Clinical Role of F-18 Fluorodeoxyglucose Positron Emission Tomography for Follow-up of Patients with Renal Cell Carcinoma / 대한비뇨기과학회지

PURPOSE: To evaluate the role of [(18)F]fluorodeoxyglucose-positron emission tomography(FDG-PET) for the follow-up of patients with a renal cell carcinoma(RCC), and compare FDG-PET with conventional imaging modalities, including computerized tomography(CT), chest PA, bone scan and brain magnetic resonance imaging(MRI). MATERIALS AND METHODS: FDG-PET and conventional imaging techniques, includingCT, chest PA, bone scan and brain MRI, were performed on 69 patients who had undergone a radical nephrectomy and/or metastatectomy, with a final pathological diagnosis of a RCC. The final diagnoses of recurrences/metastases were established from the histopathological or clinical findings. RESULTS: Recurrences and metastases were present at 47 sites(34 patients). The results of FDG-PET were true positive and false negative in 44 and 3 of the 47 sites, respectively. The results of conventional imaging techniques were true positive and false negative in 40 and 7 of the 47 sites, respectively. The results of FDG-PET were true negative and false positive in 34 and 1 of the 35 patients, respectively. The results of conventional imaging techniques were true negative and false positive in 30 and 5 of the 35 patients, respectively. Therefore, FDG-PET was more sensitive, specific and accurate than conventional imaging techniques for the follow-up of patients with a RCC. CONCLUSIONS: FDG-PET accurately detected the postoperative recurrences and metastases in patients with a RCC. FDG-PET may have a role in the follow-up of patients with a RCC.

Primary Urethral Adenocarcinoma in a Young Man Who Presented with Voiding Dysfunction / 대한비뇨기과학회지

Primary urethral carcinoma accounts for less than 1% of the malignancies in males and adenocarcinoma accounts for 5% of all urethral carcinomas. A 36-year-old man with a history suggestive of urethral stricture was scheduled to undergo retrograde urethrography and visual urethrotomy. On urethroscopic examination, an abnormal polypoid mass was found in the proximal bulbous urethra, so transurethral resection biopsy was added to the urethrotomy. Histopathologic examination demonstrated urethral adenocarcinoma with no invasion to the corpus spongiosum and cavernosa on the magnetic resonance imaging. There was no evidence of metastasis and the search for the primary focus of adenocarcinoma revealed that the tumor originated from the urethra. The patient underwent segmental urethral resection and there has been no recurrence for 1-year follow-up.

CyberKnife for the Treatment of Nonmetastatic Prostate Cancer: Preliminary Results / 대한비뇨기과학회지

Purpose: Herein is reported our initial experience of the CyberKnife to show its safety and feasibility as a treatment modality for non-metastatic prostate cancer. Materials and Methods: Twenty patients, with biopsy-proven prostate cancers, were recruited into a phase I clinical trial using the CyberKnife. The distribution of clinical risks, as assessed using the ASTRO criteria, was as follows: low (4), intermediate (5) and high (11). The mean age and follow up of the patients were 71.4 years and 15 months, respectively. The patients received 7.5-9Gy of radiation in a single fraction for 4-5 days. The total radiation dose to the prostate was 34-37.5Gy, which approximates to 86.4Gy in 2Gy fractions. The rectal and bladder acute toxicities were graded using the criteria of the Radiation Therapy Oncology Group (RTOG). The results of acute toxicities were compared to those of the historical control, which had been treated with conventional four field box techniques (received median dose 70.2Gy). The prostate-specific antigen (PSA)- based short-term efficacy was described. Results: The acute rectal toxicity scores were 0, 1 and 2 in 13, 5, and 2 patients, respectively. The acute bladder toxicity scores were 0, 1 and 2 in 16, 3 and 1 patient, respectively. No grade 3 or 4 acute toxicity was noted. These figures contrast sharply with those found for the historical control. All toxicities spontaneously subsided within 3 months after treatment. Continuous PSA reduction was noted in all patients, and no PSA failure was noted during the follow up period. Conclusions: Our data show the feasibility of the CyberKnife in terms of its efficacy and acute toxicity. Moreover, the capability of using a hypo-fractionation schedule lead to marked improvement in patient convenience, with substantial resource savings.