Criteria and indicators to evaluate quality of care in genitourinary tumour boards.

PURPOSE: Genitourinary (GU) multidisciplinary tumour boards (GUMTBs) are key components of patient care, as they might lead to changes in treatment plan, improved survival, and increased adherence to guidelines. However, there are no guidelines on how GUMTBs should operate or how to assess their quality of performance. METHODS: A systematic literature review was conducted to identify criteria and indicators to evaluate quality in GUMTBs. A scientific committee-comprising 12 GU cancer specialists from seven disciplines-proposed a list of criteria and developed indicators, evaluated in two rounds of Delphi method. Appropriateness and utility of indicators were scored using a 9-point Likert scale. Consensus was defined as at least two-thirds of Delphi respondents selecting a score sub-category that encompassed the median score of the group. RESULTS: Forty-five criteria were selected to evaluate the quality of GUMTBs covering five dimensions: organisation, personnel, protocol and documentation, resources, and interaction with patients. Then, 33 indicators were developed and evaluated in the first round of Delphi, leading to a selection of 26 indicators in two dimensions: function, governance and resources, and GUMTB sessions. In the second round, consensus was reached on the appropriateness of all 26 indicators and on the utility of 24 of them. Index cards for criteria and indicators were developed to be used in clinical practice. CONCLUSIONS: Criteria and indicators were developed to evaluate the quality of GUMTBs, aiming to serve as a guide to improve quality of care and health outcomes in patients with GU cancer.

Seizures and Neuropsychiatric Toxicity in Patients with Non-Metastatic CRPC Treated with New Antiandrogens: Systematic Review and Meta-Analysis.

INTRODUCTION: Recently, enzalutamide, apalutamide, and darolutamide have shown benefits in metastasis-free survival in non-metastatic castration-resistant prostate cancer (nmCRPC) patients compared to placebo. Previous evidence about the safety profile of these new androgens is limited. This meta-analysis studies seizure and neuropsychiatric effects of new anti-androgens compared to placebo in nmCRPC patients. METHODS: PubMed and Cochrane databases were systematically reviewed until 1 March 2020 by 2 independent researchers using a pre-specified search strategy. Placebo-compared randomized controlled trials (RCTs) of nmCRPC patients treated with new anti-androgens providing data on neuropsychiatric events and seizures were included. Variables were seizure, headache, mental impairment, and dizziness. Pooled risk ratios (RR) were calculated using the Mantel-Hansel random effects model and Review Manager v5.3 software. RESULTS: After systematic review, 3 eligible RCTs were selected that included 4,104 patients; 2,687 comprised the treatment group and 1,417 the control group. No significant increase in RR for seizures was registered with the new anti-androgens compared to placebo (RR 1.96; 95% confidence interval [CI] 0.40-9.61). However, 2 trials excluded patients with risk factors or a history of seizures. There was also no significant increase RR for grade ≥3 seizures (RR 2.50; 95% CI 0.12-52.02). RR for suffering dizziness (any grade) was 1.57 (95% CI 1.07-2.32) with the new anti-androgens, but no significant differences were found in the other study regarding neuropsychiatric events or grade ≥3 events. CONCLUSIONS: New anti-androgens (i.e., enzalutamide, apalutamide, and darolutamide) are acceptably safe in terms of seizures and neuropsychiatric toxicity compared to placebo in patients with nmCRPC.

[Mitomycin C HIVEC. Update and results in high risk patients.] / HIVEC con mitomicina C. Actualización y resultados en pacientes de alto riesgo.

Adjuvant endovesical treatment is a research field in constant exploration with the aim to minimize the risk of recurrence and progression of non muscle invasive bladder tumors. Over the last years, the administration of chemotherapy in a chemo hyperthermia regimen has been added to the existing regimens. There are various systems for its administration, but this article focus on HIVEC (Hyperthermic IntraVEsical Chemotherapy) and its current status. In this review article we update the results of this system in the case-scenarios it has been used (preoperative with ablative intention and as adjuvant therapy with prophylactic purposes), tolerance and security issues, on-going clinical trials and future perspectives.

HIVEC con mitomicina C. Actualización y resultados en pacientes de alto riesgo / Mitomycin C HIVEC. Update and results in high risk patients

Los tratamientos endovesicales adyuvantes son un campo de investigación en constante exploración con el objeto de minimizar el riesgo de recurrencia y progresión de los tumores de vejiga no músculo invasivos. En los últimos años, a los ya existentes se ha añadido la administración de quimioterapia en régimen de quimiohipertermia. Hay diversos sistemas de administración de ésta, centrándonos en este artículo en HIVEC (Hyperthermic IntraVEsical Chemotherapy) y su situación actual. En esta revisión, ponemos al día los resultados de este sistema en los escenarios en que ha sido empleado (tanto de forma preoperatoria con intención ablativa como de forma adyuvante con intención profiláctica), las cuestiones relativas a tolerancia y seguridad, los ensayos que hay en marcha y las perspectivas de futuro

Adjuvant endovesical treatment is a research field in constant exploration with the aim to minimize the risk of recurrence and progression of non muscle invasive bladder tumors. Over the last years, the administration of chemotherapy in a chemo hyperthermia regimen has been added to the existing regimens.There are various systems for its administration, but this article focus on HIVEC (Hyperthermic IntraVEsical Chemotherapy) and its current status. In this review article we update the results of this system in the case-scenarios it has been used (preoperative with ablative intention and as adjuvant therapy with prophylactic purposes), tolerance and security issues, on-going clinical trials and future perspectives

Testicular tumors: residual retroperitoneal mass surgery after chemotherapy;Is it possible to predict their histology?

OBJECTIVES: We present our series of residual retroperitoneal mass surgery after chemotherapy. We evaluate possible preoperative parameters that can predict the retroperitoneal mass histology. Survival and relapse rates were also evaluated. METHODS: We reviewed sixty resections of residual retroperitoneal masses of testicular tumours after chemotherapy performed at our department between 1995 and 2007. We evaluate the relationship between histology of the retroperitoneal mass and possible risk factors, such as outcomes after chemotherapy, which was evaluated as changes in the size of the retroperitoneal mass, and negativization of serum tumor markers. We also evaluate histology and size of the primary testicular cancer. RESULTS: The histology of retroperitoneal mass was necrosis or fibrosis in 25 (42%) cases, teratoma in 29 (48%) and viable tumor in 6 (10%). The size of the retroperitoneal mass decreased after the chemotherapy in 62% cases; moreover negative serum tumor markers were found in 87%. Elevated values of human chorionic gonadotropin were associated with viable cells in the retroperitoneal mass (p=0.014) and, the presence of teratoma in the primary tumor may be associated with teratoma in the retroperitoneal mass histology (p=0.002). However, no other preoperative factors that predict the residual mass histology were found. Repeated resections of retroperitoneal masses were required in four patients and 9 patients died during follow-up. CONCLUSIONS: We cannot determine preoperative parameters that accurately predict the histology of retroperitoneal masses. Therefore, resection of residual retroperitoneal masses after chemotherapy in non-seminomatous germ cell tumours must be performed.

Tumores testiculares: cirugía de masas retroperitoneales residuales tras tratamiento quimioterápico; ¿es posible predecir su histología? / Testicular tumors: residual retroperitoneal mass surgery after chemotherapy; ¿is it possible to predict their histology?

OBJETIVO: Presentamos nuestra serie de cirugías de masas retroperitoneales residuales postquimioterapia, evaluando aquellos parámetros que pudieran predecir su histología y mostramos la evolución tras la cirugía.MÉTODOS: Revisamos retrospectivamente 60 cirugías de masas retroperitoneales residuales tras quimioterapia, secundarias a tumores testiculares de células germinales realizadas en nuestro servicio entre 1995 y 2007. Estudiamos la relación entre la histología de la masa y sus posibles factores predictores, tales como: la respuesta a la quimioterapia valorada como reducción del tamaño de la masa retroperitoneal y evolución de los marcadores tumorales, la anatomía patológica y el tamaño del tumor primario.RESULTADOS: La histología de las masas residuales fue necrosis/fibrosis en 25 (42%) casos, teratoma en 29 (48%) y tumor viable en 6 (10%). La quimioterapia consiguió reducir el tamaño de la masa en el 62% de los casos, se logró negativización de los marcadores en el 87%. Aunque valores más altos de gonadotropina coriónica humana se asocian con masas que contienen células viables (p=0,014) y la presencia de teratoma en el tumor primario puede orientar hacia la histología de la masa retroperitoneal (p=0,002), no encontramos otros factores preoperatorios predictivos de la histología de la masa residual. En 4 pacientes fueron necesarias varias cirugías ante la existencia de recidiva y 9 pacientes fallecieron durante el seguimiento.CONCLUSIONES: No encontramos claros factores predictores de la histología de la masa retroperitoneal. Por tanto, en los tumores germinales no seminomatosos debe realizarse una completa resección quirúrgica de las masas retroperitoneales residuales tras el tratamiento quimioterápico(AU)

OBJECTIVES: We present our series of residual retroperitoneal mass surgery after chemotherapy. We evaluate possible preoperative parameters that can predict the retroperitoneal mass histology. Survival and relapse rates were also evaluated. METHODS: We reviewed sixty resections of residual retroperitoneal masses of testicular tumours after chemotherapy performed at our department between 1995 and 2007. We evaluate the relationship between histology of the retroperitoneal mass and possible risk factors, such as outcomes after chemotherapy, which was evaluated as changes in the size of the re-troperitoneal mass, and negativization of serum tumor markers. We also evaluate histology and size of the primary testicular cancer.RESULTS: The histology of retroperitoneal mass was necrosis or fibrosis in 25 (42%) cases, teratoma in 29 (48%) and viable tumor in 6 (10%). The size of the retroperitoneal mass decreased after the chemotherapy in 62% cases; moreover negative serum tumor markers were found in 87%. Elevated values of human chorionic gonadotropin were associated with viable cells in the retroperitoneal mass (p=0.014) and, the presence of teratoma in the primary tumor may be associated with teratoma in the retroperitoneal mass histology (p=0.002). However, no other preoperative factors that predict the residual mass histology were found. Repeated resections of retroperitoneal masses were required in four patients and 9 patients died during follow-up.CONCLUSIONS: We cannot determine preoperative parameters that accurately predict the histology of retroperitoneal masses. Therefore, resection of residual retroperitoneal masses after chemotherapy in non-seminomatous germ cell tumours must be performed(AU)