty in transgender men. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00769-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Barratt R, Chan G, La Rocca R, Dimitropoulos K, Martins F, Juanatey F, Greenwell T, Waterloos M, Riechardt S, Osman N, Esperto F, Ploumidis A, Lumen N. Free graft augmentation urethroplasty for bulbar urethral strictures – Which technique is best? A systematic review. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00701-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Esperto F, Verla W, Ploumidis A, Barratt R, La Rocca R, Lumen N, Juanatey F, Greenwell T, Martins F, Osman N, Riechardt S, Waterloos M, Dimitropoulos K. Surgical treatment of male Lichen Sclerosus-related urethral strictures disease: State of the art. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00702-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Verla W, Waterloos M, Waterschoot M, Van Parys B, Suarez O, Giudice C, Song L, Spinoit A, Lumen N. Interim analysis of the VeSpAR trial: A randomized controlled trial comparing Vessel- Sparing Anastomotic Repair and transecting anastomotic repair in isolated, short, bulbar urethral strictures. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32795-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Verla W, Van Nieuwenhuyse F, Spinoit A, Waterloos M, Waterschoot M, Hoebeke P, Lumen N. Urethroplasty for failed hypospadias repair related strictures in adults: A retrospective analysis with long-term follow-up. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32805-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Verla W, Waterloos M, Waterschoot M, Lambert E, Spinoit A, Lumen N. Interim analysis of the POIROT trial: Post-Operative Imaging after urethroplasty with peri-catheter Retrograde urethrography or trial of voiding with voiding cysto-urethrography. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33065-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Waterschoot M, Tailly T, Lumen N, Decaestecker K, Sinatti C, Hoebeke P, Van Laecke E, Spinoit AF. Is robotic-assisted laparoscopic pyeloplasty a good option for difficult and redo-pyeloplasty? EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33990-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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De Bleser E, Willems R, Decaestecker K, Annemans L, De Bruycker A, Fonteyne V, Lumen N, Ameye F, Billiet I, Joniau S, De Meerleer G, Ost P, Bultijnck R. A cost-utility analysis of metastasis-directed therapy for oligorecurrent prostate cancer. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33407-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Kadner G, Valerio M, Giannakis I, Arya M, Lumen N, Ho B, Alonso S, Schulman C, Barber N, Amparore D, Porpigila F. Second generation of temporary implantable nitinol device (iTind) in men with lower urinary tract symptoms (LUTS): Who profit most from treatment? 2 year results of the MT-02-study. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32815-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Spinoit AF, Roth J, Waterschoot M, Hoebeke P, Monstrey S, Buncamper M, Verla W, Waterloos M, Sinatti C, Lumen N. Metoidioplasty followed by secondary phalloplasty: The way to fewer complications? EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)34258-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Waterloos M, Verla W, Spinoit AF, Oosterlinck W, Van Laecke E, Hoebeke P, Lumen N. Urethroplasty for urethral injuries and trauma-related strictures in children and adolescents: a single-institution experience. J Pediatr Urol 2019; 15:176.e1-176.e7. [PMID: 30581060 DOI: 10.1016/j.jpurol.2018.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 11/21/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Urethral injuries and trauma-related strictures (UITSs) in children are rare. The treatment is challenging but crucial to avoid life-long urinary complications such as recurrent stricture formation, urinary incontinence, and impotence. OBJECTIVE The aim was to report on the surgical and functional outcome of urethroplasty for UITSs and to provide data on patient-reported outcome measures (PROMs). MATERIAL AND METHODS Between November 2001 and October 2017, 18 male children (≤18 years; median: 13 years) underwent urethroplasty for UITSs at a single tertiary referral center. Etiology was iatrogenic in five (27.8%), perineal straddle injury in six (33.3%) and pelvic fracture urethral injury (PFUI) in seven (38.8%) patients. PFUIs and short (≤3 cm) bulbar strictures were treated by transperineal anastomotic repair (n = 15; 83.3%), whereas a long bulbar stricture and a penile stricture were treated by, respectively, a preputial skin graft and flap urethroplasty. A penetrating penile urethral injury during circumcision underwent early exploration with primary repair of the laceration. Failure was defined as need for additional urethral instrumentation. PROMs were sent to patients ≥16 years at the latest evaluation. RESULTS Median follow-up was 57 (range: 8-198) months. No complications and grade 1, 2, and 3 were present in, respectively, 13 (72.2%), two (11.1%), one (5.6%), and two (11.1%) patients. The success rate in a tertiary referral center was 94.4%. An immediate failure was observed in a patient with a PFUI and concomitant bladder neck injury. PROMs were available in 12 patients. Four patients (33.3%) reported erectile dysfunction. Post-void dribbling (25%) and urgency (50%) were the most frequently reported complaints. All patients were satisfied after urethroplasty and stated that they would undergo the surgery again. DISCUSSION This series corroborates the recent trend in favor of transperineal anastomotic repair for PFUI, with combined abdominoperineal approach reserved for complex situations (e.g. bladder neck injury). For anterior UITSs, adaption of the technique to the characteristics of UITSs (etiology, location, length, and quality of graft bed) yielded excellent outcomes. Future systematic use of PROMs is also needed in children to elucidate the impact of urethroplasty on the urinary and sexual function. CONCLUSION External trauma is the most important etiology of UITSs, but iatrogenic causes should not be neglected. Urethroplasty, mainly by anastomotic repair (AR) but with the technique adapted to local stricture characteristics if necessary, has an excellent long-term success rate in experienced hands. Functional disturbances are frequent, but despite this, patient satisfaction is high after urethroplasty.
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Affiliation(s)
- M Waterloos
- Dept. of Urology, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium; Dept. of Urology, Algemeen Ziekenhuis Maria Middelares, Buitenring Sint-Denijs 30, 9000 Ghent, Belgium
| | - W Verla
- Dept. of Urology, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - A F Spinoit
- Dept. of Urology, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - W Oosterlinck
- Dept. of Urology, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - E Van Laecke
- Dept. of Urology, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - P Hoebeke
- Dept. of Urology, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - N Lumen
- Dept. of Urology, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium.
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Bultijnck R, Van Ruymbeke B, Everaert S, Bagué H, Rammant E, Rimbaut S, Fonteyne V, Lumen N, Decaestecker K, Ost P. Availability of prostate cancer exercise rehabilitation resources and practice patterns in Belgium: Results of a cross-sectional study. Eur J Cancer Care (Engl) 2017; 27. [PMID: 29094773 DOI: 10.1111/ecc.12788] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2017] [Indexed: 12/21/2022]
Abstract
Exercise is recommended for prostate cancer (PCa) patients treated with androgen deprivation therapy. The goal of the study was to assess the availability of hospital-based rehabilitation resources and national practice patterns for PCa in Belgium. A questionnaire was conducted with rehabilitation physical therapists in all Belgian hospital with urology and rehabilitation departments. Practice patterns were compared with the American College of Sports Medicine guidelines. PCa prevalence data were obtained from the Belgian Cancer Registry and attitude of physicians towards physical activity was documented. We included 98 Belgian hospitals. Only 25% of the PCa population had access to PCa-specific programmes. The occupancy rate of PCa-specific rehabilitation slots was 69%. The main perceived barriers to organise PCa-specific rehabilitation were existence of general programmes (40%) and low referrals (18%). All PCa programmes consisted of aerobic and resistance exercise and 62% included flexibility. Minimal criteria for frequency and duration per session were followed in 83%. The majority (89%) of physicians believed in the positive effects of supervised exercise programmes. The majority of PCa programmes follow the evidence-based guidelines except for flexibility exercises. The minority of PCa patients has access to specific programmes, although not all treatment slots are occupied.
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Affiliation(s)
- R Bultijnck
- Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
| | - B Van Ruymbeke
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
| | - S Everaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - H Bagué
- Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
| | - E Rammant
- Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
| | - S Rimbaut
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
| | - V Fonteyne
- Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
| | - N Lumen
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - K Decaestecker
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - P Ost
- Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
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De Wolf K, Rottey S, Vermaelen K, Decaestecker K, Sundahl N, De Meerleer G, Lumen N, Fonteyne V, De Maeseneer D, Ost P. PV-0550: Combined high dose radiation and tyrosine kinase inhibitors in renal cell carcinoma: a phase I trial. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30990-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Chowdhury S, Birtle A, Bjartell A, Costa L, Feyerabend S, Galli L, Kalinka-Warzocha E, Kramer G, Rey JM, Lumen N, Matveev V, Paiss T, Spaeth D, Antoni L, Klumper E, Wapenaar R, Lee E. The prostate cancer registry: Patient characteristics, treatments and preliminary outcomes from a large observational study of metastatic castration-resistant prostate cancer (mCRPC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw372.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lumen N, Vierstraete-Verlinde S, Oosterlinck W, Hoebeke P, Palminteri E, Goes C, Maes H, Spinoit AF. Buccal Versus Lingual Mucosa Graft in Anterior Urethroplasty: A Prospective Comparison of Surgical Outcome and Donor Site Morbidity. J Urol 2016; 195:112-7. [DOI: 10.1016/j.juro.2015.07.098] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2015] [Indexed: 11/16/2022]
Affiliation(s)
- N. Lumen
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | | | - W. Oosterlinck
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - P. Hoebeke
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - E. Palminteri
- Center for Urethral and Genitalia Reconstructive Surgery, Arezzo, Italy
| | - C. Goes
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - H. Maes
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - A.-F. Spinoit
- Department of Urology, Ghent University Hospital, Ghent, Belgium
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Chowdhury S, Birtle A, Bjartell A, Costa L, Feyerabend S, Galli L, Lumen N, Kalinka-Warzocha E, Maroto P, Matveev V, Paiss T, Spaeth D, Klumper E, Thingstad T, Wapenaar R, Lee E. 2548 The Prostate Cancer Registry: First results from an international, prospective, observational study of men with metastatic castration-resistant prostate cancer (mCRPC). Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31367-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Devos J, Van Praet C, Decaestecker K, Claeys T, Fonteyne V, Decalf V, De Meerleer G, Ost P, Lumen N. Cognitive factors influencing treatment decision-making in patients with localised prostate cancer: development of a standardised questionnaire. Acta Clin Belg 2015; 70:272-9. [PMID: 25816107 DOI: 10.1179/2295333715y.0000000015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Men diagnosed with localised prostate cancer have to make a well-informed treatment choice between (robot-assisted) radical prostatectomy, external beam radiotherapy and, in selected cases, brachytherapy and active surveillance. We developed and validated a questionnaire to determine the cognitive reasons motivating this choice. MATERIALS AND METHODS The Prostate Cancer Decision-Making Questionnaire (PC-DMQ) was designed in-house and validated through the Delphi method. Finally, we tested the questionnaire in a cohort of 24 men, recently diagnosed with localised PC, before undergoing RARP (n = 16), EBRT (n = 6), brachytherapy (n = 1) or active surveillance (n = 1). RESULTS The experts reached consensus after three rounds. In the patient cohort, 75% of men undergoing RARP chose this treatment because 'it provides the best chance of cure'. Reasons to choose EBRT were not as explicit: 33.3% chose this treatment because 'it provides the best chance of cure' and 33.3% because 'the maintenance of potency is important to them'. CONCLUSIONS The PC-DMQ is a comprehensive and standardised tool that allows further research into cognitive factors that influence treatment decision-making in patients with localised PC.
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Abstract
We report a 49-year-old patient with necrotizing myopathy and a right renal mass. After laparoscopic radical nephrectomy, a remission of myopathy was seen. Pathologic evaluation of the nephrectomy specimen revealed a clear cell renal cell carcinoma. Relapse of myopathy 6 months postoperatively coincided with the diagnosis of the appearance of liver metastatic disease. After initiation of treatment with an mTOR-inhibitor, myopathy became less active requiring smaller amounts of corticosteroids with a complete remission of myopathy after 3 months of systemic treatment for metastatic renal cell cancer.
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Affiliation(s)
| | | | - N. Lumen
- Department of UrologyGhent University Hospital, Ghent, Belgium
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Cornelis N, Vermassen T, Schallier D, Machiels JP, Gil T, Debruyne PR, D'hondt R, Bols A, Schrijvers D, Mebis J, Lumen N, Rottey S. Prospective non-interventional multicentre observational trial of first-line anti-cancer treatment in patients with metastatic renal cell cancer in Belgium. Acta Clin Belg 2014; 69:335-40. [PMID: 25056491 DOI: 10.1179/2295333714y.0000000051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES Renal cell carcinoma (RCC) accounts for 2·4% of all new cancers in Belgium. Over the past decade, the armamentarium for systemic therapy of metastatic RCC (mRCC) has undergone important changes with implementation of targeted therapies directed against pathways involved in the pathogenesis of RCC. We describe first-line treatment choice of a group of patients in 9 Belgian oncology centres between October 2009 and November 2012. METHODS A clinical report form was established to assess patient characteristics, Karnofsky performance score, Memorial Sloan-Kettering Cancer Center risk criteria (MSKCC) and first-line therapy of mRCC patients. Choice of therapy and starting dose was analyzed before and after reimbursement of pazopanib in Belgium. RESULTS Ninety-six patients were eligible for the study. Non-smokers accounted for 53% of the patients. Seventy-three per cent of the patients had 0 or 1 MSKCC criteria in the group of patients that started treatment more than 1 year after initial diagnosis. In the group of patients that started therapy less than 1 year after diagnosis, 85% had 2 or more MSKCC criteria. This difference was statistically significant (P<0·0001). Overall distribution of the first-line therapies consisted of 43% sunitinib, 33% pazopanib, 14% temsirolimus, 7% everolimus and 3% sorafenib. Seventeen (18%) out of 96 patients started at a reduced dose level. CONCLUSION This report shows that the guidelines for the start of first-line treatment in mRCC in 9 centres in Belgium were applied most of the time: a tyrosine kinase inhibitor was the first treatment choice for most patients while temsirolimus was an option for poor prognosis patients. In the majority of patients standard dose levels were initiated, although in some patients adaptation of dosage/treatment schedule was recorded.
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Vermassen T, Lumen N, van Praet C, Vanderschaeghe D, Callewaert N, Hoebeke P, van Belle S, Delanghe J, Rottey S. Possible Use of Urinary Prostate Proteins Glycosylation Profile As a Diagnostic Biomarker for Prostate Cancer. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu326.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lumen N, Houtmeyers P, Monstrey S, Spinoit AF, Oosterlinck W, Hoebeke P. Revision of perineal urethrostomy using a meshed split-thickness skin graft. Case Rep Nephrol Dial 2014; 4:12-7. [PMID: 24575117 PMCID: PMC3934782 DOI: 10.1159/000358556] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Perineal urethrostomy is considered to be the last option to restore voiding in complex/recurrent urethral stricture disease. It is also a necessary procedure after penectomy or urethrectomy. Stenosis of the perineal urethrostomy has been reported in up to 30% of cases. There is no consensus on how to treat a stenotic perineal urethrostomy, but, in general, a form of urinary diversion is offered to the patient. We present the case of a young male who underwent perineal urethrostomy after urethrectomy for urethral cancer. The postoperative period was complicated by wound dehiscence with subsequent complete obliteration of the perineal urethrostomy. Revision surgery was performed with reopening of the obliterated urethral stump and coverage of the skin defect between the urethra and the perineal/scrotal skin with a meshed split-thickness skin graft. To date, this patient is voiding well and satisfied with the offered solution.
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Affiliation(s)
- N Lumen
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - P Houtmeyers
- Department of Plastic and Reconstructive Surgery, Ghent University Hospital, Ghent, Belgium
| | - S Monstrey
- Department of Plastic and Reconstructive Surgery, Ghent University Hospital, Ghent, Belgium
| | - A-F Spinoit
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - W Oosterlinck
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - P Hoebeke
- Department of Urology, Ghent University Hospital, Ghent, Belgium
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De Meerleer G, Claeys T, Delrue L, Lambert B, Lumen N, Fonteyne V, Decaestecker K, Ost P. SP-0021: Should oligometastatic disease in prostate cancer be treated systemically?: the radiation oncologist point of view. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30126-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lumen N, Fonteyne V, De Meerleer G, De Visschere P, Ost P, Oosterlinck W, Villeirs G. Screening and early diagnosis of prostate cancer: an update. Acta Clin Belg 2012; 67:270-5. [PMID: 23019802 DOI: 10.2143/acb.67.4.2062671] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Screening for prostate cancer has become a main controversial topic. First the currently used screening tools, PSA (Prostate Specific Antigen) and DRE (Digital Rectal Examination) have a low accuracy in the prediction of prostate cancer. Second, the benefit of screening in reducing the prostate cancer related mortality was not uniformly shown in older screening studies and there was concern about the risk of overdiagnosis and over-treatment of insignificant prostate cancers. Very recently, 3 major prospective, randomized screening studies have been published. This paper aims to provide an overview how the performance of the current screening tools can be ameliorated and evaluates the recently published screening studies with practical considerations for future screening protocols.
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Affiliation(s)
- N Lumen
- Dept. of Urology, Ghent University Hospital, Ghent, Belgium.
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Lumen N, Spiers S, De Backer S, Pieters R, Oosterlinck W. Assessment of the short-term functional outcome after urethroplasty: a prospective analysis. Int Braz J Urol 2012; 37:712-8. [PMID: 22234005 DOI: 10.1590/s1677-55382011000600005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2011] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To assess the short-term functional outcomes on urinary symptoms, erectile function, urinary continence and patient's satisfaction after urethroplasty. MATERIALS AND METHODS A prospective analysis was done in 21 patients who underwent urethroplasty. An assessment of the urinary flow, urinary symptoms (International Prostate Symptoms Score <IPSS>), erectile function (International Index of Erectile Function-5 <IIEF-5>) and urinary continence International Consultation Committee on Incontinence Questionnaire male Short Form <ICI-Q-SF>) was done before urethroplasty and 6 weeks and 6 months after urethroplasty. Patients were also asked to score their satisfaction with the urethroplasty after 6 weeks and 6 months. RESULTS Mean patient's age was 48 years range: 26-80 years). Mean stricture length was 4.2 cm (range: 1-12 cm). Three patients suffered a stricture recurrence. Mean maximum urinary flow increased from 5.83 mL/s to 24.92 mL/s (p < 0.001). Mean IPSS preoperative, 6 weeks and 6 months postoperative was respectively 15.86, 4.60 and 6.41(p < 0.001). The mean IIEF-5 score preoperative, 6 weeks and 6 months postoperative was respectively 15, 12.13 and 11.62 (not significant). The mean ICI-Q-SF score preoperative, 6 weeks and 6 months postoperative was respectively 10.47, 8.33 (p = 0.04) and 9.47 (p = 0.31). Patient's satisfaction 6 weeks and 6 months postoperative was respectively 17.14/20 and 17.12/20. CONCLUSIONS Urethroplasty leads to a significant improvement in urinary flow and IPSS and urinary continence is tending to improve. Although not significant, erectile function was slightly diminished after urethroplasty. Functional outcome should be assessed when urethroplasty is performed.
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Affiliation(s)
- N Lumen
- Department of Urology, Ghent University Hospital, Ghent and University of Ghent, Belgium.
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Lumen N, Oosterlinck W, Hoebeke P. Urethral reconstruction using buccal mucosa or penile skin grafts: systematic review and meta-analysis. Urol Int 2012; 89:387-94. [PMID: 22889835 DOI: 10.1159/000341138] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2012] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Different types of grafts have been described in urethral reconstruction (UR), with penile skin graft (PSG) and buccal mucosa graft (BMG) as the most frequently used ones. It still remains unclear whether one graft is superior in terms of success when compared to the other. MATERIAL AND METHODS A systematic review of the literature was performed searching the MEDLINE database with the following search strategy: 'urethroplasty' AND 'penile skin'/ 'urethroplasty' AND 'buccal mucosa'. 266 and 144 records were retrieved for urethroplasty with PSG and BMG, respectively. These records were reviewed to identify papers where PSG and BMG were used in UR and where individualized data on success were available within the same series. RESULTS 18 papers were found eligible for further analysis. In total, 428 and 483 patients were respectively treated with PSG or BMG. If available, follow-up duration was 64.1 versus 42.1 months (p < 0.0001) and stricture length 6.2 versus 4.6 cm (p < 0.0001) for PSG and BMG, respectively. Success of UR with PSG was 81.8 versus 85.9% with BMG (p = 0.01). CONCLUSIONS Success of UR using BMG is significantly better compared to PSG. Results might be seriously biased by a longer follow-up duration and stricture length for PSG compared to BMG.
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Affiliation(s)
- N Lumen
- Department of Urology, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium. lumennicolaas @ hotmail.com
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De Meerleer G, Berkovic P, Delrue L, Lambert B, Lumen N, Fonteyne V, Villeirs G, Ost P. EP-1132 SALVAGE STEREOTACTIC BODY RADIOTHERAPY FOR PATIENTS WITH LIMITED PROSTATE CANCER METASTASES. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71465-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lumen N, Fonteyne V, De Meerleer G, Villeirs G, De Troyer B, Oosterlinck W, Mottrie A. 8 Surgical outcome of robot-assisted radical prostatectomy after a training program in a high-volume robotic centre. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/s1569-9056(11)61336-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kruse V, Noens L, Lumen N, Hoebeke P, Van Belle S, Rottey S. High dose chemotherapy and stem cell rescue for metastatic germ cell tumours: long-term results from a single institution. Acta Clin Belg 2011; 66:254-9. [PMID: 21938979 DOI: 10.2143/acb.66.4.2062565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the long term results and the characteristics of patients treated with high dose chemotherapy (HDCT) for an advanced germ cell tumour at Ghent University Hospital from 1996 to 2010. MATERIALS AND METHODS A retrospective analysis of patients treated with HDCT for germ cell tumours was performed. Data about stage at diagnosis, different prognostic scoring systems, timing of HDCT, response to HDCT and relapse-free period were collected. The following endpoints were evaluated: complete or incomplete response to HDCT, relapse free survival and overall survival time. RESULTS Of the 148 patients treated with chemotherapy for an advanced germ cell tumour from 1996 to 2010, 10 (6.8%) needed salvage treatment by means of HDCT. Six patients achieved a complete response to one cycle of HDCT and 2 additional patients achieved a complete response to a second cycle of HDCT. A retrospective analysis showed 8 long-term survivors with a maximum follow-up time of 152 months. Two patients were recently transplanted and are not evaluable for survival yet. CONCLUSIONS Our study suggests that long-term survival can be obtained by means of HDCT for metastatic germ cell tumours, even in patients with bad prognostic features at diagnosis. The question of whether to use 1 or 2 cycles of HDCT still remains unanswered.
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Affiliation(s)
- V Kruse
- Department of Medical Oncology, Ghent University Hospital, Belgium.
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Ost P, De Potter B, Beerens A, Lumen N, Fonteyne V, De Meerleer G. Adjuvant high-dose intensity-modulated radiotherapy following radical prostatectomy: Updated 5-year results. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
69 Background: Approximately 25% of patients treated with immediate post-prostatectomy (adjuvant) radiotherapy will develop a biochemical failure within 5 years after radiotherapy when doses of 60-64 Gy are used. We wanted to report on the safety and biochemical outcome of adjuvant intensity-modulated radiotherapy (AIMRT) with a median dose of 74 Gy. Methods: Between 1999 and 2008, 104 patients underwent a radical prostatectomy followed by AIMRT +/− androgen deprivation (AD). Indications for AIMRT were capsule perforation, seminal vesicle invasion and/or positive surgical margins at prostatectomy specimen. All patients were irradiated at a single tertiary academic centre. AD was initiated in 65% of the patients on the basis of seminal vesicles invasion, pre-prostatectomy PSA > 20ng/mL, Gleason score ≥ 4+3 or personal preference of the referring urologist. A median dose of 74 Gy was prescribed to the planning target volume using IMRT in all patients. AD consisted out of a LHRH analogue for 6 months. The Kaplan-Meier method was used to estimate biochemical relapse-free survival (bRFS). Univariate and multivariate analysis were used to examine the influence of patient- and treatment-related factors on bRFS. Results: The median follow-up was 5 years. Late toxicity: no patients developed grade 3 gastrointestinal (GI) toxicity. Grade 2 GI toxicity was seen in 8%. Seven patients (7%) and 24 (23%) developed grade 3 and 2 genitourinary (GU) toxicity, respectively. An urethral stricture was observed in 8 patients (8%). The 3- and 5-year actuarial bRFS was 91% and 85%, respectively. On univariate analysis bRFS rates was reduced with seminal vesicle invasion (p < 0.04) or Gleason score ≥ 4+3 (p < 0.02) or negative margins (p < 0.001). AD and preoperative PSA levels did not influence bRFS. None of the variables remained significant on multivariate analysis.Eight patients had a distant clinical relapse (pelvic lymph nodes: 3, bone metastases: 3 and 2 patients had both). Seven patients died (3 prostate cancer related deaths). Conclusions: Adjuvant high-dose IMRT after prostatectomy is safe. Five-year bRFS is excellent. No significant financial relationships to disclose.
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Affiliation(s)
- P. Ost
- Ghent University Hospital, Ghent, Belgium; Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
| | - B. De Potter
- Ghent University Hospital, Ghent, Belgium; Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
| | - A. Beerens
- Ghent University Hospital, Ghent, Belgium; Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
| | - N. Lumen
- Ghent University Hospital, Ghent, Belgium; Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
| | - V. Fonteyne
- Ghent University Hospital, Ghent, Belgium; Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
| | - G. De Meerleer
- Ghent University Hospital, Ghent, Belgium; Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
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Villeirs GM, De Visschere PJ, Fonteyne VH, Lumen N, De Meerleer GO. Magnetic resonance imaging in diagnosis, staging and radiotherapy planning for prostate cancer. Acta Clin Belg 2010; 65:371-6. [PMID: 21268949 DOI: 10.1179/acb.2010.65.6.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
T2-weighted magnetic resonance imaging (MRI), preferably using an endorectal coil, is able to clearly depict the normal prostatic anatomy and to identify prostate cancer with fair diagnostic accuracy. The latter can be further increased by using functional techniques such as spectroscopy (assessment of prostatic metabolism), dynamic contrast-enhanced MRI (assessment of angiogenesis) and diffusion-weighted imaging (assessment of cellular density). T2-weighted MRI is an important tool for local staging of prostate cancer in patients clinically staged as cT1 or cT2, because of its high specificity for macroscopic capsular extension or seminal vesicle invasion. Compared to CT-imaging, MRI depicts the internal prostatic anatomy, prostatic margins and the extent of prostatic tumours much more clearly. This benefit can be exploited to improve the accuracy of target delineations in radiotherapy planning.
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Affiliation(s)
- G M Villeirs
- Department of Radiology, Universitair Ziekenhuis Gent, Gent, Belgium.
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Everaert K, Lumen N, Kerckhaert W, Willaert P, van Driel M. Urinary tract infections in spinal cord injury: prevention and treatment guidelines. Acta Clin Belg 2009; 64:335-40. [PMID: 19810421 DOI: 10.1179/acb.2009.052] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES AND METHODS The literature on prevention and therapy of urinary tract infection (UTI) in patients with spinal cord injury (SCI) was reviewed using 3 levels of evidence. RESULTS Antibiotic therapy is only indicated in symptomatic bacteriuria or in symptomatic exacerbations of chronic UTI. During the acute phase of a SCI, UTI's are more prevalent and bacteria are different and more resistant to antibiotics compared with the chronic phase of SCI. In SCI in general, routine screening urine cultures are not valuable as a high species turn over is seen. Intermittent catheterisation, tapping or Crédé manoeuvre coincide significantly with lower frequency of UTI compared to permanent catheter drainage. No measures are proven efficient in the long term in prevention of bacteriuria or UTI. Methenamine salts are perhaps useful in the prevention of UTI but not in patients with a permanent catheter (level III). Antibiotic prophylaxis was found useful in reducing asymptomatic bacteriuria but not in the prevention of symptomatic infections (level I). However, during prophylaxis a doubling of antibiotic resistance was found. In patients with augmented bladder antibiotic prophylaxis is useless (level II). In chronic SCI the first choice antibiotics are nitrofurantoin or trimethoprim, the second choice are fluoroquinolones (level III) whereas in acute SCI a higher resistance profile to antibiotics is frequent and therefore fluoroquinolones or cefuroxime are suggested (level III). There is no consensus in the literature but we suggest 5 days of antibiotic treatment in UTI during chronic SCI without fever, 7 days in acute SCI without fever and a minimum of 14 days in patients with UTI and fever (level III).
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Affiliation(s)
- K Everaert
- Department of Urology, Ghent University hospital, Ghent, Belgium.
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Lumen N, Monstrey S, Ceulemans P, van Laecke E, Hoebeke P. Reconstructive surgery for severe penile inadequacy: phalloplasty with a free radial forearm flap or a pedicled anterolateral thigh flap. Adv Urol 2008; 2008:704343. [PMID: 19009034 PMCID: PMC2581740 DOI: 10.1155/2008/704343] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2008] [Accepted: 07/06/2008] [Indexed: 11/17/2022] Open
Abstract
Objectives. Severe penile inadequacy in adolescents is rare. Phallic reconstruction to treat this devastating condition is a major challenge to the reconstructive surgeon. Phallic reconstruction using the free radial forearm flap (RFF) or the pedicled anterolateral thigh flap (ALTF) has been routinely used in female-to-male transsexuals. Recently we started to use these techniques in the treatment of severe penile inadequacy. Methods. Eleven males (age 15 to 42 years) were treated with a phallic reconstruction. The RFF is our method of choice; the ALTF is an alternative when a free flap is contraindicated or less desired by the patient. The RFF was used in 7 patients, the ALTF in 4 patients. Mean followup was 25 months (range: 4-49 months). Aesthetic and functional results were evaluated. Results. There were no complications related to the flap. Aesthetic results were judged as "good" in 9 patients and "moderate" in 2 patients. Sensitivity in the RFF was superior compared to the ALTF. Four patients developed urinary complications (stricture and/or fistula). Six patients underwent erectile implant surgery. In 2 patients the erectile implant had to be removed due to infection or erosion. Conclusion. In case of severe penile inadequacy due to whatever condition, a phalloplasty is the preferred treatment nowadays. The free radial forearm flap is still the method of choice. The anterolateral thigh flap can be a good alternative, especially when free flaps are contraindicated, but sensitivity is markedly inferior in these flaps.
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Affiliation(s)
- N Lumen
- Department of Paediatric Urology and Urogenital Reconstruction, Ghent University Hospital, De Pintelaan 185, B-9000 Gent, Belgium.
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Lumen N, Monstrey S, Decaestecker K, Opdenakker Y, Beysens M, Hoebeke P. ERECTILE IMPLANTS IN FEMALE-TO-MALE TRANSSEXUALS: OUR EXPERIENCE IN 130 PATIENTS. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s1569-9056(08)60184-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
The present article reviews the literature regarding the endoscopic treatment of urethral strictures. Only few prospective randomised clinical trials with sufficient power have been performed and most of the literature provides evidence of only level 3 and 4. Since length, location, extent and calibre of the urethral stricture have an important impact on prognosis, diagnosis and the role of ultrasonography are discussed. Pathophysiology of wound healing is discussed in relation to urethrotomy, as it explains the outcomes of the procedure. Operative techniques using cold knife and laser, use of endoprostheses, indications, complications, results and postoperative management are described. The possible role of urethral catheters, hydraulic dilatations and corticosteroid applications are discussed.
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Affiliation(s)
- W Oosterlinck
- Département d'urologie, Clinique Universitaire de Gand, Belgique.
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