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1.
Radiologia (Engl Ed) ; 66 Suppl 1: S40-S46, 2024 Apr.
Article in English | MEDLINE | ID: mdl-38642960

ABSTRACT

OBJETIVE: To assess the ability of an artificial intelligence software to detect pneumothorax in chest radiographs done after percutaneous transthoracic biopsy. MATERIAL AND METHODS: We included retrospectively in our study adult patients who underwent CT-guided percutaneous transthoracic biopsies from lung, pleural or mediastinal lesions from June 2019 to June 2020, and who had a follow-up chest radiograph after the procedure. These chest radiographs were read to search the presence of pneumothorax independently by an expert thoracic radiologist and a radiodiagnosis resident, whose unified lecture was defined as the gold standard, and the result of each radiograph after interpretation by the artificial intelligence software was documented for posterior comparison with the gold standard. RESULTS: A total of 284 chest radiographs were included in the study and the incidence of pneumothorax was 14.4%. There were no discrepancies between the two readers' interpretation of any of the postbiopsy chest radiographs. The artificial intelligence software was able to detect 41/41 of the present pneumothorax, implying a sensitivity of 100% and a negative predictive value of 100%, with a specificity of 79.4% and a positive predictive value of 45%. The accuracy was 82.4%, indicating that there is a high probability that an individual will be adequately classified by the software. It has also been documented that the presence of Port-a-cath is the cause of 8 of the 50 of false positives by the software. CONCLUSIONS: The software has detected 100% of cases of pneumothorax in the postbiopsy chest radiographs. A potential use of this software could be as a prioritisation tool, allowing radiologists not to read immediately (or even not to read) chest radiographs classified as non-pathological by the software, with the confidence that there are no pathological cases.


Subject(s)
Pneumothorax , Adult , Humans , Pneumothorax/diagnostic imaging , Pneumothorax/etiology , Artificial Intelligence , Retrospective Studies , Biopsy, Needle/adverse effects , Tomography, X-Ray Computed
2.
Radiologia (Engl Ed) ; 63(4): 358-369, 2021.
Article in English | MEDLINE | ID: mdl-34246426

ABSTRACT

OBJECTIVE: To describe the radiologic findings of extrapulmonary air in the chest and to review atypical and unusual causes of extrapulmonary air, emphasizing the importance of the diagnosis in managing these patients. CONCLUSION: In this article, we review a series of cases collected at our center that manifest with extrapulmonary air in the thorax, paying special attention to atypical and uncommon causes. We discuss the causes of extrapulmonary according to its location: mediastinum (spontaneous pneumomediastinum with pneumorrhachis, tracheal rupture, dehiscence of the bronchial anastomosis after lung transplantation, intramucosal esophageal dissection, Boerhaave syndrome, tracheoesophageal fistula in patients with esophageal tumors, bronchial perforation and esophagorespiratory fistula due to lymph-node rupture, and acute mediastinitis), pericardium (pneumopericardium in patients with lung tumors), cardiovascular (venous air embolism), pleura (bronchopleural fistulas, spontaneous pneumothorax in patients with malignant pleural mesotheliomas and primary lung tumors, and bilateral pneumothorax after unilateral lung biopsy), and thoracic wall (infections, transdiaphragmatic intercostal hernia, and subcutaneous emphysema after lung biopsy).


Subject(s)
Mediastinal Emphysema , Subcutaneous Emphysema , Humans , Mediastinal Emphysema/diagnostic imaging , Rupture , Subcutaneous Emphysema/etiology , Thorax , Trachea
3.
Radiología (Madr., Ed. impr.) ; 62(5): 411-414, sept.-oct. 2020. ilus
Article in Spanish | IBECS | ID: ibc-199820

ABSTRACT

Se presenta el caso de una mujer joven con antecedente de tuberculosis pleural y pulmonar previamente tratada, que acudió a nuestro hospital por dolor torácico y nódulo pleural único visualizado en radiografía simple y TC torácicas. Se realizó punción con aguja fina guiada por ecografía torácica de la lesión pleural con la que se obtuvo material de tipo inflamatorio para estudio con cultivo positivo para Mycobacterium tuberculosis complex. El diagnóstico fue de reacción paradójica al tratamiento antituberculoso y fue tratada durante 6 meses más con resolución de la lesión pleural y el dolor torácico


We present the case of a young woman with a history of previously treated pleural and pulmonary tuberculosis referred to our hospital for chest pain and a single pleural nodule seen on plain chest films and chest CT. Cultures of inflammatory-type material obtained by US-guided fine-needle biopsy of the pleural lesion were positive for Mycobacterium tuberculosis complex. The diagnosis was a paradoxical reaction to antituberculosis treatment; after 6 more months of treatment, the pleural lesion and chest pain disappeared


Subject(s)
Humans , Female , Young Adult , Pleural Neoplasms/diagnostic imaging , Tuberculosis, Pleural/diagnostic imaging , Tuberculosis, Pulmonary/diagnostic imaging , Mycobacterium tuberculosis/isolation & purification , Tuberculosis, Pulmonary/pathology , Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods , Antitubercular Agents/therapeutic use , Radiography, Thoracic
4.
Radiologia (Engl Ed) ; 62(5): 411-414, 2020.
Article in English, Spanish | MEDLINE | ID: mdl-32381376

ABSTRACT

We present the case of a young woman with a history of previously treated pleural and pulmonary tuberculosis referred to our hospital for chest pain and a single pleural nodule seen on plain chest films and chest CT. Cultures of inflammatory-type material obtained by US-guided fine-needle biopsy of the pleural lesion were positive for Mycobacterium tuberculosis complex. The diagnosis was a paradoxical reaction to antituberculosis treatment; after 6 more months of treatment, the pleural lesion and chest pain disappeared.


Subject(s)
Antitubercular Agents/therapeutic use , Tuberculosis, Pleural/drug therapy , Female , Humans , Time Factors , Tuberculosis, Pleural/diagnostic imaging , Young Adult
5.
Urologe A ; 59(6): 700-709, 2020 Jun.
Article in German | MEDLINE | ID: mdl-32020241

ABSTRACT

BACKGROUND: There is to date no convincing literature that has assessed the association between traumatic spinal cord injury (SCI) and the later development of urinary bladder cancer. The aim of this work is to present medical experts as well as the national accident insurance and the social courts decision-making aids based on the latest medical scientific knowledge, for assessment of this causal association. MATERIALS AND METHODS: A study conducted between April 1998 and March 2017 in the BG Trauma Hospital Hamburg forms the basis for the decision-making aids. Urinary bladder cancer was diagnosed in 32 out of 6432 treated outpatient and inpatient SCI patients. Furthermore, relevant published literature was taken into consideration for the decision-making aids. RESULTS: It was found that urinary bladder cancer in SCI patients occurs at a considerably younger age as compared to the general population, more frequently shows muscle invasive carcinoma with a higher grade at first diagnosis and a higher proportion of the more aggressive squamous cell carcinoma than that of the general population. Correspondingly, the survival time is extremely unfavorable. For medical experts a matrix was compiled where the various influencing factors, either for or against the recognition of an association between SCI and urinary bladder cancer, were weighted according to their relevance. CONCLUSION: The results showed that urinary bladder cancer in SCI patients differs considerably from that of able-bodied patients. These differences drastically shorten the survival time. A study on patients with spina bifida, i.e., a congenital spinal cord disorder, corroborates these observations. They indicate histopathological differences that have so far been intangible.


Subject(s)
Carcinoma, Squamous Cell/etiology , Decision Support Techniques , Spinal Cord Injuries/complications , Urinary Bladder Neoplasms/etiology , Urinary Bladder/pathology , Carcinoma, Squamous Cell/pathology , Disease Progression , Humans , Urinary Bladder Neoplasms/pathology
6.
Prostate Cancer Prostatic Dis ; 20(1): 85-92, 2017 03.
Article in English | MEDLINE | ID: mdl-27824042

ABSTRACT

BACKGROUND: Non-prostatic bed recurrence of prostate cancer (PCa) is usually treated with androgen deprivation therapy (ADT). We analyzed the impact of salvage extended lymph node dissection (sLND) on cancer control in patients with rising PSA and lymph node (LN) metastases. METHODS: Between 2009 and 2016 we performed sLND in 87 patients with biochemical recurrence (BCR) and positive LNs on 18FEC and 68Ga-PSMA positron emission tomography/X-ray computer tomography (PET/CT) after primary treatment (PT) of PCa. Intra- and postoperative complications according to Clavien-Dindo were assessed and the rates of biochemical response (BR), BCR-free and clinical recurrence (CR)-free survival, as well as time to initiation of systemic treatment were evaluated. RESULTS: Mean age of patients and mean PSA at sLND was 66.7 years (46-80 years) and 2.63 ng ml-1 (1.27-3.75 ng ml-1), respectively. With 87.4% radical prostatectomy (RP) was the most common PT. In all, 57.9% of patients additionally underwent adjuvant/salvage radiation therapy (RT) and 18.4% received ADT before sLND. Complete BR (cBR) was diagnosed in 27.5% of patients and incomplete BR in 40.6%. In total, 62.2% of patients remained without ADT at follow-up. With a median follow-up of 21 months (1-75 months), the cancer-specific mortality rate was 3.7%. The 3-year BCR-free, systemic therapy-free and CR-free survival rates for patients with cBR were 69.3%, 77.0% and 75%, respectively. CONCLUSIONS: sLND can be performed without significant complications and achieves an immediate BR, thus allowing a significant postponement of systemic therapy in selected patients with BCR and nodal recurrence of PCa. Therefore, sLND following 68Ga-PSMA PET/CT should be considered as part of a multimodal diagnostic and treatment concept for selective patients.


Subject(s)
Positron Emission Tomography Computed Tomography , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/therapy , Aged , Aged, 80 and over , Follow-Up Studies , Humans , Lymph Node Excision , Lymphatic Metastasis , Male , Middle Aged , Neoplasm Grading , Neoplasm Recurrence, Local , Neoplasm Staging , Positron Emission Tomography Computed Tomography/methods , Prostate-Specific Antigen , Prostatic Neoplasms/mortality , Salvage Therapy , Treatment Outcome
7.
Radiología (Madr., Ed. impr.) ; 58(6): 491-495, nov.-dic. 2016. ilus
Article in Spanish | IBECS | ID: ibc-158682

ABSTRACT

Los quistes mediastínicos del conducto torácico son extremadamente raros y pueden dar lugar a quilotórax por rotura espontánea o en el postoperatorio de estas lesiones. Se presenta el caso de una mujer de edad adulta con un quiste mediastínico del conducto torácico y quilotórax debido a rotura espontánea, no descrito previamente en la bibliografía de forma específica. Los hallazgos clínico-radiológicos, el manejo terapéutico y la anatomía patológica se describen, revisando la bibliografía respecto a esta entidad (AU)


Thoracic duct cysts in the mediastinum are extremely rare; they can give rise to chylothorax when they spontaneously rupture or after they are operated on. We present the case of an adult woman with a thoracic duct cyst in the mediastinum and chylothorax from its spontaneous rupture; to our knowledge, this phenomenon has not been specifically reported before. We describe the clinical and radiological findings, the therapeutic management, and the pathology findings, reviewing the literature for this entity (AU)


Subject(s)
Humans , Female , Aged , Mediastinal Cyst/complications , Mediastinal Cyst , Thoracic Duct/pathology , Thoracic Duct , Rupture, Spontaneous/complications , Rupture, Spontaneous , Chylothorax , Radiography, Thoracic/instrumentation , Radiography, Thoracic/methods , Multidetector Computed Tomography/instrumentation , Multidetector Computed Tomography/methods , Multidetector Computed Tomography
9.
Radiologia ; 58(6): 491-495, 2016.
Article in English, Spanish | MEDLINE | ID: mdl-27117300

ABSTRACT

Thoracic duct cysts in the mediastinum are extremely rare; they can give rise to chylothorax when they spontaneously rupture or after they are operated on. We present the case of an adult woman with a thoracic duct cyst in the mediastinum and chylothorax from its spontaneous rupture; to our knowledge, this phenomenon has not been specifically reported before. We describe the clinical and radiological findings, the therapeutic management, and the pathology findings, reviewing the literature for this entity.


Subject(s)
Mediastinal Cyst/diagnostic imaging , Aged , Female , Humans , Mediastinal Cyst/complications , Radiography, Thoracic , Rupture, Spontaneous , Tomography, X-Ray Computed
10.
Urologe A ; 54(10): 1402-6, 2015 Oct.
Article in German | MEDLINE | ID: mdl-25616766

ABSTRACT

BACKGROUND: Postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) is associated with complications and decreased adjunctive surgery. Little data are available concerning PC-RPLND in patients with advanced seminomas and residual retroperitoneal tumor lesions. We examined intra- and postoperative complications as well as the frequency of adjunctive surgeries in patients with seminoma and compared the data to a cohort of patients with non-seminomatous germ cell tumors (NSGCT) who underwent PC-RPLND. PATIENTS AND METHODS: In our retrospective analysis, 580 patients (43 patients with advanced seminomas and 537 patients with NSGCT) underwent PC-RPLND between 1989 and 2010. The surgical approach was preferred via midline incision or a thoracoabdominal approach depending on the location of the residual tumor. RESULTS: Of the 43 patients with seminoma, a total number of 13 adjunctive surgeries were performed in 7 patients. There were only three intraoperative complications, two postoperative complications (prolonged intestinal paralyses). There were no significant differences in adjunctive surgeries and postoperative complications (p=0.49 and p=0.133) between the two groups. There were significantly fewer intraoperative complications in favor of seminomas (p=0.001). CONCLUSION: PCRLND in seminomas and NSGCT is a demanding surgical intervention. In contrast to other series we did not find significant differences in the two patient groups concerning adjunctive surgeries and postoperative complications. The indication for PCLND in patients with seminoma is limited, but if necessary it can be performed safely in experienced centers.


Subject(s)
Antineoplastic Agents/therapeutic use , Neoplasm Recurrence, Local/epidemiology , Seminoma/epidemiology , Seminoma/therapy , Testicular Neoplasms/epidemiology , Testicular Neoplasms/therapy , Adult , Age Distribution , Aged , Combined Modality Therapy/methods , Comorbidity , Disease-Free Survival , Humans , Incidence , Lymph Node Excision/statistics & numerical data , Male , Middle Aged , Neoplasm Recurrence, Local/prevention & control , Neoplasm, Residual , Retrospective Studies , Risk Assessment , Sex Distribution , Young Adult
11.
Urologe A ; 54(1): 14-21, 2015 Jan.
Article in German | MEDLINE | ID: mdl-25519996

ABSTRACT

BACKGROUND: Androgen deprivation therapy (ADT) represents the standard treatment for patients with prostate cancer (PCA) and osseous metastases. We explored the role of cytoreductive radical prostatectomy in PCA with low volume skeletal metastases in terms of a feasibility study. MATERIAL AND METHODS: A total of 23 patients with biopsy proven PCA, minimal osseous metastases (≤3 hot spots on bone scan), absence of visceral or extensive lymph node metastases and a decrease in prostate-specific antigen (PSA) to <1.0 ng/ml after neoadjuvant ADT were included in the feasibility study (group A). The control group (group B) consisted of 38 men with metastatic PCA who were treated by ADT alone. Surgery-related complications, time to castration resistance, symptom-free, cancer-specific and overall survival were analyzed using descriptive statistical analyses. RESULTS: The mean age was 61 years (range 42-69 years) and 64 years (47-83) in groups A and B, respectively, with similar patient characteristics in terms of initial PSA level, biopsy Gleason score, clinical stage and extent of metastatic disease. The median follow-up was 34.5 months (7-75 months) and 47 months (28-96 months) in groups A and B, respectively. Median time to castration resistance was 40 months (9-65 months) and 29 months (16-59 months) in groups A and B, respectively (p=0.04). Patients in group A experienced significantly better clinical symptom-free (38.6 versus 26.5 months, p=0.032) and cancer-specific survival rates (95.6% versus 84.2%, p=0.043) whereas the overall survival was similar. In group A none of the men underwent palliative surgical procedures for locally progressing PCA compared to 29% in group B. CONCLUSIONS: Cytoreductive radical prostatectomy is feasible in well-selected men with metastatic PCA who responded well to neoadjuvant ADT. These men have a long life expectancy and the risk of locally recurrent PCA and local complications are reduced. Cytoreductive radical prostatectomy might be a treatment option in the multimodal management of PCA with minimal osseous metastases.


Subject(s)
Androgen Antagonists/therapeutic use , Bone Neoplasms/secondary , Cytoreduction Surgical Procedures/methods , Prostatectomy/methods , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/therapy , Adult , Aged , Bone Neoplasms/diagnosis , Bone Neoplasms/therapy , Case-Control Studies , Feasibility Studies , Humans , Male , Middle Aged , Treatment Outcome
13.
Urologe A ; 53(6): 823-31, 2014 Jun.
Article in German | MEDLINE | ID: mdl-24824471

ABSTRACT

The therapeutic role of cytoreductive surgery for urogenital malignancies is controversially discussed in the literature. The current article critically reflects the potential impact of cytoreductive surgery in patients with renal cell cancer and prostate cancer with locoregional lymph node or systemic metastases based on a review of the literature and personal experience.Even in the era of molecular targeted therapies in metastatic renal cell cancer, cytoreductive radical nephrectomy seems to exert survival benefit when compared to systemic therapy alone if (1) patients demonstrate a good ECOG performance status, (2) exhibit good or intermediate prognosis according to the Heng criteria, (3) cerebral metastases have been excluded, and (4) >90% of the total cancer volume can be eliminated. Preliminary clinical studies suggest that neoadjuvant systemic treatment might be associated with a significantly reduced 1-year mortality rate.For prostate cancer cytoreductive radical prostatectomy is one of the guideline-recommended treatment options for men with intrapelvic lymph node metastases resulting in survival benefit when compared to androgen deprivation as monotherapy. Cytoreductive radical prostatectomy should be performed (1) in the presence of limited intrapelvic lymph node metastasis without bulky disease, (2) if complete resectability of the primary cancer and its metastasis can be achieved by extended radical prostatectomy and extended pelvic lymphadenectomy, (3) if the patient is included in a multimodality approach, and (4) if the life expectancy is > 10 years.The role of cytoreductive radical prostatectomy in men with osseous metastases remains unclear due to the lack of large clinical trials. Despite the presence of the first promising studies, it is not justified to perform cytoreductive radical prostatectomy outside clinical trials. Preliminary results from small studies indicate that patients with minimal metastatic burden, PSA decrease < 1.0 ng/ml following neoadjuvant ADT for 6 months and complete resectability of the tumor exhibit the best prognosis to benefit from this new surgical approach.


Subject(s)
Carcinoma, Renal Cell/secondary , Carcinoma, Renal Cell/surgery , Kidney Neoplasms/secondary , Kidney Neoplasms/surgery , Nephrectomy/methods , Prostatectomy/methods , Prostatic Neoplasms/surgery , Carcinoma, Renal Cell/pathology , Humans , Lymphatic Metastasis , Male , Neoplastic Cells, Circulating/pathology , Prostatic Neoplasms/pathology , Treatment Outcome
14.
Urologe A ; 52(9): 1261-4, 2013 Sep.
Article in German | MEDLINE | ID: mdl-23975220

ABSTRACT

In the prostate-specific antigen (PSA) era, prostate cancer is detected at more local stages. Nevertheless, depending on e.g. the differentiation stage there is recurrent disease in 10-40% of the cases with the need of further treatment. Once hormonal therapy has been initiated the disease can progress to the castration resistant stage and the question of chemotherapy arises. At this stage PSA sensitivity decreases. Although there is a significant improvement in survival only about 50% of the patients benefit from chemotherapy. Recently several new drugs have or will soon be approved in the setting of castration-resistant prostate cancer (CRPCA). Several prognostic molecular markers have been investigated. In this review some objective important biomarkers, proteins and targets will be presented.


Subject(s)
Biomarkers, Tumor/blood , Neoplasm Proteins/blood , Prostatic Neoplasms/blood , Prostatic Neoplasms/drug therapy , Taxoids/therapeutic use , Antineoplastic Agents/therapeutic use , Docetaxel , Evidence-Based Medicine , Humans , Male , Prevalence , Prognosis , Prostatic Neoplasms/diagnosis , Reproducibility of Results , Risk Factors , Sensitivity and Specificity
15.
Minerva Urol Nefrol ; 65(3): 171-87, 2013 Sep.
Article in English | MEDLINE | ID: mdl-23872628

ABSTRACT

The approval or clinical evaluation of several new agents - cabazitaxel, abiraterone acetate, enzalutamide, sipuleucel-T, and radium-223 - has changed the management of patients with metastatic castration-resistant prostate cancer (mCRPC) prior to or after docetaxel-based chemotherapy significantly. All of these agents have resulted in a significant survival benefit as compared to their control group. However, treatment responses might differ depending on the associated comorbidities and the extent and the biological aggressiveness of the disease. Furthermore, treatment associated side effects differ between the various drugs. As new drugs become approved, new treatment strategies and markers to best select which patients will best respond to which drug are needed. It is the aim of the current article to: (1) summarize the data of established treatment options in mCRPC; (2) highlight new developments of medical treatment; (3) provide clinically useful algorithms for the daily routine and to (4) point out future developments of medical treatment.


Subject(s)
Prostatic Neoplasms, Castration-Resistant/drug therapy , Prostatic Neoplasms, Castration-Resistant/pathology , Antineoplastic Agents/therapeutic use , Biomarkers/blood , Decision Trees , Docetaxel , Humans , Male , Neoplasm Metastasis , Prostatic Neoplasms, Castration-Resistant/blood , Taxoids/therapeutic use , Treatment Outcome
16.
Urologe A ; 51(10): 1424-31, 2012 Oct.
Article in German | MEDLINE | ID: mdl-23053039

ABSTRACT

BACKGROUND: The aim of this study was to evaluate the perioperative oncological and functional outcomes after robot-assisted radical prostatectomy (RALP) in older men. PATIENTS AND METHODS: The records of n = 2,000 men who underwent RALP from February 2006 to April 2010 were retrospectively reviewed. A total of 45 patients ≥ 75 years were indentified. Subsequently this subgroup was compared to the overall patient cohort with regard to perioperative results, pathological tumor stage, functional outcomes after 12 months and the prostate cancer-specific mortality and biochemical recurrence free survival. RESULTS: The following results reflect the comparison of the cohort of patients who were ≥75 years of age versus the overall cohort of patients. A statistical difference of the parameters analyzed was observed only for minor complications 15.5 % versus 11.4 % (p<0.05), neurovascular bundle (NVB) preservation 51.1 % versus 65.7 % (p<0.05) and potency after 12 months 39.6 % versus 66.2 % (p<0.001). Major complications were noted in 2.2 % versus 1.3 % of cases. A Gleason score <7 was noted in 37.4 % versus 42.8 %, a Gleason score 7 in 51.1 % versus 47.7 % and a Gleason score >7 in 11.6 % versus 9.5 %. Tumor stages pT2 and pT3 were noted in 68.8 % versus 73.5 % and in 31.2 % versus 25.2 %, respectively. The positive surgical margin status was encountered in 11.1 % versus 8.9 % of cases, respectively. At 12 months 86.9 % versus 92.8 % of patients were continent and 39.6 % versus 66.2 % were potent, respectively. After a median follow-up of 17.2 months the prostate cancer-specific mortality in the subgroup of elderly patients was 0 % and the biochemical recurrence-free survival was 95.5%. CONCLUSIONS: The RALP approach in patients ≥75 years of age is a safe surgical procedure with a limited complication rate, excellent oncologic and continence outcomes as well as acceptable erectile function. Nevertheless, RALP should be limited to a selected cohort of patients with a good health status and an individual life expectancy of more than 10 years. For the assessment of the final oncological benefits of RALP in this patient population a longer follow-up is necessary.


Subject(s)
Prostatectomy/mortality , Prostatic Neoplasms/mortality , Prostatic Neoplasms/surgery , Robotics/statistics & numerical data , Surgery, Computer-Assisted/mortality , Urinary Incontinence/mortality , Urinary Incontinence/prevention & control , Aged , Aged, 80 and over , Comorbidity , Germany/epidemiology , Humans , Male , Prevalence , Recovery of Function , Retrospective Studies , Risk Factors , Treatment Outcome
17.
Urologe A ; 51(9): 1202-8, 2012 Sep.
Article in German | MEDLINE | ID: mdl-22733397

ABSTRACT

BACKGROUND: Metastasectomy prior to or after systemic medical cancer treatment is performed within a multimodal therapeutic approach in metastatic renal cell cancer (mRCC) to improve the prognosis. The role of metastasectomy in mRCC is controversially discussed and the potential therapeutic benefit is unquantifiable. The purpose of the current review is to critically discuss the available data. METHODS: A systematic literature search was carried out in the MedLinedatabase to identify original publications, review articles and editorials with respect to metastasectomy in mRCC and the current European guidelines were also taken into consideration. RESULTS: Metastasectomy is one of the approaches for mRCC recommended in the guidelines in cases of stable disease for at least 3 months, complete resectability of all metastatic lesions independent of the anatomic localization and a good performance status of the patient. The median survival time varies between 35 and 55 months. CONCLUSIONS: In mRCC metastasectomy is an indiviudal therapeutic approach which might be considered for limited metastatic disease and the presence of good prognostic risk factors to improve average survival time. Especially in renal cell cancer metastasectomy should be considered early.


Subject(s)
Carcinoma, Renal Cell , Kidney Neoplasms , Nephrectomy/mortality , Carcinoma, Renal Cell/mortality , Carcinoma, Renal Cell/secondary , Carcinoma, Renal Cell/surgery , Humans , Kidney Neoplasms/mortality , Kidney Neoplasms/secondary , Kidney Neoplasms/surgery , Prevalence , Risk Assessment , Survival Analysis , Survival Rate , Treatment Outcome
18.
Urologe A ; 51(9): 1282-7, 2012 Sep.
Article in German | MEDLINE | ID: mdl-22733398

ABSTRACT

INTRODUCTION: Medicinal or surgical castration remains the treatment of choice in metastatic, hormone-naive prostate cancer; however, 2-12% of patients never reach the target serum levels for medicinal castration. We analyzed the therapeutic efficacy of triptorelin pamoate (TP) as salvage treatment due to its higher potency than endogenous luteinizing hormone-releasing hormone (LHRH). The amino acid sequence of TP is identical to that of endogenous LHRH except for position 6 where L-glycine is replaced by D-tryptophane rendering the synthetic moiety less susceptible to cleavage by proteolytic enzymes. PATIENTS AND METHODS: In this study 36 patients with prostate-specific antigen (PSA) progression following first line complete androgen blockade and antiandrogen (ADT) withdrawal were retrospectively analyzed. All patients demonstrated no or minimal metastatic disease. The PSA levels, PSA doubling time (PSADT), PSA velocity (PSAV) and testosterone serum concentrations were correlated with the therapeutic response. All patients received TP at a dose of 11.5 mg at 3-month intervals until documented progression. RESULTS: The mean patient age was 69.2 years (range 52-79 years), the mean PSA level was 23.4 ng/ml (8.7-53.1 ng/ml) and the mean PSADT was 9.2 months (2.9-15.4 months). Mean testosterone serum concentration was 38.67 ng/dl (21-76 ng/dl), the mean time between start of ADT and progression was 42.4 months (13-76 months) and the median time was 46.8 months (16-82 months). A PSA decrease of ≥50% was reached in 9 out of 36 (25%) patients, 3 out of 36 (13.9%) patients each demonstrated stable PSA levels and a prolongation of PSADT from 6.2 to 9.8 months. Mean progression-free survival (PFS) was 21.4 weeks (7-53 weeks). PSA-responders exhibited a PFS of 53.2 weeks (26-64 weeks) as compared to 28 weeks (17-35 weeks) in nonresponders. PSA responders demonstrated significantly higher testosterone serum concentrations of 48.3 ng/dl (29-76 ng/dl) as compared to nonresponders with 32.6 ng/dl (21-62 ng/dl, p=0.02). Mean follow-up was 31.4 months (27-39 months), overall survival was 80.5% and cancer-specific survival was 88.9%. CONCLUSION: Changing the LHRH analogue in castration-refractory prostate cancer (CRPC) with testosterone serum concentrations at or above the castration level results in a temporary PSA response. This treatment option might be included in the therapeutic algorithm of CRPC. Although the PFS is short it allows the continuation of a treatment option with minimal side effects in a mere palliative situation. The data underline the need for continuous monitoring of testosterone during treatment with LHRH analogues.


Subject(s)
Gonadotropin-Releasing Hormone/analogs & derivatives , Gonadotropin-Releasing Hormone/agonists , Prostatic Neoplasms/drug therapy , Salvage Therapy/methods , Triptorelin Pamoate/therapeutic use , Aged , Castration , Humans , Male , Middle Aged , Prostatic Neoplasms/surgery , Treatment Outcome
19.
Urologe A ; 51(9): 1246-52, 2012 Sep.
Article in German | MEDLINE | ID: mdl-22526182

ABSTRACT

For pT3 prostate cancer with positive resection margins, the importance of postoperative radiation therapy is confirmed by a high level of evidence. However, for the pT2,R1 situation prospective, randomized studies concerning this question are lacking. Despite better local tumor control in the pT2 stage the PSA recurrence rate lies between 25% and 40% and positive margins are an independent factor for recurrence. Retrospective studies suggest a positive effect of adjuvant or salvage radiation for the oncological outcome in the pT2,R1 situation. On the other hand the side effects profile, with a potentially negative influence of postoperative continence and various delayed toxicities, is not insignificant despite modern radiation techniques and in the era of ultrasensitive PSA analysis should be considered in the risk-benefit assessment. As long as the optimal initiation of postoperative radiation therapy is unclear, the assessment of indications for adjuvant or salvage radiation for organ-limited prostate cancer with positive resection margins should be made after an individual patient consultation and under consideration of the recurrence risk factors, such as the Gleason grade and the localization and extent of the resection margins.


Subject(s)
Neoplasm Recurrence, Local/radiotherapy , Neoplasm, Residual/radiotherapy , Prostatectomy , Prostatic Neoplasms/surgery , Humans , Male , Radiotherapy, Adjuvant
20.
Radiología (Madr., Ed. impr.) ; 54(2): 182-186, mar.-abr. 2012.
Article in Spanish | IBECS | ID: ibc-99853

ABSTRACT

El tumor fibroso solitario intrapulmonar es una neoplasia mesenquimal extremadamente rara sobre la que existen muy pocas referencias en la literatura. Presentamos el caso de una mujer joven con hemoptisis que en la radiografía simple de tórax presentó una masa pulmonar, efectuándose a continuación una TCMD con contraste que mostró una tumoración pulmonar sólida, bien definida y con realce heterogéneo. Se realizó resección quirúrgica de dicha lesión y el estudio histológico reveló un tumor fibroso solitario intrapulmonar con un área de degeneración mixoide. A propósito de este caso realizamos una descripción de los hallazgos clínicos, radiológicos e histológicos de esta rara entidad, así como una revisión de la bibliografía (AU)


Intrapulmonary solitary fibrous tumor is an extremely rare mesenchymal neoplasm about which very few references can be found in the literature. We present the case of a young woman with hemoptysis in whom plain-film chest radiographs showed a pulmonary mass. Contrast-enhanced MDCT showed a solid lung tumor with well-defined margins and heterogeneous enhancement. Histological study after surgical resection of the lesion revealed an intrapulmonary solitary fibrous tumor with an area of myxoid degeneration. We describe the clinical, radiological, and histological findings for this rare entity and review the relevant literature (AU)


Subject(s)
Humans , Female , Adult , Solitary Fibrous Tumor, Pleural/complications , Solitary Fibrous Tumor, Pleural/diagnosis , Hemoptysis/complications , Hemoptysis/diagnosis , Thoracotomy , Immunohistochemistry/methods , Diagnosis, Differential , Solitary Fibrous Tumor, Pleural , Radiography, Thoracic/methods , Radiography, Thoracic , Multidetector Computed Tomography/methods , Multidetector Computed Tomography/trends , Multidetector Computed Tomography , Thoracotomy/instrumentation , Thoracotomy/methods , Chondrosarcoma, Mesenchymal/diagnosis , Chondrosarcoma, Mesenchymal/surgery
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