Stereotactic focal radiotherapy as an alternative treatment for low-risk prostate cancer: Results of a single-arm monocenter Phase-II trial.

Introduction: Since radical treatments in low risk prostate cancer do not improve overall survival in comparison to active surveillance, preserving quality of life (QOL) remains the key objective. Active surveillance of indolent prostate cancer avoids curative treatment side-effects but necessitates repeated biopsies. Focal stereotactic body radiation therapy (focal SBRT) may be an alternative. This non-randomized Phase-II trial examined the feasibility and safety of focal SBRT for low and favorable intermediate-risk prostate cancer. Methods: Patients were recruited in 2016-2019 if they had: localized CAPRA ≤ 3 prostate adenocarcinoma; an isolated PIRADS≥4 macroscopic tumor on MRI; WHO Performance Status 0-1; and no major urinary symptoms. 36.25 Gy (80% isodose prescription) were delivered in 5 fractions every other day. Primary outcome was delay between focal SBRT and salvage-treatment initiation. Secondary outcomes were: acute/late genitourinary/rectal toxicity; biological, clinical and MRI local control; and change in QOL measures. Results: Over a median follow-up of 36 months, salvage prostatectomy in the 24 eligible patients was never required. Three-year biochemical progression-free survival was 96%. The single biochemical recurrence was a small (2-mm) Gleason 6 (3 + 3) lesion in the non-irradiated lobe. All 19 patients with ≥1 post-treatment MRI evaluations demonstrated complete radiological response. Acute/late grade ≥3 toxicities did not occur: all acute toxicities were grade-1 genitourinary (38% patients), grade-2 genitourinary (8%), or grade-1 rectal (13%) toxicities. There was one (4%) late grade-1 genitourinary toxicity. QOL was unchanged at last follow-up, as shown by IPSS (2.86 to 3.29, p>0.05), U-QOL (0.71 to 0.67, p>0.05), and IIEF5 (the 14 initially potent patients maintained potency (IIEF5 > 16)). Conclusion: Focal SBRT is feasible, well-tolerated, and preserves QOL. This innovative robotized approach challenges active surveillance.

Reverse remodelling through exercise training is more pronounced in non-ischemic heart failure.

PURPOSE: Most training studies in patients with chronic heart failure (CHF) do not consider CHF aetiology in the interpretation of the results. About 60% of the patients in those studies have ischemic CHF (IHF) and 40% non-ischemic CHF (NHF). Recently, we conducted a randomized controlled trial to study three different training modalities in 60 patients with severe CHF, with a similar distribution of IHF and NHF patients. In the present post hoc analysis we compared the differences in training results between ischemic and non-ischemic patients. METHODS: Left ventricular ejection fraction (EF), end diastolic volume (EDV), end systolic volume (ESV), measured with radionuclide ventriculography (RNV) and echocardiography, NT-pro BNP, peak oxygen uptake (peak V(O)(2)), working capacity and muscular volume were analyzed before and after training in 45 patients training for 40 sessions, 3 times per week. Fifteen patients served as control group. The outcome was analyzed considering the aetiology of CHF, either ischemic or non-ischemic. RESULTS: There were no significant differences in improvements of peak V(O)(2), working capacity and muscular volume between IHF and NHF patients. In NHF patients, EF increased while EDV and ESV decreased after training. These parameters remained unchanged in IHF patients after training. NT-pro BNP decreased significantly in NHF patients and increased in IHF patients after training. In the control group, patients showed a mild improvement of EF and a decrease of NT-pro BNP. CONCLUSION: This post hoc analysis shows that training intervention is associated with significant reverse remodelling in NHF, but not in IHF patients, whereas V(O)(2) peak and muscle volume improve regardless of CHF aetiology. Future prospective studies are needed to confirm our findings.

Is strength training the more efficient training modality in chronic heart failure?

PURPOSE: An open, randomized, controlled study was designed to study the effects of exclusive strength training (ST) in patients with severe chronic heart failure (CHF) in comparison with conventional endurance (ET) and combined ET-ST training (CT). The hypothesis was that ST would at least be equal to ET or CT, because peripheral muscle atrophy and weakness play a key role in exercise limitation in CHF patients. METHODS: Three groups of 15 patients underwent ST, ET, or CT during 40 sessions, three times a week, for 45 min. Fifteen patients served as control group. Before and after intervention, left ventricular ejection fraction (LVEF), peak oxygen consumption (VO2peak), peak workload, thigh muscle volume, knee extensor strength, endurance, and quality of life (QoL) were assessed. RESULTS: All measured parameters improved significantly in the three training groups, except for knee extensor strength in ET. Training outcome was superior in all three training groups compared with the control group, but statistical significance was only reached for VO2peak and peak workload, thigh muscle volume, and knee extensor endurance. In contrast, knee extensor strength, LVEF, and QoL did not reach statistical significance. None of the training modalities proved to be superior to any other, although small differences between the three groups were observed. CONCLUSION: Independently of the training modality, intensive exercise training is efficient in increasing cardiac function, exercise capacity, peripheral muscle function, and QoL in CHF patients.

[Puncture-lavage-infiltration of calcifying tendinitis of the rotator cuff]. / Ponction-lavage-infiltration des calcifications tendineuses de l'epaule.

Calcifying tendinitis of rotator cuff is a common and evolutive pathology of the shoulder. This article supports the efficiency of imaging-guided needle puncture trituration and lavage in rotator cuff calcifications after failure of medical treatment. Overall efficiency of this economical ambulatory treatment ranges in the literature from 49 to 100 % and no complication is noted. In our opinion this technique should be used before arthroscopic or surgical removal of the calcifying tendinitis.