Table of Contents
Welcome
4
Organisers
5
Sponsor Acknowledgement
6
Floorplan
6
General Information
9
Continuing Medical Education Accreditation (CME)
12
Scientific Programme
13
Programme Thursday, 3 November 15
Programme Friday, 4 November 16
Programme Saturday, 5 November
18
Programme Sunday, 6 November
21
Abstracts
25
Oral Presentations
27
Unmoderated Poster Presentations
37
Exhibition
167
Company Profiles
169
About the Organisers
173
European Association of Urology (EAU)
175
European Society for Medical Oncology (ESMO)
177
European Society for Radiotherapy & Oncology (ESTRO)
178
Indices
181
Abstract Authors
183
Abstracts sorted by Topic
192
Faculty List
194
3
Welcome to the 3rd European Multidisciplinary
Meeting on Urological Cancers
In 2007, Barcelona hosted a pioneering multidisciplinary meeting, bringing together medical professionals
involved in the treatment of urological cancer patients. Since then, the European Multidisciplinary Meeting
on Urological Cancers (EMUC) has established itself as an indispensible forum for experts working across
the board of onco-urology.
It is always beneficial to look at our own practice and experience from a different perspective, and EMUC
enables us to do just that. Organised jointly by the EAU, ESMO and ESTRO, this intensive three-day event
offers exposure to the views and experience of the world’s leading urologists, oncologists and radiologists.
The format and the scale of the meeting allows for a very efficient exchange of information and personal
interaction.
As in the previous years, this edition of the European Multidisciplinary Meeting on Urological Cancers will
feature state-of-the-art lectures, debates and round-table discussions, presentations on the latest findings
of clinical significance, as well as scientific and educational sessions. The scientific programme is intensive
and compact and it offers an all-embracing approach to this multifaceted field of medical science.
In today’s fast-paced world of innovative research, it is vital that we stay up-to-date the technology which
is most relevant in the urological clinical practice today. We invite you to join the 3rd EMUC and tap into
the most current knowledge on expert strategies in prevention, screening, diagnosis and treatment of
prostate, renal and bladder cancers.
Please visit this site regularly for updates on the scientific programme, abstract submission and
registration.
Looking forward to seeing you in Barcelona!
Prof. Per-Anders Abrahamsson
EAU Secretary General
Prof. Hans Joachim Schmoll
ESMO Executive Committee Member
Prof. Jean Bourhis
ESTRO Past-president
4
Organisers
EMUC Organising Steering Committee
EAU
EAU
ESMO
ESTRO
Per-Anders Abrahamsson, Malmö (SE)
Manfred Wirth, Dresden (DE)
Hans Joachim Schmoll, Halle (DE)
Jean Bourhis, Villejuif (FR)
EMUC Scientific Committee
EAU
EAU
ESMO
ESMO
ESTRO
ESTRO
EORTC
Walter Artibani, Verona (IT)
Manfred Wirth, Dresden (DE)
Johann De Bono, Sutton (GB)
Bernard Escudier, Villejuif (FR)
Alberto Bossi, Villejuif (FR)
Peter Hoskin, Northwood (GB)
Susanne Osanto, Leiden (NL)
EMUC Congress Office
Congress Consultants B.V.
PO Box 30016
6803 AA Arnhem
The Netherlands
T +31 (0)26 389 1751
F +31 (0)26 389 1752
W www.emucbarcelona2011.org
E [email protected]
5
Sponsor Acknowledgement
The organisers respectfully acknowledge the following sponsors for providing unrestricted educational
grants and services to the 3rd European Multidisciplinary Meeting on Urological cancers “Embracing
Excellence in Prostate, Bladder and Kidney Cancer”.
Platinum Sponsor
Gold Sponsor
Silver Sponsors
Floorplan
6
General
General Information
Continuing Medical Education Accreditation
(CME)
7
General
Embracing Excellence
in Prostate, Bladder
and Kidney Cancer
Selected webcasts will be available shortly
after the sessions
www.emucbarcelona2011.org
General
General Information
Abstracts and Posters
The abstracts are included in this book. Abstracts and posters are available on-line from 4 November 2011
on www.emucbarcelona2011.org.
Accessibility Congress Venue
The EMUC 2011 will take place at the Palau de Congressos de Catalunya which is easily accessible by
public transport. Congress delegates will receive a transportation pass which is valid on all public transport
within the city of Barcelona during the meeting.
Metro
Green Line (L3) to metro stop “Zona Universitaria” (2 minutes walking distance)
Address
Palau de Congressos de Catalunya
Av. Diagonal, 661 - 671
08028 Barcelona
Spain
T +34 (0)93 3644 400
F +34 (0)93 3644 401
W www.pcongresos.com
W www.hrjuancarlos.com
Barcelona Information
Information on Barcelona will be available at a special desk in the main entrance area of the congress
venue.
Certificate of Attendance
A Certificate of Attendance for the 3rd European Multidisciplinary Meeting on Urological Cancers can be
printed online from Sunday, 6 November onwards on www.emucbarcelona2011.org. A barcode (indicated
on badge) is necessary to access the dedicated website.
Cloakroom/luggage
A cloakroom is located in the main entrance area and is at participants’ disposal during meeting hours.
Be sure to collect all personal belongings at the end of the day.
Congress Bag
Each delegate may collect a congress bag including a programme/abstract book.
Disclosure Links to Industry
It is requested that that all faculty disclose to the audience any links with the industry related to the topic of
their lecture at the beginning of the session. A link can be: Being a member of an advisory board or having
a consulting agreement with a specific company.
Emergency Information
Emergency phone number for police, fire brigade and ambulance service is 112. In case of an emergency
in the congress venue contact the security or the organisation immediately. A First Aid unit is available on
level -1.
9
General
Exhibition
A technical exhibition will be held jointly with the meeting. See page 167 for more information on the
exhibiting companies and the company profiles.
Opening hours:
Friday, 4 November
Saturday, 5 November
Sunday, 6 November
09.00 - 16.00 hrs
09.00 - 16.00 hrs
09.00 - 13.00 hrs
First Aid
There is be a First Aid unit present on level -1. In case of an emergency contact a security guard or the
organisation immediately.
Insurance
The organisers do not accept responsibility for any personal damage. Participants are strongly
recommended to arrange their own personal insurance.
Language
All presentations during the meeting will be conducted in English. There will be no translation provided.
Lost and Found
Found items should be returned to the registration desk in the main entrance area. If you lose something,
please report to this desk for assistance.
Mobile Phones
Mobile phones must be switched off during session.
Press
Journalists can obtain free registration to the meeting. All media operators must show their credentials
(press card dated 2011 and original assignment letter).
Registration area
The registration area is located in the main entrance on level 0.
Safety
All bags may be subject to inspection. Security is present for your safety. Please take all personal effects
with you when leaving the session room.
Scientific Posters
The scientific posters are on display from 4 to 6 November in the poster area in the exhibition hall.
Members of the EMUC Scientific Committee will visit the poster area per topic to discuss the posters with
the presenters according to the following schedule.
It has been requested that one of the authors is present to answer questions during the following poster
viewing hours:
Friday, 4 November
Sunday, 6 November 10
09.45 - 10.15 hrs
11.25 - 12.55 hrs
14.15 - 14.45 hrs 09.40 - 10.10 hrs 12.10 - 13.40 hrs
14.40 - 15.10 hrs 09.40 - 10.10 hrs
Topics: Prostate cancer and Testicular cancer
Topics: Prostate cancer and Testicular cancer
Topics: Kidney cancer and Bladder cancer
Topics: Kidney cancer and Bladder cancer
General
Smoking Policy
Smoking is prohibited inside the congress venue.
Speaker Service Centre (SSC)
All presentations should be handed in at the Speaker Service Centre at least three hours prior to the start
of the session. Please follow the signage from the main entrance to the Speaker Service Centre.
Opening hours:
Thursday, 3 November
Friday, 4 November
Sunday, 6 November
15.00 - 19.30 hrs
07.00 - 18.00 hrs
07.00 - 18.30 hrs
07.00 - 13.00 hrs
Transportation
Delegates may collect a transportation pass in the registration area. The pass provides 10 journeys on the
metro, FGC (FGC run train lines similar to the metro around the city centre) buses, tram and RENFE trains all Zone 1 areas. The main city centre areas are all in Zone 1. The nearest metro stop “Zona Universitaria”
on the Green line (L3) is within 2 minutes’ walking distance of the congress venue.
Note: To use the transportation ticket you have to put the card in the machine and then pull it out completely
from the ticket validation machine - this will release the turnstile to allow you through.
Webcasts
All sessions during the 3rd European Multidisciplinary Meeting on Urological Cancers in Barcelona will be
broadcasted via www.emucbarcelona2011.org to a worldwide audience (provided the speaker has given
approval).
11
General
Continuing Medical Education Accreditation (CME)
The 3rd European Multidisciplinary Meeting on Urological Cancers, Embracing Excellence in Prostate,
Bladder and Kidney Cancer, Barcelona, Spain, 4-6 November 2011 is accredited with 15 hours of European
CME credits in compliance with the UEMS/EACCME regulations: 1 hour = 1 European CME credit with a
maximum of 6 European CME credits per day.
The EBU works according to the quality standards of the European Accreditation Council for Continuing
Medical Education (EACCME).
Both the EBU and the EACCME are the institutions of the European Union of Medical Specialists (UEMS),
www.uems.net.
All CME events accredited by the EBU have the EACCME endorsement.
The EBU/EACCME CME Credits are recognised by National Accreditation Authorities.
Each medical specialist should claim only those hours of credit that he/she actually spent in the
educational activity.
All CME activities approved by the EBU/EACCME are valid for recognition by the American Medical
Association towards the Physician’s Recognition Award (PRA). To convert EACCME credit to AMA PRA
category 1 credit, contact the AMA.
12
Scientific Programme
Friday, 4 November
Scientific
Programme
Sunday, 6 November
13
Programme
Session will take place in the main auditorium
17.30 – 19.00 Prostate cancer clinical case battles
This symposium will focus on informative clinical case discussions in the field of prostate cancer, by
a multidisciplinary panel of top experts (urologists, radiation oncologists and medical oncologists).
Throughout the symposium, patient stories will be followed from locally advanced prostate cancer to
castration-resistant prostate cancer. Interactive voting questions will poll the opinion of the audience, and
after each voting, the outcomes will be discussed with the panel and the audience.
Moderator:
B. Tombal, Brussels (BE)
Urologists:
A. Govorov, Moscow (RU)
M. Graefen, Hamburg (DE)
Radiation oncologists: M. Bolla, Grenoble (FR)
D. Dearnaley, Sutton (GB)
Medical oncologists:
J. Bellmunt, Barcelona (ES)
D. Berthold, Lausanne (CH)
Sponsored by ASTELLAS
15
Programme
Symposium
Friday, 4 November
Programme
All sessions will take place in the main auditorium
08.00 – 08.15
Welcome and introduction
J. Bourhis, Villejuif (FR)
S. Osanto, Leiden (NL)
H. Schmoll, Halle (DE)
M. Wirth, Dresden (DE)
08.15 – 09.45
Session 1: Update on bladder cancer
Chairs:
M. Babjuk, Prague (CZ)
U. Studer, Berne (CH)
08.15 – 08.35
State-of-the-art lecture: Are there reliable markers for diagnosis recurrence and progression?
08.35 – 08.55
State-of-the-art lecture: Management of NMIBC – treatment and follow up
T. De Reijke, Amsterdam (NL)
08.55 – 09.45
Debate: Radical cystectomy and lymphnode dissection or radiotherapy
(with use of audience response system)
Moderators: M. Marberger, Vienna (AT)
T. Wiegel, Ulm (DE)
Surgery:
Radiotherapy:P. Hoskin, Northwood (GB)
09.45 – 10.15 Coffee break and poster viewing
10.15 – 11.25
Session 2: Cystectomy
Chair:
10.15 – 11.05
Debate: Neoadjuvant chemotherapy and adjuvant chemotherapy
Moderators:A. Alcaraz, Barcelona (ES)
Neoadjuvant chemotherapy: S. Osanto, Leiden (NL)
Adjuvant chemotherapy:
A. Stenzl, Tübingen (DE)
11.05 – 11.25
State-of-the-art lecture: New systemic treatment options
M. De Santis, Vienna (AT)
11.25 – 12.55
Coffee break and poster viewing
12.55 – 14.15
Session 3: Penile cancer
Chairs:O. Hakenberg, Rostock (DE)
P. Hoskin, Northwood (GB)
16
12.55 – 13.15
State-of-the-art lecture: Is there a role for immunisation?
S. Minhas, London (GB)
13.15 – 13.35
State-of-the-art lecture: Local treatment - cosmetic result vs.
maximal curative effect
13.55 – 14.15
Programme
13.35 – 13.55
State-of-the-art lecture: Systemic treatment - When and how
O. Hakenberg, Rostock (DE)
State-of-the-art lecture: Radiotherapy and brachytherapy
C. Haie Meder, Paris (FR)
14.15 – 14.45
14.45 – 16.45
Session 4: Renal Cell Cancer
Chairs:P. Mulders, Nijmegen (NL)
C. Sternberg, Rome (IT)
14.45 – 15.35
Debate: Laparoscopic vs. open partial nephrectomy
Moderator: P-A. Abrahamsson, Malmö (SE)
Laparoscopic: G. Janetschek, Salzburg (AT)
Robotic surgery:
A. Mottrie, Aalst (BE)
Open partial nephrectomy: H. Van Poppel, Leuven (BE)
15.35 – 16.25
Debate: Is there a role for neoadjuvant treatment in advanced RCC
Moderator: J. Bellmunt, Barcelona (ES)
Pro: B. Escudier, Villejuif (FR)
Con: P. Mulders, Nijmegen (NL)
16.25 – 16.45
State-of-the-art lecture: Update on systemic treatment in
metastasised disease
16.45 – 17.25
Session 5: Awards for excellence in urology and radiation oncology
Chairs:
A. Bossi, Villejuif (FR)
16.45 – 17.05 State-of-the-art lecture: Differences in time to disease progression
cannot be used as surrogate endpoint for survival in patients under
immediate or deferred androgen deprivation. Final results from EORTC
trial 30891
17.05 – 17.25 State-of-the-art lecture: Radiotherapy trials in prostate cancer interpretation and challenges
17
Programme
08.00 – 08.40
Session 6: From basic science to the clinic
Chairs: M. Brausi, Modena (IT)
S. Fossa, Oslo (NO)
08.00 – 08.20
State-of-the-art lecture: MiRNAs
08.20 – 08.40 State-of-the-art lecture: Stem Cells
N. Maitland, York (GB)
08.40 – 09.40
Session 7: Testicular cancer
Chairs:
M. Brausi, Modena (IT)
S. Fossa, Oslo (NO)
08.40 – 09.00
State-of-the-art lecture: Lessons learned in chemotherapy
09.00 – 09.20
State-of-the-art lecture: Current role of radiotherapy
A. Horwich, Sutton (GB)
09.20 – 09.40 State-of-the-art lecture: Retroperitoneal lymphadenectomy and tumour
resection: When and how?
A. Heidenreich, Aachen (DE)
10.10 – 12.10
Session 8: Prostate cancer
Chairs:P-A. Abrahamsson, Malmö (SE)
10.10 – 11.00 Debate: Screening of prostate cancer
Moderator: P-A. Abrahamsson, Malmö (SE)
Pro: C. Bangma, Rotterdam (NL)
Con: P. Albertsen, Farmington (US)
Panel:P. Albertsen, Farmington (US)
C. Bangma, Rotterdam (NL)
T. Wiegel, Ulm (DE)
11.00 – 11.20
State-of-the-art lecture: Pathology of prostate cancer – What is new?
N. Wernert, Bonn (DE)
18
11.20 – 12.10
Debate: Focal treatment instead of active surveillance
Moderator: G. De Meerleer, Ghent (BE)
Pro: M. Emberton, London (GB)
Con: B. Tombal, Brussels (BE)
Part I
13.40 – 16.20
Session 9: Prostate cancer
Chairs:
13.40 – 14.00
State-of-the-art lecture: The role of brachytherapy in low, intermediate
and high risk prostate cancer
A. Polo, Madrid (ES)
14.00 – 14.20
State-of-the-art lecture: When is lymphadenectomy needed?
N. Clarke, Manchester (GB)
14.20 – 14.40
State-of-the-art lecture: Robot, laparoscopic and open surgery –
What do studies show?
P. Dahm, Gainesville (US)
14.40 – 15.10
15.10 – 15.30
State-of-the-art lecture: Why robotic RPE will stay
W. Artibani, Verona (IT)
Part II
15.30 – 16.20
Debate: Best treatment of high risk prostate cancer?
Moderators: W. Artibani, Verona (IT)
T. Wiegel, Ulm (DE)
Radiotherapy and hormonal treatment
Radical prostatectomy with/ without adjuvant radiotherapy
19
Programme
12.10 – 13.40 Saturday, 5 November
Session will take place in the main auditorium
Programme
Symposium
16.30 – 18.00
Innovating skeletal care in urological cancer patients
Denosumab – a new standard in bone-targeted therapy
P. Mulders, Nijmegen (NL)
Preserving bone health across the prostate cancer continuum of care
Metastases to bone – is prevention possible?
A. Tubaro, Rome (IT)
Skeletal-related events – reducing the risk
P. Maroto, Barcelona (ES)
Sponsored by AMGEN
20
Sunday, 6 November
O1
A
randomised phase II trial of intensive induction chemotherapy
(CBOP/BEP) and standard BEP in poor prognosis germ cell
tumours (MRC TE23, CRUK 05/014, ISRCTN53643604)
Huddart R.A., Gabe R., Cafferty F.H., Pollock P., White J.D., Shamash J.,
Stenning S.P. (Sutton, London, Glasgow, United Kingdom)
O2 inal analysis of the phase 2 randomized discontinuation trial
F
of tivozanib (AV-951) versus placebo in patients with renal cell
cancer
Nosov D.A., Bhargava P., Esteves B., Strahs A.L., Lipatov O.N.,
Lyulko A.A., Anischenko A.O., Chacko R.T., Doval D., Slichenmyer
W.J. (Moscow, Ufa, Russia; Cambridge, United States of America;
Zaporizhia, Donetsk, Ukraine; Vellore, New Delhi, India)
O3 Incomplete thermal ablation induces increased proliferation of
renal carcinoma cells
Kroeze S.G.C., Van Melick H.H.E., Nijkamp M.W., Kruijssen L.W.J.,
Van Diest P.J., Bosch J.L.H.R., Jans J.J.M. (Utrecht, Nieuwegein, The
Netherlands)
O4 C
anadian Urological Oncology Group (CUOG) randomized,
double-blind placebo-controlled phase II trial of sunitinib in
patients with metastatic urothelial carcinoma progressed on or
ineligible for cisplatin-based chemotherapy
Cheng T., North S., Winquist E., Blais N., Mukherjee S. (Calgary,
Edmonton, London, Montreal, Hamilton, Canada)
O5 F
requent mutations of chromatin remodeling genes in
transitional cell carcinoma of the bladder
Gui Y., Guo G., Huang Y., Hu X., Cai Z. (Shenzhen, China)
O6 hase III trial comparing long-term versus short-term androgen
P
deprivation in intermediate and high risk prostate cancer
patients treated with high-dose radiotherapy: Preliminary
results
Maldonado X., Zapatero A., Alvarez A., Guerro A., González San
Segundo C., Cabeza A., Macías V., Casas F., Pedro Olivé A., Boladeras
A., Vazquez De La Torre M.L., Martín De Vidales C., Calvo F.A.
(Barcelona, Madrid, Palma De Mallorca, Vigo, Spain)
21
Programme
08.00 – 09.00
Session 10: Oral presentations of the best abstracts
B. Escudier, Villejuif (FR)
Programme
O7 P
hase 1/2 study of TAK-700, an investigational 17,20-Lyase
Inhibitor, in chemotherapy-naïve patients with metastatic
Castration-Resistant Prostate Cancer (mCRPC): Safety,
efficacy, and evaluation of Circulating Tumor Cells (CTCs)
P. Mortimer, Gross M., Shevrin D., Dreicer R., Trepicchio W.L., MacLean
D., Webb I., Wang J., Agus D.B. (London, United Kingdom, Beverly Hills,
Evanston, Cleveland, Cambridge, United States of America)
09.00 – 09.40
Session 11: Update on medical treatment
09.00 – 09.20
State-of-the-art lecture: New hormonal treatment opportunities in
prostate cancer
J. De Bono, Sutton (GB)
09.20 – 09.40
State-of-the-art lecture: Update on bisphosphonates and RANK-L.
inhibitors
10.10 – 11.10
Session 12: Update on imaging of urological tumours
Chairs:
G. Janetschek, Salzburg (AT)
10.10 – 10.30
State-of-the-art lecture: Prostate Cancer MRI
J. Barentsz, Nijmegen (NL)
10.30 – 10.50
State-of-the-art lecture: Pet scan
J. Kotzerke, Dresden (DE)
10.50 – 11.10
State-of-the-art lecture: Sonography
F. Frauscher, Innsbruck (AT)
11.10 – 12.50
12.50 – 13.00
22
Session 13: Take home messages
Medical oncology: S. Osanto, Leiden (NL)
Radiotherapy: V. Khoo, London (GB)
Urology: W. Artibani, Verona (IT)
Closing remarks
23
Programme
24
Programme
Abstracts
Oral Presentations
Abstracts
Disclaimer
The statements and the opinions published in this abstract book are solely those of the individual
abstract authors and not of the organisers. The abstracts have been printed as submitted. For the
consistency of this publication only a standard language spelling check was made on all abstracts;
it is the decision of the organisers not to edit the abstracts in order not to change any contexts.
25
Oral Presentations
Oral Presentations
Sunday, 6 November, 08.00 - 09.00 hrs
27
28
O1
A randomized phase II trial of intensive induction chemotherapy (CBOP/BEP) and standard BEP
in poor prognosis germ cell tumours (MRC TE23, CRUK 05/014, ISRCTN53643604)
Huddart R.A.1, Gabe R.2, Cafferty F.H.2, Pollock P.3, White J.D.4, Shamash J.5, Stenning S.P.2, TE23 Trial
Management Group and Collaborators
Institute of Cancer Research, Sutton, United Kingdom, 2Medical Research Council Clinical Trials Unit,
London, United Kingdom, 3Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom,
4
Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom, 5St Bartholomew’s Hospital,
London, United Kingdom
1
Material & Methods: Patients were randomized to standard 4xBEP (12 weeks) or CBOP/BEP (Weeks
1 and 3: Cisplatin 50mg/m2 D1&2; vincristine 2mg D1; bleomycin 15000iu D1. Weeks 2 and 4: cisplatin
40mg/m2, vincristine 2mg, carboplatin AUC3, all D1; bleomycin 15000iu D1-5. Weeks 5 and 6: vincristine
2mg D1; bleomycin 15000iu D1. Weeks 7-15 3xBEP with bleomycin 15000iu weekly). The primary outcome
was RR, with favourable response defined as either complete response (normal markers and no residual
mass or complete resection with no viable tumour) or partial response (residual mass unresected) and
normal markers. Secondary outcomes were toxicity, progression-free survival (PFS) and overall survival.
60% RR was anticipated with BEP. Assuming 80% RR with CBOP/BEP, 44 pts were needed to exclude a RR
<60% with 90% power (1-sided 5% significance). Patients were randomized to BEP to benchmark RR; the
trial was not powered to compare arms.
Results: Between 2005 and 2009 89 patients (43 CBOP/BEP) were randomized, median follow-up 33
months. 81 patients (40 CBOP/BEP) completed treatment. CBOP/BEP toxicity, largely haematological, was
high (96% had CTC grade ≥3, 63% with BEP). RRs were 74% with CBOP/BEP and 61% with BEP (90% CIs
(61%, 85%) and (48%, 73%)). Additionally 2 BEP and 0 CBOP/BEP had complete resection of viable tumour.
1-year PFS was 65% and 43% respectively (hazard ratio, HR=0.60, 95% CI (0.33, 1.07)) and overall survival
was 74% and 72% (HR=0.78, 95% CI (0.39, 1.57). 3/14 CBOP/BEP and 2/18 BEP deaths were attributed to
toxicity, one (bleomycin toxicity on CBOP/BEP) after an overdose during treatment.
Conclusions: The trial met its primary outcome with a 90% confidence interval for CBOP/BEP excluding
RRs <61% but CBOP/BEP was more toxic. PFS is promising and similar to that seen after high dose
chemotherapy in EORTC 30974, though with no clear impact on survival. Results should be confirmed in an
international phase III trial.
29
Oral Presentations
Introduction & Objectives: Up to 50% of patients with IGCCCG poor prognosis non-seminomatous tumours die yet BEP (bleomycin, etoposide, cisplatin) has remained standard chemotherapy for many years.
TE23 was a randomized phase II trial evaluating a new intensive induction chemotherapy regimen, CBOP/
BEP, and also establishing current BEP response rates (RR).
O2
Final analysis of the phase 2 randomized discontinuation trial of tivozanib (AV-951) versus
placebo in patients with renal cell cancer
Nosov D.A.1, Bhargava P.2, Esteves B.2, Strahs A.L.2, Lipatov O.N.3, Lyulko A.A.4, Anischenko A.O.5, Chacko
R.T.6, Doval D.7, Slichenmyer W.J.2
1
Blokhin Oncology Research Center, Moscow, Russia, 2AVEO Pharmaceuticals, Inc., Cambridge, United
States of America, 3Bashkortostan Clinical Oncology Center, Ufa, Russia, 4Zaporizhia Medical Academy,
Zaporizhia, Ukraine, 5Donetsk Regional Antitumor Center, Donetsk, Ukraine, 6Christian Medical College,
Vellore, India, 7Rajiv Gandhi Cancer Institute, New Delhi, India
Oral Presentations
Introduction & Objectives: Tivozanib is a potent and selective small molecule tyrosine kinase inhibitor
(TKI) of vascular endothelial growth factor receptor (VEGFR)-1, -2, and -3.
Material & Methods: Patients with advanced renal cell carcinoma (RCC; all histologies) and no prior
VEGF-targeted therapy were enrolled. All patients received 16 weeks of open-label tivozanib 1.5 mg/day,
following which patients were stratified: patients with ≥25% tumor shrinkage continued tivozanib, patients
with ≥25% tumor increase were discontinued, and patients with <25% tumor change from baseline were
randomized to 12 weeks of double-blind tivozanib or placebo. Randomized patients were un-blinded at the
time of progressive disease or at the end of the double-blind phase, and those on placebo were allowed to
restart tivozanib. Computed tomography (CT) scans were read by blinded, independent reviewers.
Results: 272 patients were enrolled: 83% had clear cell RCC, 73% had undergone prior nephrectomy,
and 46% had received prior therapy. In the overall study population, 84% of patients demonstrated
partial response or stable disease by Week 16. After the 16-week open-label phase, 118 patients were
randomized to tivozanib (n = 61) or placebo (n = 57). Significantly more patients were progression free
after 12 weeks of double-blind treatment with tivozanib (49%) compared with placebo (21%; P = 0.001).
In the overall population, the overall response rate (ORR) was 24% and an additional 54% of patients
experienced stable disease; median progression-free survival (PFS) was 11.7 months. In a subset of
patients with clear cell histology who had undergone a nephrectomy, the ORR, stable disease rate, and
median PFS were 30%, 52%, and 14.8 months, respectively. Hypertension (45%) and dysphonia (22%) were
the most common drug-related adverse events (AEs) of any grade. There was a low incidence of drugrelated diarrhea (12%), asthenia (10%), fatigue (8%), dyspnea (6%), cough (5%), anorexia (5%), stomatitis
(4%), hand-foot syndrome (4%), and proteinuria (3%). Grade 3/4 AEs were infrequent; the most common
grade 3/4 AE was hypertension, reported in 12% of patients.
Conclusions: Tivozanib shows promising efficacy and acceptable safety and tolerability as a selective
VEGFR TKI for patients with advanced or metastatic RCC. In the overall study population, the ORR and
median PFS were 24% and 11.7 months, respectively. In patients with clear cell RCC who had undergone
nephrectomy, tivozanib demonstrated the greatest efficacy with an ORR of 30% and median PFS of 14.8
months. The safety profile was acceptable with a low incidence of off-target toxicities, such as hand-foot
syndrome and proteinuria. Based on these results, tivozanib is being evaluated in nephrectomized patients
with advance clear cell RCC in the global phase 3 TIVO-1 study.
30
O3
Incomplete thermal ablation induces increased proliferation of renal carcinoma cells
Kroeze S.G.C.1, Van Melick H.H.E.2, Nijkamp M.W.3, Kruijssen L.W.J.1, Van Diest P.J.4, Bosch J.L.H.R.1,
Jans J.J.M.1
University Medical Center Utrecht, Dept. of Urology, Utrecht, The Netherlands, 2St. Antonius Hospital,
Dept. of Urology, Nieuwegein, The Netherlands, 3University Medical Center Utrecht, Dept. of Surgical
Oncology, Utrecht, The Netherlands, 4University Medical Center Utrecht, Dept. of Pathology, Utrecht, The
Netherlands
Introduction & Objectives: Local recurrences of renal tumors occur frequently after radiofrequency
ablation (RFA) and cryoablation (CA), and are observed more often compared to partial nephrectomy (PN).
Although these high recurrence rates may be partly due to incomplete tumour ablation, stimulatory factors
triggered by the thermal ablation could contribute by accelerating growth of remnant tumor cells. The aim
of this study was to examine the presence of cell proliferation and growth stimulatory factors in remnant
renal carcinoma cells following incomplete thermal ablation.
Material & Methods: Renal tumors were orthotopically transplanted under the renal capsule of mice (4-6
mice/group). RFA, CA or PN was performed. At several time points (2h and 1, 2, 3, 7, 14 days) hereafter,
presence of cell proliferation (Ki67), hypoxia, inflammatory factors (CD45, F4/80) and heat shock proteins
(HSP70 and HSP90) was evaluated using immunohistochemistry.
Results: Increased cell proliferation was evident at the border of the ablated region starting at 2 hours,
peaking 3 days, and remaining elevated for 2 weeks after thermal ablation. Hypoxia and HSP70 elevation
also occurred from 2 hours following thermal ablation. Inflammatory cells infiltrated at a later time point
(24h) following thermal ablation, mainly within the ablated area. These observations were comparable
between RFA and CA, although they were more pronounced in the RFA treatment group. HSP90 was only
present in RFA treated tumors. The described effects were not observed following PN.
Conclusions: Following both RFA and CA, accelerated growth of residual tumor cells is observed. This is
not present following PN. We hypothesize that thermal ablation induced stimulatory factors as hypoxia and
HSP70 are responsible for the growth and survival of remnant tumor cells. This underlines the importance
of complete ablation for good oncological outcomes.
31
Oral Presentations
1
O4
Canadian Urological Oncology Group (CUOG) randomized, double-blind placebo-controlled
phase II trial of sunitinib in patients with metastatic urothelial carcinoma progressed on or
ineligible for cisplatin-based chemotherapy
Cheng T.1, North S.2, Winquist E.3, Blais N.4, Mukherjee S.5
Tom Baker Cancer Centre, Dept. of Medical Oncology, Calgary, Canada, 2Cross Cancer Institute, Dept.
of Medical Oncology, Edmonton, Canada, 3London Health Sciences Centre, Dept. of Medical Oncology,
London, Canada, 4Chum – Hopital Notre-Dame, Dept. of Medical Oncology, Montreal, Canada, 5Juravinski
Cancer Centre, Dept. of Medical Oncology, Hamilton, Canada
1
Oral Presentations
Introduction & Objectives: Sunitinib is a small molecule inhibitor of class III/IV receptor tyrosine kinases
including VEGFR-1, -2, and-3, PDGFR-α and -β, KIT and FLT3. This randomized double-blind phase II trial
investigated the efficacy and safety of sunitinib or placebo in the treatment of incurable advanced or
metastatic urothelial carcinoma. We report the interim analysis from the blinded phase.
Material & Methods: Eligibility criteria included: advanced urothelial carcinoma, progression on or
ineligible for cisplatin-based chemotherapy, ≤ 4 lines of prior systemic therapy, ECOG PS≤ 2, and adequate
organ function. Target accrual was 58 patients. Patients were randomized to receive sunitinib 50mg or placebo for 4 weeks followed by 2 weeks off drug, with cycles repeated every 6 weeks. All patients received
best supportive care. Unblinding was allowed at disease progression, and patients receiving placebo were
then eligible to receive open label sunitinib. The primary endpoint was progression-free survival. Response
was assessed by RECIST 1.0.
Results: From March 2008 to March 2011, 32 patients were recruited (69% female, median age 67, 79%
had visceral involvement) at 5 Canadian centres. 17 received sunitinib and 15 received placebo, with the
median number of prior chemotherapy regimens was 1.5 and 1.0, respectively. The median duration of
treatment was 66 days for sunitinib and 53 days for placebo. At a median follow of 4.5 months the 6-month
PFS rate was 16.4% for sunitinib and 22.0% for placebo (p=0.89). Median survival was 5.4 months for both
groups (p=0.90).
Conclusions: Patients with metastatic urothelial carcinoma progressed on or ineligible for chemotherapy
have a very poor prognosis, and sunitinib demonstrated very modest activity compared to placebo on this
study. Effective treatments for these patients are needed.
32
O5
Frequent mutations of chromatin remodeling genes in transitional cell carcinoma of the bladder
Gui Y.1, Guo G.2, Huang Y.1, Hu X.2, Cai Z.1
Peking University Shenzhen Hospital, Dept. of Urology, Shenzhen, China, 2BGI-Shenzhen, Dept. of
Bio-informatics, Shenzhen, China
1
Material & Methods: The exomes of nine TCC patients were captured with NimbleGen 2.1M Human
Exome Arrays and sequenced with Illumina GAII platform. All the somatically mutated genes discovered
from the nine patients were screened in a prevalence set of 88 additional TCCs with different tumor stages
and grades. The non-silent somatic substitutions and indels were validated by mass spectrum and Sanger
sequencing, respectively.
Results: 54 significantly mutated genes in the 97 patients were identified. Five genes with well-established
roles in TCC showed significantly higher mutation frequency in our study, including TP53 (altered in 21%
of TCCs), RB1 (altered in 11%), HRAS (altered in 10%), FGFR3 (altered in 9%), and KRAS (altered in 6%). The
other 49 significantly mutated genes were all novel candidates with no previously well-defined roles in
TCCs and 33% (16/49) of them were frequently mutated genes which showed mutations in more than 5%
of TCCs. Most notably, frequent non-silent mutations in eight genes that were involved in the chromatin
remodeling process were detected. Of these genes, the most frequently altered were the histone demethylase gene (HDMT) UTX (mutated in 21% of TCCs); two histone acetyltransferase (HAT) genes CREBBP
and EP300, and the SWI/SNF-related chromatin remodeling gene ARID1A (all mutated in 13%). Aberration
of each of the remaining four genes was also detected in more than 5% of TCCs, including the histone
methyltransferase (HMT) genes MLL and MLL3, and two other chromatin remodeling genes NCOR1 (encoding a constitutive subunit for the N-coR-HDAC3 complex that possesses histone deacetylation (HDAT)
activity) and CHD6 (encoding a component of SNF2/RAD54 helicase family that remodels chromatin to
allow cell-type specific gene expression). The genetic aberrations of the eight chromatin remodeling genes
(UTX, MLL/MLL3, CREBBP/EP300, NCOR1, ARID1A and CHD6) were identified in 59% of 97 TCC patients.
Of these genes, UTX was shown to be altered significantly more frequently in tumors of low stages and
grades, highlighting its potential role in the classification and diagnosis of bladder cancer.
Conclusions: These results provided an overview of the genetic basis of TCC and suggested that aberration of chromatin regulation might be a hallmark of bladder cancer.
33
Oral Presentations
Introduction & Objectives: Transitional cell carcinoma (TCC) is the most common type of bladder cancer. Previous studies based on candidate gene approaches have provided important insights into potential
diagnoses and therapeutic applications, yet no comprehensive analysis of this cancer has been performed.
In this study, we aimed to screen TCC systematically to identify other novel bladder cancer associated
genes by exomic capture and massively parallel sequencing technologies.
O6
Phase III trial comparing long-term versus short-term androgen deprivation in intermediate and
high risk prostate cancer patients treated with high-dose radiotherapy: Preliminary results
Maldonado X.1, Zapatero A.2, Alvarez A.3, Guerro A.4, González San Segundo C.3, Cabeza A.5, Macías V.6,
Casas F.7, Pedro Olivé A.8, Boladeras A.9, Vazquez De La Torre M.L.10, Martín De Vidales C.11, Calvo F.A.3,
GICOR
Hospital Valle De Hebrón, Dept. of Radiation Oncology, Barcelona, Spain, 2Hospital Universitario De La
Princesa. Instituto Investigación Sanitaria IP, Dept. of Radiation Oncology, Madrid, Spain, 3Hospital Universitario Gregorio Marañón, Dept. of Radiation Oncology, Madrid, Spain, 4Hospital Son Dureta, Dept. of Radiation Oncology, Palma De Mallorca, Spain, 5Hospital 12 De Octubre, Dept. of Radiation Oncology, Madrid,
Spain, 6Hospital General De Cataluña, Dept. of Radiation Oncology, Barcelona, Spain, 7Hospital Clinic, Dept.
of Radiation Oncology, Barcelona, Spain, 8Clínica Plató, Dept. of Radiation Oncology, Barcelona, Spain,
9
Institut Catala Oncolgia, Dept. of Radiation Oncology, Barcelona, Spain, 10Hospital Do Meixoeiro, Dept.
of Radiation Oncology, Vigo, Spain, 11Ospital Universitario De La Princesa, Dept. of Radiation Oncology,
Madrid, Spain
Oral Presentations
1
Introduction & Objectives: This trial was designed to determine whether long-term AD (LTAD) is superior
to short-term AD (STAD) when combined with high-dose radiotherapy (HDRT) in patients with intermediate
and high risk prostate cancer (PC).
Material & Methods: Patients with cT1c-T3aN0M0 adenocarcinoma of prostate with intermediate and
high risk factors according to 2005 NCCN criteria and PSA less than 100 ng/ml were included. All patients
received 4 months of neoadjuvant and concomitant AD (STAD) + HDRT (minimum dose to the prostate
76 Gy) before randomization to adjuvant gosereline (LTAD) for two years. Stratification was performed
according to risk group (intermediate risk [IR] versus high risk [HR]). Study endpoints included biochemicaldisease free survival (bDFS), overall survival (OS), metastasis free survival (MTS) and toxicity. We present
the preliminary results.
Results: A total of 361 men were registered, of whom 180 were randomly assigned, to STAD (97 HR and
83 IR) and 181 to LTAD (94 HR and 87 IR). Median isocenter radiation dose to the prostate was 78.0 Gy for
both groups and elective pelvic radiotherapy was administered in 28 patients treated with STAD and in 20
patients with LTAD. Demographic data, tumour and treatment characteristics were evenly distributed in the
two arms. After a median follow-up of 36 months, 9 patients in the STAD group (2 intermediate risk and 7
high risk PCa, p>0.05) and none in the LTAD group had biochemical failure according to Phoenix definition (p=0.002). The median time to biochemical relapse was 28 months. Four patients developed distant
metastasis (all of them in the STAD arm) and 3 patients have died from causes other than PCa. Grade ≥ 2
radiation related adverse effects in both groups were not statistically significant.
Conclusions: Although preliminary, the results of the present study suggest that LTAD could be superior
to STAD in patients with unfavourable PCa treated with HDRT.
34
O7
Phase 1/2 study of TAK-700, an investigational 17,20-Lyase Inhibitor, in chemotherapy-naïve
patients with metastatic Castration-Resistant Prostate Cancer (mCRPC): Safety, efficacy, and
evaluation of Circulating Tumor Cells (CTCs)
P. Mortimer1, Gross M.2, Shevrin D.3, Dreicer R.4, Trepicchio W.L.5, MacLean D.6, Webb I.7, Wang J.8,
Agus D.B.7
Takeda Global Research & Development Centre (Europe) Ltd, London, United Kingdom, 2USC Westside
Cancer Center, Dept. of Medicine, Beverly Hills, United States of America, 3NorthShore University Health
System, Dept. of Medicine, Evanston, United States of America, 4Cleveland Clinic, Dept. of Solid Tumor
Oncology, Cleveland, United States of America, 5Millennium Pharmaceuticals, Inc., Dept. of Molecular
Medicine, Cambridge, United States of America, 6Millennium Pharmaceuticals, Inc., Dept. of Oncology
Clinical Research, Cambridge, United States of America, 7Millennium Pharmaceuticals, Inc., Dept. of Biostatistics, Cambridge, United States of America, 8USC Keck School of Medicine, Dept. of Medicine, Beverly
Hills, United States of America
Introduction & Objectives: Limited therapeutic options exist for patients with mCRPC following failure
of initial treatments. CTC enumeration can be utilized as a surrogate for disease activity in these patients
with select therapeutics. In particular, the categorical shift from ≥5 to <5 cells per 7.5 mL of whole
blood, during therapy, may represent a better predictor of overall survival than changes in prostatespecific antigen (PSA) levels. TAK-700 is an investigational, selective, reversible, non-steroidal inhibitor of
17,20-lyase, a key enzyme in the production of adrenal androgens. Here, in addition to safety and efficacy,
we report preliminary data on CTC enumeration as a biomarker of response from a phase 1/2 study in
chemotherapy-naïve patients with mCRPC (TAK-700_201, NCT00569153) who received TAK-700.
Materials & Methods: Patients received oral TAK-700 at 100–600 mg BID (phase 1), or in phase 2,
at 300 mg BID, 600 mg QD, or two dose levels with prednisone: 400 or 600 mg BID plus prednisone 5
mg BID. Blood samples were collected on a 28-day cycle (at baseline and on Day 1 of cycles 2, 4, and
every 3 cycles thereafter) for evaluation of biomarkers of response to TAK-700. PSA was determined by
conventional methods and CTCs were enumerated using the CellSearch methodology.
Results: In the phase 2 portion, 97 pts received TAK-700 (n=23–26 per group). The most common AEs
were fatigue (72%), nausea (44%), and constipation (31%); most common grade ≥3 AEs were fatigue (9%)
and diarrhea (3%). TAK-700 resulted in reductions in circulating concentrations of testosterone and the
adrenal androgen DHEA-S. Of 43 RECIST-evaluable patients, six had a partial response, 23 had stable
disease, and 9 had disease progression. As of November 2010, CTCs could be enumerated in 99 (90%)
of 110 patients enrolled in the phase 1/2. CTCs at baseline were ≥5 in 43 (43%) patients and <5 in 56
(57%) patients. Of those with CTCs ≥5 at baseline, 21 (49%) achieved CTCs <5 at follow-up. Overall, 31
(72%) patients with baseline CTCs ≥5 had a ≥50% reduction in CTCs at follow-up. Of patients with CTCs
<5 at baseline, all but 5 patients (n=51, 91%) maintained CTCs <5 at follow-up. PSA response rates (≥50%
decrease) at 12 weeks were similar across treatment groups, with an overall response rate of 53%.
Conclusions: In patients with mCRPC, oral TAK-700 (with/without prednisone) at doses of ≥300 mg BID
was well tolerated and appears active. TAK-700 treatment resulted in CTCs reductions in the majority of
patients. Notably, approximately half of patients with CTCs ≥5 at baseline converted to CTCs <5 with TAK700 treatment. Correlation with other biomarkers of clinical outcome will be presented, as well as updated
safety and response data. Patient follow-up is ongoing.
35
Oral Presentations
1
36
09.45 - 10.15 hrs
11.25 - 12.55 hrs
14.15 - 14.45 hrs
Saturday, 5 November 09.40 - 10.10 hrs
12.10 - 13.40 hrs
14.40 - 15.10 hrs
Sunday, 6 November 09.40 - 10.10 hrs
Unmoderated
Friday, 4 November
Unmoderated
PostersPosters
Poster viewing hours
37
P001
The role of total testosterone and total testosterone/ total PSA ration in prostate cancer
screening
Botelho F.J.S.1, Pina F.M.1, Cruz F.1, Lunet N.2
Unmoderated Posters
1
Hospital S. João, Dept. of Urology, Porto, Portugal, 2University of Porto Medical School, Dept. of Hygiene
and Epidemiology, Porto, Portugal
Introduction & Objectives: Prostate cancer (PC) is an endocrine-responsive tumor and several pathways
may explain the association between serum total Testosterone (tT) and PC. Previous studies on this topic
are conflicting with some authors defending that either tT or the ratio tT/total PSA (tPSA) can be lower in
patients with PC, particularly in patients with lower tPSA. However none of these investigations evaluate
patients with prostatitis or high grade prostate intraepithelial neoplasia (HGPIN) as individual groups, none
had samples bigger than 600 patients, and some suffer from limited challenged bias. We evaluated tT as a
diagnostic tool for PC, using a large sample of patients with increased risk of PC and presenting different
prostatic pathologies.
Material & Methods: We consecutively enrolled 1577 candidates referred to ultrasound guided transrectal prostate biopsy in S. João Hospital (median tPSA: 7.0ng/mL), in whom tT, tPSA, and free PSA (fPSA)
were measured in fast blood samples collected before biopsy. Groups were compared using Kruskal-Wallis
test, and Spearman correlation coefficients were computed to quantify the association between continuous variables. Diagnostic capability of the different biomarkers was evaluated with receiver operating
characteristic (ROC) analysis. Analyses were repeated using only patients with tPSA < 4ng/mL.
Results: Prostatic biopsies revealed PC in 620 cases (39.3%), HGPIN in 51 cases (3.2%), pathological prostatitis in 624 cases (39.6%), BPH or no alteration in 282 cases (17.9%). No difference was observed when
comparing tT levels between prostatic biopsy pathologies (median: 4.26 vs. 4.44 vs. 4.31 vs. 4.16 pg/mL,
respectively; p=0.58). The tT level were the same in prostatic cancer and benign pathology (median: 4.25
vs. 4.25 pg/mL, respectively; p=0.97). No significant correlations were observed between tT and age (r=0.002; p=0.94), tPSA (r=-0.034; p=0.20), or f/t PSA ratio (r=0.029; p=0.282). Considering ROC analysis
tT/tPSA ratio is a better diagnostic test than tT alone (AUC of 0.62 (95%CI: 0.59-0.65) vs. 0.51 (95%CI:
0.48-0.53)), but worse than f/t PSA ratio (AUC: 0.70 (95%CI: 0.67-0.73)). In PC patients the tT levels were
not significantly different across Gleason score groups. Results were similar if we only considerer patients
with PSA < 4 ng/mL.
Conclusions: These results indicate that tT serum values were similar between patients with pathology
proved different prostatic diagnosis and they don’t have any clinical utility in screening for PC. The f/t PSA
ratio still was the best diagnostic tool to help detecting PC.
38
P002
Screening for prostate cancer in men younger than 50 years
Botelho F.J.S.1, Pina F.M.1, Lopes I.1, Cruz F.1, Lunet N.2
1
Hospital S. João, Dept. of Urology, Porto, Portugal, 2University of Porto Medical School, Dept. of Hygiene
and Epidemiology, Porto, Portugal
Material & Methods: Between January 2005 and June 2010, a total of 43 men less than 50 years of age
were referred to ultrasound guided trans-rectal prostate biopsy, on the basis of abnormal rectal examination and/or elevated total Prostate Specific Antigen (tPSA) levels, in the department of urology of S. João
Hospital. The final prostate pathology and the prostate cancer cases Gleason score were defined by biopsy
results. We describe this population and performed ROC analysis for the value of freePSA/ tPSA (f/tPSA)
ratio.
Results: The median age of the 43 men was 47 years (range, 38-49 years) and the mean PSA level was
8.04 ng/ml (range: 2.25-54.46 ng/ml). The results of the primary biopsy was 18 (41.1%) cases of prostate
cancer, 12 cases (27.9%) with pathological prostatitis and 13 cases (31.0%) benign prostatic hyperplasia
or no alteration. Of the cases with prostate cancer, there were 12, 2 and 1 cases of Gleason 7, 8 and 9
respectively. A lower f/tPSA ratio was a weak indicator of malignancy (Area Under Curve: 0.623; 95% CI:
0.417-0.828).
Conclusions: The prostate cancer detection rate in young men less than 50 years of age with high PSA
levels and normal DREs was significant and with clinical relevant cancers. The f/tPSA ratio add modest
information about the probability of neoplasm detection in the biopsy.
39
Unmoderated Posters
Introduction & Objectives: Prostate cancer is rarely diagnosed in men younger than 50 years of age. At
present, the available data show a low rate of cancer detection from prostate-specific antigen (PSA) screening of this group of young men. We analyzed the outcome of prostate biopsy results in patients of this age
group with indication for a prostate biopsy.
P003
Extended and super-extended lymph node dissection in prostate cancer patients – Is there any
diagnostic difference?
Golovashchencko M.1, Alekseev B.Ya.2, Nyushko K.M.2, Kalpinskiy A.S.2, Vorobyev N.V.2, Frank G.A.2,
Andreeva Yu.Yu.2, Chissov V.I.2
Moscow Research Oncology Institute, Dept. of Oncology, Moscow, Russia, 2Moscow Hertzen Oncology
Institute, Dept. of Oncourology, Moscow, Russia
1
Unmoderated Posters
Introduction & Objectives: Recent clinical data have established that standard pelvic lymph node dissection (s-PLND) in prostate cancer (PC) patients is less accurate in assessing lymph node (LN) metastases
than extended pelvic lymph node dissection (e-PLND). Currently new templates of PLND boundaries in PC
patients have been determined – super-extended PLND (se-PLND). The aim of our study was to compare
diagnostic results and complication rate of e-PLND and se-PLND.
Material & Methods: 205 patients with intermediate and high risk PC who had undergone radical prostatectomy (RPE) and PLND from 2008 till 2011 in our institution were included in the study. E-PLND was
performed in 153 (74.6%) patients. Mean patient’s age was 62.1 ± 6.7 (42-75 years); mean PSA level – 14.7
± 10.6 ng/ml. Clinical stage was T1c-T2c in 116 (75.8%) patients, T3a in 37 (24.2%) patients; biopsy Gleason score 2-4 was verified in 6 (3.9%) patients, 5-6 – in 77 (50.3%), 7 – in 58 (38%) and 8-10 in 12 (7.8%)
patients. Mean percentage of positive biopsy cores was 59.4 ± 29.2%. In this group of patients external
iliac, obturator and internal iliac LN were removed. Se-PLND was performed in 52 (25.4%) patients. Mean
patient’s age in this group was 61.9 ± 5.8 (48-72 years); mean PSA level – 15.2 ± 8.7 ng/ml. Clinical stage
was T1c-T2c in 38 (73.1%) patients, T3a in 14 (26.9%) patients; biopsy Gleason score 2-4 was in 2 (3.9%)
patients, 5-6 – in 24 (46.2%), 7 – in 20 (38.4%) and 8-10 in 6 (11.5%) patients. Mean percentage of positive
biopsy cores was 61.4 ± 29.1%. In all patients of this group external, internal, common iliac, obturator
and presacral LN were removed. There was no significant difference in patient’s age, PSA level before the
operation, biopsy Gleason score, clinical stage and percentage of positive biopsy cores in two groups of
patients (p>0.05).
Results: Mean number of LN removed in e-PLND group was 24.6 ± 7.9 (12-52), in se-PLND group – 27 ±
7 (15-44), p=0.02. LN metastases were verified in 27 (17.7%) patients in e-PLND group and in 16 (30.8%)
patients in se-PLND group, p=0.038. In se-PLND group LN metastases were verified in internal ileac region
in 38.7% of cases, external ileac – in 28%, obtarator region – in 14.7%, common ileac – in 14.6% and in
presacral region – in 4% of cases. In e-PLND internal ileac LN metastases were verified in 41.5% of cases,
external ileac – in 34% and in obturator – in 24.5% of cases. Mean lymphorrhea duration was 11.5 ± 6.2
days in e-PLND group and 11.2 ± 5.3 days in se-PLND group, p>0.05. No significant difference in complication rate was observed between these groups (p>0.05).
Conclusions: Se-PLND is associated with enlarged number of LN removed and number of LN metastases
diagnosed. Se-PLND is more accurate in diagnosis of LN invasion rate; it is not associated with increased
morbidity and could be recommended to be performed in all patients with intermediate and high risk PC.
40
P004
Prostate biopsy: A safe procedure
Moreno Alarcón C., López González P.A., López Cubillana P., Server Pastor G., Doñate Iñíguez G., Ruiz
Morcillo J.C., Olarte Barragán E.H., Gómez Gómez G.
Hospital Universitario Virgen De La Arrixaca, Dept. of Urology, Murcia, Spain
Introduction & Objectives: To evaluate the incidence of minor complications (haematuria, hematospermia and rectal bleeding) and major complications (fever and shock) in patientes undergoing transrectal
biopsy of the prostate and to identify risk factors.
Results: Eight patients (5,5%) suffered fever and 7 (4,8%) of them were admitted. One of the patients
(0,7%) suffered shock. The mean of time between biopsy and fever was 4,3 days. Haematuria and hematospermia were more frequent in patients younger than 65 years (p<0.05) and fever and sepsis were more
frequent in patients with prostate volume smaller than 55 mL (p<0.05).
Conclusions: Transrectal biopsy of the prostate complications are frequent, autolimited and they rarely
suppose a health hazard for the patients. The higher incidence of haematuria and hemospermia in younger
patients could be related to the lower prostate volume and the fact that their greater sexual activity give
them more chance of watching the hemospermia. The lower prostate volume as a risk factor could make
us think in a relationship between aggression-volume that could increase the risk of infection.We must take
into account that the information to the patient is very important after a prostate biopsy, so we can avoid
useless consultations (for example with haematuria) and it will enable to identify important signs like fever
earlier.
41
Unmoderated Posters
Material & Methods: We present a prospective and descriptive study where we evaluated 146 patients
subjected to transrectal biopsy of the prostate. Complications rates and risk factors were analized by
t-student univariate test.
P005
Saturation prostatic biopsy for diagnosis of curable prostate cancer in young men
Padilla-Fernandez B.1, Lorenzo-Gomez M.F.1, Silva-Abuin J.M.1, Antunez-Plaza P.2, Gil-Vicente A.1, GarciaCriado F.J.3
1
Universitary Hospital of Salamanca, Dept. of Urology, Salamanca, Spain, 2Universitary Hospital of Salamanca, Dept. of Pathology, Salamanca, Spain, 3Faculty of Medicine, Dept. of Surgery, Salamanca, Spain
Unmoderated Posters
Introduction & Objectives: In the PSA era, for the diagnosis on early phases with undetectable tumours
by digital rectal examination and PSA below 10ng/ml, the prostate biopsy becomes the key tool of the
confirmation diagnosis. We present the results of a study performed regarding a prostate saturation biopsy
instruction protocol in a sample of 328 patients investigated because of prostate cancer suspicion.
Material & Methods: 328 patients, mean age 66.86 years (45-81), were investigated because elevated
PSA or PSA velocity (>4ng/ml or >0.75ng/dl/year respectively) undergoing a prostate biopsy. Study
groups: Group R (n=170): patients having an outpatient 10-core (5-core bilateral) trans-rectal ultrasound
guided prostate biopsy with local anaesthesia; and Group S (n=158): patients having a 24-28-core (1214-core bilateral) trans-rectal ultrasound guided prostate biopsy with sedation. Saturation biopsy was
indicated when PSA increased ≥0.375ng/ml after negative regular biopsy in 6 months follow-up.
Results: Group R: mean age 70.17 years (50-84 range, 99% confidential interval 68.44-71.90), Mean PSA
11.51nanogram/milliliter (0.87-118.2, 99%CI 8.78-14.24), prostate adenocarcinoma n=77 (45.45%) Gleason
score (GS) 5 or 6 n=31 (18%), GS ≥7 n=46 (27%), high grade prostatic intraepithelial neoplasia (PIN) n=42,
atypical samall acinar proliferation (ASAP) n= 6, benign prostatic hyperplasia (BPH) n= 45. Group S: Mean
age 63.56years (45-81range, 99%CI 61.72-65.23), Mean PSA 13.24 nanogram/milliliter (3.1-109.1, 99%CI
10.65-15.83), prostate adenocarcinoma n=65 (40.84%) GS 5 or 6 n=29 (18.35%), GS ≥7 n=36 (22.78%),
high grade PIN n=36, ASAP n= 6, BPH n= 51. There were no difference in PSA (p=0.0577), GS (p=0.8571),
PIN (p=0.4341), ASAP (p=1.0000). Group S were younger (p<0.0001). Group R: small-medium correlation
age-PSA (cor=0.3452). Group S: no correlation age-PSA (cor=0.1177).
Conclusions: Patients below 65 years with prostate cancer suspicion and negative regular prostate
biopsy is advisable new PSA at 6 months follow-up and perform saturation biopsy (24-28-core). Saturation
biopsy detects 40.84% of cancer which were negative in regular biopsy. Age is independent risk factor
associated with prostate cancer discovered in saturation biopsy.
42
P006
Radiotherapy after radical prostatectomy: Doses and volumes to treat
Carcaterra M., Loffreda M., Fiorentino G., Rosetto M.E., Mazzuoli L., D’ambrosio M.S., Russo M., Pompei L.
Hospital “Belcolle”, Dept. of Radiation Oncology, Viterbo, Italy
Material & Methods: From 2007 to 2010 we have treated 142 patients with diagnosis of prostate cancer
that underwent radical prostatectomy. All the patients in the adjuvant setting were studied by digital rectal
exam, transrectal ultrasound and CT imaging of abdomen and assigned at risk group on the basis of pre
treatment PSA , Gleason score and TNM stage according the NCCN guidelines. 25 patients underwent
whole pelvis irradiation and subsequent boost on prostate bed and 117 prostate bed irradiation only; the
whole pelvis simulation was performed in prone position with belly board and 5mm CT scan slice thickness
and a conventional 4field-box arrangement has been used. The total dose to the pelvis was 45 Gy in 1.8
Gy/Fr (5Fr/W). For prostate bed CT simulation was performed in supine position with arms on the chest
and vac lok system under the legs, MRI simulation and subsequent CT-MR images fusion. The minimum
prescribed dose to the prostate bed was 70.2 Gy, (74-77,4 Gy to macroscopic residual) using a 3D CRT
technique with 4-6 wedged fields.
Results: We consider immediate post-op RT in all patients with high risk features and WPRT in selected
high risk patients. Post-op RT appears to have a minimal influence on continence and urethral stricture and
a slightly increment of acute grade-3 intestinal toxicity in WPRT. A dose of 70 Gy on prostate bed is feasible
and safe but, in presence of well documented macroscopic disease, we consider to escalate the dose up
to 77 Gy, assuming a dose-PSA free progression correlation, after an accurate analysis of Dose Volume
Histogram.
Conclusions: Many authors support the use of immediate post-op RT to improve biochemical progression
free survival but no prospective data are available about the optimal dose and necessity of dose escalation. Is open the debate about the equivalence between immediate and salvage post-op RT and the question
concerning the WPRT is not yet been resolved too. Technique improvement in radiotherapy promise to
obtain an high therapeutic ratio and may be permitted to treat different volumes at the same time and to
escalate the dose without increase toxicity.
43
Unmoderated Posters
Introduction & Objectives: The role of adjuvant radiation therapy to reduce the risk of local recurrence is
well established in many tumors sites. After radical prostatectomy the most important high-risk pathologic features are: extracapsular extension (ECE), positive margins and seminal vesicle involvement (SVI).
Patients with these features have an increased risk of biochemical failure of about 40-50%. In these cases
the appropriate treatment is radiotherapy. At the same time clinical stage (TNM), Gleason score, and PSA
level are known to influence the risk of pelvic nodal involvement but there are some controversies about
the optimal dose and volumes to treat as well as the necessity of pelvic nodal irradiation. We report our
experience concern these arguments of debate.
P007
Adapting a clinical trial design due to changing clinical practice: Lessons learned from the
EORTC prostate cancer trial 22043-30041
Bolla M.1, Van Poppel H.2, Pylkkanen L.H.3, Pouillon V.4, Maingon P.5, Bosset J.F.6, Villafranca Iturre A.E.7,
Billiet I.8, Boladeras A.9, Bossi A.10, Budach W.11, De Meerleer G.12, Doneux A.13, Herrera F.14, Hinkelbein W.15,
Kitsios P.16, Lammering G.17, Lozano J.18, Martens M.19, Renard L.20, Richetti A.21, Scholten A.22, Stuschke
M.23, Te Slaa E.24, Van Den Bergh A.C.M.25, Vekemans K.26, Verhagen P.27, Villa S.28, Weytjens R.29, BaskinBey E.S.30, Collette L.31
Centre Hospitalier Regional De Grenoble-La Tronche, Dept. of Radiotherapy, Grenoble, France, 2University Hospital Leuven - UZ Gasthuisberg, Dept. of Urology, Leuven, Belgium, 3EORTC Headquarters, Dept.
of Translational Research, Radiotherapy and Imaging, Brussels, Belgium, 4EORTC Headquarters, Project
Management Unit, Brussels, Belgium, 5Centre Georges François Leclerc, Dept. of Radiotherapy, Dijon,
France, 6Centre Hospitalier Regional De Besançon - Hopital Jean Minjoz, Dept. of Radiotherapy, Besançon,
France, 7Hospital De Navarra, Dept. of Radiotherapy, Pamplona, Spain, 8AZ Groeninghe, Dept. of Urology,
Kortrijk, Belgium, 9ICO L’Hospitalet, Dept. of Radiotherapy, Barcelona, Spain, 10Institut Gustave Roussy,
Dept. of Radiotherapy, Villejuif, France, 11Heinrich-Heine Universitaetsklinik, Dept. of Radiotherapy, Dusseldorf, Germany, 12Universiteit Gent, Dept. of Radiotherapy, Ghent, Belgium, 13Hopital De Jolimont, Dept.
of Radiotherapy, Haine St Paul, Belgium, 14Centre Hospitalier Universitaire Vaudois, Dept. of Radiotherapy,
Lausanne, Switzerland, 15Charite - Universitaetsmedizin, Dept. of Radiotherapy, Berlin, Germany, 16Bank of
Cyprus Oncology Centre, Dept. of Radiotherapy, Nicosia, Cyprus, 17MAASTRO Clinic, Dept. of Radiotherapy,
Maastricht, The Netherlands, 18Hospital Del Mar, Dept. of Radiotherapy, Barcelona, Spain, 19AZ Turnhout,
Center For Oncology, Turnhout, Belgium, 20Cliniques Universtaires St Luc, Dept. of Radiotherapy, Brussels,
Belgium, 21Ospedale Regionale Bellinzona E Valli, Dept. of Radiotherapy, Bellinzona, Switzerland, 22Leiden
University Medical Centre, Dept. of Radiotherapy, Leiden, The Netherlands, 23Universitaetsklinikum, Dept.
of Radiotherapy, Essen, Germany, 24Isala Klinieken, Dept. of Urology, Zwolle, The Netherlands, 25University
Medical Center Groningen, Dept. of Radiotherapy, Groningen, The Netherlands, 26Virga Jesse Hospital,
Dept. of Urology, Hasselt, Belgium, 27Erasmus MC, Dept. of Urology, Rotterdam, The Netherlands, 28ICO
Badalona, Dept. of Radiotherapy, Barcelona, Spain, 29Algemeen Ziekenhuis Sint-Augustinus, Dept. of Radiotherapy, Wilrijk, Belgium, 30Astellas Pharma Europe Ltd, Medical Affairs Urology, Staines, United Kingdom,
31
EORTC Headquarters, Dept. of Radiotherapy, Brussels, Belgium
Unmoderated Posters
1
Introduction & Objectives: In May 2009, the EORTC ROG and GU Groups launched a phase III trial to
assess the role of 6 mo adjuvant hormone therapy (Eligard®) added to immediate postoperative irradiation for patients with cT1-3aN0M0 high risk prostate cancer. The trial required preoperative PSA ≤ 20 ng/
ml, Gleason 5-10, stage pT2R1/pT3a-b, pN0 (or pNX for low risk cT1c), undetectable postoperative PSA
level, WHO PS 0-1 and randomization within 3 mo after surgery. The trial did not recruit well. We report the
actions taken to identify problems and amend the protocol.
Material & Methods: The files of potentially eligible patients in Leuven and Grenoble were reviewed on
site to identify the causes of poor recruitment. Five changes were initially proposed by the EORTC: Extend
the time since surgery to the start of RT; Allow patients in the early salvage RT setting; Allow pre-operative
PSA ≤ 30 ng/ml; Authorize sites to select their preferred RT schedule; Offer a preoperative information
brochure. 26/30 institutions authorized to participate in the study completed a questionnaire documenting the elements in the protocol that were preventing recruitment and evaluated if each of the proposed
protocol changes would likely facilitate recruitment.
Results: Several factors were considered important reasons for patient ineligibility. On average 35-73% of
respondents stated that the proposed protocol changes would assist patient enrollment. In addition to the
proposed changes, the survey also suggested allowing pNx patients in the trial.
44
Unmoderated Posters
Conclusions: Steps were taken to understand the poor patient recruitment and to address the issues with
appropriate protocol amendments that reflect the investigators’ experience and current clinical practice.
Once implemented, the impact on recruitment should be observed within a few months. These actions
could be utilized for other trials undergoing similar limited rates of enrollment.
45
P008
More space - less toxicity: Toxicity report of the first prostate cancer patients treated in Heidelberg within the Space OAR hydrogel study
Uhl M., Habl G., Schubert K., Debus J., Herfarth K.
University of Heidelberg, Dept. of Radiooncology, Heidelberg, Germany
Unmoderated Posters
Introduction & Objectives: Delivering high radiation dose to prostate while sparing adjacent OARs like
the rectum and bladder is challenging. We evaluated acute and late genitourinary (GU) and gastrointestinal
(GI) toxicities in prostate cancer patients within the SpaceOAR Hydrogel study.
Material & Methods: Overall, 20 patients with localized prostate cancer received definitive radiotherapy by tomotherapy from Oct. 2009 through Jan. 2011. Patients were treated within the SpaceOAR
Hydrogelstudy, a prospective, multi-center, open-label trial. Before treatment planning the spacer gel, an
absorbable polyethylene glycol (PEG) hydrogel spacer, which extends the space between anterior rectum
wall and prostate, was transperineally injected between rectum and prostate. Absorption time of the gel is
about 6 months. The prescribed dose for the PTV (= [prostate+2/3 seminal vesicle] +margin of 5mm in all
directions) was 78 Gy in 39 fractions. During the treatment and at 3, 6 and 12 months after treatment GI
and GU toxicity was evaluated utilizing the grading developed by the Radiation Therapy Oncology Group/
European Organization for Research and Treatment of Cancer (RTOG/EORTC). Late rectal toxicity was also
detected by using proctoscopy 12 months after the completion of irradiation and scored using the Vienna
rectoscopy score (VRS-Score).
Results: The space between rectum and prostate could be increased an average of 10.48mm at base,
9.61mm at mid gland and 9.35mm at the apex. So far, 13 patients have finished irradiation. The incidences of acute Grade 1 GI or GU toxicities at the end of treatment were 7% and 46% in these patients. One
patient showed Grade 2 GU toxicity (n=13). After 3 months follow up 27% had Grade 1 GU toxicity but no
patient showed GI toxicity (n=11). After 6 month fu Grade 1 GU toxicity decrease to 25% (n=8). After one
year (n=4) no patient showed late GI toxicities and 2 patients had Grade I GU toxicity No patient showed
any problems of the rectal mucosa in the rectoscopy after 12 months (100% VRS score 0).
Conclusions: Use of SpaceOAR Hydrogel is an easy and safe way to reduce toxicity to the rectum. Further
evaluations with dose escalation to the prostate or application in other regions are possible.
46
P009
Improved relief of lower urinary tract symptoms (LUTS) with a gonadotrophin-releasing
hormone (GnRH) blocker compared with an agonist + antiandrogen (AA) in an open-label,
randomised study (CS28)
Anderson J.1, Al-Ai G.2, Wirth M.3, Gual J.B.4, Veiga F.G.5, Colli E.6, Van Der Meulen E.7, Persson B.E.8
Introduction & Objectives: LUTS are common in prostate cancer (PCa) patients (pts) and can significantly reduce quality of life (QoL). Here we compare a GnRH agonist + AA flare protection vs a GnRH blocker for
relief of LUTS in PCa pts.
Material & Methods: Pts with PCa requiring androgen deprivation were randomised 3:1 to degarelix (240
mg starting dose; then 80 mg/month), or goserelin 3.6 mg/month + bicalutamide 50 mg (starting 3 days before goserelin therapy and continuing 1 wk afterwards). Eligible pts had prostate-specific antigen (PSA) >10
ng/mL, International Prostate Symptom Score (IPSS) ≥12 and Qmax ≤12 mL/sec (voided volume ≥150 mL).
Results: Due to recruitment issues, only 40 pts were included (degarelix n=27; agonist + AA n=13; median
age 71 (53-87) years, 95% had a Gleason score ≥7). Protocol violation led to exclusion of 3 pts from the
per-protocol (PP) analysis. Median baseline PSA was 54.5 vs 41.1 ng/mL in the degarelix vs agonist + AA
groups; levels were reduced by >90% at Wk 12 in both groups. Degarelix was non-inferior to agonist +
AA for the primary endpoint (IPSS at Wk 12) and superior in the PP analysis (p=0.04). Degarelix induced
numerically better improvements in prostate volume and Qmax (Table). Significantly more degarelix pts had
improved QoL (IPSS question) at Wk 12 (85% vs 46%; p=0.0129). Notable adverse events (AEs) occurring
in >10% pts in the degarelix vs agonist + AA groups included injection-site reactions (33% vs 0%), hot
flushes (19% vs 15%), cystitis (11% vs 15%) and urinary tract infection (UTI; 4% vs 15%). Two pts receiving
agonist + AA had severe AEs related to obstruction, one of which was serious (fatal). No severe or serious
AEs occurred in the degarelix group.
Full analysis
Mean (SEM)
PP analysis
Mean (SEM)
Degarelix, n=27a Agonist + AA,
n=13a
P value
Degarelix,
n=26a
Agonist + AA, n=11a P value
20.3 (1.1)
22.2 (1.6)
-8.6 (1.9)
0.20
-11.8 (1.3)
-5.9 (2.3)
0.039
-7.4 (1.8)
0.065
-11.7 (1.3)
-6.0 (2.2)
0.0036
IPSS score (primary endpoint)
Baseline
20.1 (1.1)
21.1 (1.6)
Change at Wk 12 (LOCF)
-11.6 (1.3)
Change at Wk 12 (OC)
-11.6 (1.3)
Secondary endpoints
Prostate volume, mL
Baseline
53.5 (5.5)
50.2 (4.5)
Change at Wk 12 (LOCF)
-21.8 (2.7)
-14.0 (3.9)
Qmax, mL/sec
Baseline
9.3 (0.8)
8.3 (0.8)
Change at Wk 12 (OC)
3.3 (1.2)
1.3 (1.6)
0.10
0.32
Actual number of observations may vary; LOCF, last observation carried forward; OC, observed cases
Conclusions: Degarelix may offer improved LUTS relief vs agonist + AA in PCa pts. Degarelix also led to a
significantly greater improvement in QoL, larger numeric improvements in Qmax and prostate volume, and
a lower incidence of cystitis and UTI.
47
Unmoderated Posters
1
Royal Hallamshire Hospital, Dept. of Urology, Sheffield, United Kingdom, 2VITURO Gesellschaft Für Klinische
Studien, Urologisches Gesundheitszentrum, Leipzig, Germany, 3University Hospital Carl Gustav Carus Dresden, Dept. of Urology, Dresden, Germany, 4Hospital Manacor, Dept. of Urology, Manacor, Spain, 5Complexo
Hospitalario Universiatario A Coruña, Dept. of Urology, A Coruña, Spain, 6Ferring Pharmaceuticals, Dept. of
Global Clinical Research and Development, Copenhagen, Denmark, 7Ferring Pharmaceuticals, Dept. of Statistics, Copenhagen, Denmark, 8Ferring Pharmaceuticals, Dept. of Urology/Oncology, Saint-Prex, Switzerland
P010
Watchful waiting in localized prostate cancer: A single institution experience
Mermershtain W., Rouvinov K., Gusakova I., Ariad S.
Soroka University Medical Center, Dept. of Oncology, Beer Sheva, Israel
Unmoderated Posters
Introduction & Objectives: Following widespread introduction of prostate-specific antigen (PSA) testing,
prostate cancer incidence has increased dramatically. Many of these diagnoses represent clinically irrelevant tumors, and the risk of overdiagnosis and overtreatment poses a tremendous clinical and ethical
dilemma. Surgical resection and radiation therapy can lead to such problems as incontinence, impotence,
and rectal dysfunction. Watchful waiting as traditionally practiced involves the institution of palliative
therapy as the disease progresses at a time when cure is no longer possible. Watchful waiting, also called
expectant management, and may preserve better quality of life.
Material & Methods: From, November 1999, through, May 2011, 61 men with clinically localized prostate
cancer were assigned to watchful waiting. The median age was 69 years (range 57 to 81 years). All men
were followed every 4 months during for a clinical examination and blood tests, including PSA assay. All
patients have a baseline bone scan. Repeated bone scan was obtained PSA level increases that would suggest disease progression. All patients asked about quality of life with each follow-up visit.
Results: During a median of 4.6 years of follow-up (range 15 months to 9 years), 1 men in the watchful
waiting group died (acute MI). At diagnosis, the median PSA level was 6.4ng/ml. The Gleason score (GS)
distribution was as follows: 7 (11.5%) with GS-5, 52 (85%) GS-6, and 2 (3.3%) with GS-7. 9 (14.8%) repeated
the biopsy. At the rate of therapy was 24.6% (15pts). and the median time from diagnosis to treatment was
36.9 months (range from 15 to 89 months). The treatment distribution was as follows: 9pts (14.8%) treated
by radiotherapy and 6pts (9.8%) received intermittent hormonal therapy. The median PSA level at start of
the treatment was 6.3ng/ml in group with received radiotherapy, and 5.6ng/ml in intermittent hormonal
therapy group. The median age of patients was 68.8 years (range 61-81) and 72.8 years (range 66-78) in
radiotherapy and intermittent hormonal therapy group respectively. The distribution of patients received
treatment by age group was: <70 years: 7pts, initial PSA – 6.5 ng/ml, PSA at start of treatment 10.5ng/
ml, and median time to start of treatment 27.8 months. In group of 70-79 years: 7 pts, initial PSA – 6.8 ng/
mk, PSA at start of treatment – 9.8 ng/ml, and median time to start of treatment 48 months. In group >80
years: 1pt, initial PSA – 3.14ng/ml, PSA at start of treatment – 4.8ng/ml, and time to start of treatment –
22 months.
Conclusions: Watchful waiting is as acceptable approach for patients with low risk prostate cancer and
preserves the better quality of life.
48
P011
Impact of experience and technical changes on dosimetry for prostate brachytherapy
Le Fur E.1, Malhaire J.P.1, Valeri A.2, Pene-Baverez D.1, Erauso A.2, Rousseau B.2, Papin G.2, Delage F.2,
Toulouzan M.2, Perrouin-Verbe M.A.2, Fournier G.2, Pradier O.1
1
CHU Morvan, Dept. of Radiation Oncology, Brest, France, 2CHU Cavale Blanche, Dept. of Urology, Brest,
France
Material & Methods: From July 2003 to May 2010, 150 prostate cancer patients (mainly low risk:
96,7%) underwent low-dose, loose seeds I125 PBT as monotherapy with a technique of intra-operative
planning. We prescribed 160 Gy on the prostate. Patients were divided into three periods of time (P1, P2,
P3) according to technical changes: use of an automatic stepper at the beginning of P2 and use of a high
frequency ultrasound probe in P3. Per and post dosimetric parameters were reported: D90 (dose received
by 90% of prostate volume), V100 and V150 (prostate volume receiving respectively 100% and 150% of the
prescribed dose), D2cc and D0.1cc (doses received by 2cc and 0.1cc of the rectum), R100 (rectum volume
which received 100% of the prescribed dose) and D10 and D30 (doses received by 10% and 30% of the
uretra, only in per implantation).
Results: The mean per-implantation D90 was 187,52 Gy without significant differences between the 3
periods (p=0.48). The per-implantation D0.1cc and the R100 significantly decreased with time from 170.5
Gy in P1 to 147.7 Gy in P3 (p=1.10-5) and from 0.29 cc in P1 to 0.05 cc in P3 (p=4.10-6) whereas the
uretral doses remained stable. At post-implantation assessment, D90, V100, V150 were respectively 168.3
Gy, 91.9% and 55% with no significant differences between the 3 periods of time. The dose received by the
rectum decreased with time (D2cc P1=129.8 Gy vs D2cc P3=113.5 Gy (p=0.006), D0.1cc P1=223.1 Gy vs
D0.1cc P3=190.4 Gy (p=8.10-5), R100 P1=1.06cc vs R100 P3=0.53cc (p=0,0008).
Conclusions: We could not found any significant learning curve for prostate dosimetry neverthless we did
observe a significant decrease in the rectal doses with experience.
49
Unmoderated Posters
Introduction & Objectives: To assess the impact of experience and technical changes on per- and postimplantation (1 month later) dosimetry for prostate brachytherapy (PBT).
P012
Active surveillance in prostate cancer low-risk patients: 6 years experience
Marenghi C.1, Bellardita L.1, Rancati T.1, Villani D.1, Avuzzi B.1, Nicolai N.2, Villa S.3, Bedini N.3, Magnani T.1,
Salvioni R.2, Valdagni R.4
Fondazione IRCCS - Istituto Nazionale Dei Tumori, Prostate Program, Milan, Italy, 2Fondazione IRCCS Istituto Nazionale Dei Tumori, Dept. of Urology, Milan, Italy, 3Fondazione IRCCS - Istituto Nazionale Dei
Tumori, Dept. of Radiation Oncology, Milan, Italy, 4Fondazione IRCCS - Istituto Nazionale Dei Tumori,
Prostate Program and Dept. of Radiation Oncology, Milan, Italy
1
Unmoderated Posters
Introduction & Objectives: Since 2005, active surveillance (AS) is proposed as an alternative to radical
therapies in low-risk prostate cancer (PCa) patients (pts). We here present results on 6 yrs experience.
Material & Methods: In our Institute pts can enter 2 AS protocols: SAINT and PRIAS. The 2 protocols
have some common entry criteria: initial PSA (iPSA) ≤10ng/ml, clinical stage ≤T2 and GPS ≤3+3. SAINT
requires max 20% positive cores and max 50% core involvement, while PRIAS max 2 positive cores and
PSA density <0.2ng/ml/cc. Follow-up is scheduled in both cases with PSA every 3 mos, DRE every 6 mos,
re-biopsy after 1 yr of AS. When PSA doubling time (DT) is between 3 and 10 yrs a yearly repeated biopsy
is scheduled. Whenever during the follow-up the PSADT<3 yrs, clinical stage is >T2, the re-biopsies show
more than 2 (or 20%) positive cores or GPS >3+3, the protocols advise a change to active treatment. The
quality of life (QoL) of patients participating in the PRIAS protocol is also evaluated through MINI-Mac and
FACT-P.
Results: 293 pts were enrolled in AS (May 2011). 203/293 pts remain in AS (median f-up of 20 mos, range
1-95): 5 pts dropped out due to comorbidities, 6 due to personal choice (anxiety), 8 due to non-compliance
with AS protocol and 1 due non-PCa death. 70/293 (23.9%) pts dropped out because of disease progression/reclassification: 15 due to PSADT, 55 to upgrading and/or upsizing at re-biopsy (36/55 at first
re-biopsy). The actuarial treatment free survival is 84% and 68% at 14 and 27 mos. To date, no unfavorable outcome has been observed. QoL investigation shows an improvement with time in coping with the
disease: % of pts experiencing avoidance is reduced from 30% (at AS enrollment) to 18.2% (at 15mos
later), anxious preoccupation is reduced from 11.5% to 2.3%, helplessness/hopelessness from 3.4% to 0%.
Physical, emotional, social and functional well beings are high and show no relevant changes during the
considered screening period.
Conclusions: AS is feasible in selected men with early PCa. 1 yr re-biopsy is an important check, which
can be used as a diagnostic clarification point. Further follow-up is needed to detect the effect of deferred
treatment on disease control. QoL results show that exhaustive information, good communication between
pts and clinicians and on-demand psychological support can help to cope with anxiety and uncertainty
related to AS acceptance. This work was partly supported by Fond I Monzino, Milan.
50
P013
Prostate cancer: New radiotherapy treatment results
Bolzicco G.1, Favretto M.S.1, Baiocchi C.1, Testolin A.1, Scalchi P.2, Scremin E.3, Tasca A.3
San Bortolo Hospital, Dept. of Radiation Oncology, Vicenza, Italy, 2San Bortolo Hospital, Dept. of Medical
Physics, Vicenza, Italy, 3San Bortolo Hospital, Dept. of Urology, Vicenza, Italy
1
Material & Methods: From June 2006 to June 2011 seventy patients, median age 74 years, with biopsyproved adenocarcinoma of the prostate received 35 Gy in 5 fractions of 7 Gy with image-guided SBRT
using the Cyberknife. Twenty-three patients received also androgen suppression. Clinical stage was T1c in
26 patients, T2a-b in 23, T2c in 21. The Gleason score was <6 in 6 patients, 6 in 55 patients and >6 in 9
patients. Thirty-one patients were low, 34 intermediate and 5 high risk. The mean PSA value at diagnosis
was: 6.89 ng/ml in the patients treated with radiotherapy as monotherapy (RT group) and 11.68 ng/ml in
the patients who had androgen suppression also (ART group). Five patients had transurethral resection
(TUR), mean 8 months prior radiotherapy. Four gold-fiducials were implanted in the prostate for imageguided SBRT. To create the planning target volume (PTV) a margin was added to prostate. OAR constraints
were: 38 Gy to 5% of the rectum, 40 Gy to 5% of bladder and urethra, 29 Gy to 25% penile bulb and 25 Gy
to 25% of femoral heads. Rectal and bladder acute toxicities were graded using RTOG criteria.
Results: Mean follow-up was 26 months (range 6-60 months). Mean PTV volume delineated on CT scan
was 64 cc (range 52-104 cc). The mean percentage of PTV covered of prescription dose was 96.3% (range
94.5-99.8). The treatment was well tolerated. Urinary acute toxicity was Grade II in 10 patients (14%) and
rectal acute toxicity was Grade II in 13 patients (18.5%); no patients had Grade III and IV acute toxicities.
Five patients had late urinary toxicity: 3 patients Grade I (4.2%), 1 patient Grade II (1.42%) and 1 patient
Grade III (1.42%). Three patients developed late rectal toxicity: 2 patients Grade I (2.8%) and 1 patient
Grade II (1.42%). In five TUR patients (mean volume prostate 24 cc.) late urinary toxicity occurred: 1 Grade
III, 1 Grade I, 2 Grade 0. Median PSA value progressively declined from 5.80 ng/ml prior to RT to 1.57 ng/
ml, to 0.89 ng/ml and to 0.50 ng/ml at 6, 12, 24 months respectively for RT group, and from 0.90 ng/ml
prior to RT to 0.29 ng/ml, down to 0.30 ng/ml and 0.10 ng/ml at 6, 12, 24 months respectively for ART
group. One patient (PSA at diagnosis 8.6 ng/ml, T2a, Gleason 3+3) had local recurrence, 1 patient (PSA
6.2 ng/ml, T2a, Gleason 3+3) had nodal relapse and 1 patient (PSA 15.3 ng/ml, T1c, Gleason 3+3) had
bone metastases, 36, 18 and 9 months after radiotherapy respectively.
Conclusions: CyberKnife-delivered hypofractionated radiotherapy seems to be an encouraging treatment
for prostate cancer: has low rates of acute/late toxicity with a good biochemical control. Ongoing data
collection is being performed for further assessment of toxicity and PSA response.
51
Unmoderated Posters
Introduction & Objectives: To evaluate the safety and efficacy of CyberKnife-Stereotactic Body Radiation
Therapy (SBRT) in a series of 70 prostate cancer patients with two years mean follow-up.
P014
Experience and technical changes decrease acute urinary morbidity after prostate brachytherapy
Le Fur E.1, Malhaire J.P.1, Erauso A.2, Rousseau B.2, Pene-Baverez D.1, Papin G.2, Delage F.2, Toulouzan M.2,
Perrouin-Verbe M.A.2, Fournier G.2, Pradier O.1, Valeri A.2
1
CHU Morvan, Dept. of Radiation Oncology, Brest, France, 2CHU Cavale Blanche, Dept. of Urology, Brest,
France
Unmoderated Posters
Introduction & Objectives: To assess the impact of experience and technical changes on acute morbidity occuring during the first year after prostate brachytherapy (PBT).
Material & Methods: From 07/2003 to 05/2010, 150 prostate cancer patients (mainly low risk: 96,7%)
underwent I 125 PBT as monotherapy (loose seeds, real time planning). Patients were divided into three
periods of time: P1 (n=64), P2 (n=45), P3 (n=40) according to technical changes: use of an automatic
stepper for P2, use of a high frequency ultrasound probe in P3. Initial mean IPSS (International Prostate
Symptom Score) (4.4-5.2), mean prostatic volume (37-42 cc), proportion of patients with neo-adjuvant hormonotherapy (to reduce prostate volume if > 50cc) (9.7-15%), proportion of patients treated with 6 months
post PBT α-bloquers (68-75%) were not significantly different between the 3 groups (p=0.5, p=0.1, p=0.6
and p=0,4 respectively). Urinary toxicity was analysed taking into account: incidence of acute urinary
retention (AUR), Δ IPSS (IPSS maximal - IPSS at baseline) and proportion of patients with Δ IPSS ≥ 5 and
IPSS total > 15. Rectal morbidity was scored according to the modified Radiation Therapy Oncology Group
(RTOG) classification.
Results: The incidence of AUR (6% of the overall population) decreased significantly with time: 12.5% in
P1, 2.2% in P2 and 0% for P3 (p=0,014). Median duration of catheterization was 5 weeks [1 day-6 months]
and 3 patients (2%) needed a bladder neck incision 6 to 9 months after PBT (bladder voiding was efficient
post-operatively and no patient had incontinence). Moreover, mean Δ IPSS (11.5) was stable during the 3
periods of time. Patients with Δ IPSS ≥ 5 and IPSS total > 15 were respectively 59.5%, 57.1% and 50% for
P1, P2 and P3 (p=0,66). In addition, Grade 1 and 2 proctitis were observed in 15.3% and 8.6% of patients
with no significant difference between the 3 periods.
Conclusions: The incidence of acute urinary retention after prostate brachytherapy decreased significantly with experience and the use of an automatic stepper. We found no impact of experience on urinary
morbidity (except for AUR) and rectal morbidity.
52
P015
Indications, analysis and trends in laparoscopic pelvic lymph node dissection for prostate cancer in our serie of laparoscopic radical prostatectomy
Alvarez Maestro M., Sanchez Gomez F.J., Linares Quevedo A., Rios Gonzalez E., Martínez-Piñeiro L., Díez
Rodríguez J., López-Tello J.
Hospital Universitario Infanta Sofía, Dept. of Urology, Madrid, Spain
Material & Methods: We perform the removal of the lymphatic tissue inferior to the bifurcation of the
common iliac artery, bound inferiorly by the femoral canal; laterally by the pelvic sidewall; and medially and
inferiorly by obturator nerve, collectively (external iliac nodes) in patients with PSA >20 ng/ml. or Gleason
score 7-10 or cT2 or Gleason 6 and >50% positive biopsies. From our serie of LRP we study the lymphadenectomies, anatomical regions, the number of dissected lymph nodes and the correlation with surgeon´s
experience, pN+, PSA preoperative, PSA density, clincal T-staging(cT), Gleason score biopsy, pathological
T-stage(pT) and Gleason score specimen. Data were analyzed through the PASW 18.0. The univariate
analysis was performed using Student’s T for quantitative variables or ANOVA for more than two variables
and Chi square test or Fisher’s exact test for qualitative variables.For multivariate analysis we carried out a
binary logistic regression.
Results: From June 2008 to May 2011, 148 underwent LRP with 87 lymphadenectomies according to the
above criteria. The median number of Lymph Nodes(LN) removed was 16.44 (95% CI: 14.56-17.79): 7.94 in
the right side and 8.40 in the left one (p=0.355). There were differences between the surgeon´s experience and the number of LN removed (1. Expert: 17.84, 95% CI=13.82-21.86; 2. Intermediate: 13.52,95%
CI=9.95-15.10; 3. Beginner:17.59,95% CI=15.55-19.62, p=0.020). Proven LN metastasis were detected in
3 patients (3.4%),PSA prior to biopsy was similar between pN0 and pN+ (8.87 vs. 11.2750, p=0.627) and
PSA density (pN0= 0.2939 vs. pN+=0.4627, p=0.361), probably the difference was not significant due to
the small size of the sample with lymph node involvement. Finally, we didn´t find correlation between pN+
and cT, Gleason score biopsy and specimen and pT.
Conclusions: 1. The low incidence of lymph node involvement should make us reconsider criteria for realization of lymphadenectomy in prostate cancer surgery. 2. The average number of nodes obtained is acceptable from the oncological point of view. 3. In our case, surgical experience limits the number of nodes
obtained.4. We don´t find differences in number of nodes according to the side of lymphadenectomy.
53
Unmoderated Posters
Introduction & Objectives: The role of PLND in PCa remains controversial. The extent of PLND and the
candidates most suitable for this procedure is still a matter of intense debate.The prevalence of LNI ranges
from 1.1% to 26% and is related to PLND extent. No consensus has yet been reached about the extent of
PLND or, more specifically, the number of lymph nodes that should be removed to achieve optimal cancer
staging. Some authors based their decision on nomograms, others prefer performing PLND in all patients.
Objectives: analyze the results of lymphadenectomy in our serie of laparoscopic RP.
P016
Hypofractionatied radiotherapy for localized prostate cancer: A comparison to a standard
radiotherapy schedule
Mok G.C.1, Martin J.2, Massey C.3, Finkbeiner M.1, Bayley A.1, Ménard C.1, Chung P.W.1, Bristow R.G.1,
Warde P.1, Gospodarowicz M.1, Catton C.1
Princess Margaret Hospital, Dept. of Radiation Oncology, Toronto, Canada, 2Radiation Oncology Queensland, Dept. of Radiation Oncology, Toowoomba, Australia, 3Princess Margaret Hospital, Dept. of Biostatistics, Toronto, Canada
1
Unmoderated Posters
Introduction & Objectives: Prostate cancer has been reported to be sensitive to hypofractionated (HF)
radiotherapy. There are potential practical and biological advantages in treating prostate cancer with
larger radiation doses and shorter treatment courses. We review a single institution experience of HF and
conventionally fractionated (CF) radiation schedules in the treatment of localized prostate cancer.
Material & Methods: 87 HF and 263 CF patients were treated from 2001 - 2004. All HF patients were
treated with 60 Gy in 20 fractions delivered via image-guided (IG) intensity modulated radiotherapy (IMRT)
on a phase II study. CF patients received 79.8 Gy in 42 fractions delivered via IG 3D conformal radiotherapy
in 87.1% of cases and IG-IMRT in 12.9%. Patients on adjuvant hormone therapy were excluded. The primary
endpoint was the 5-year clincal progression free rate (cPFR) defined as post-radiation nadir + 2 ng/mL,
salvage therapy or positive prostate biopsy. Non-inferiority of HF was tested with a hazard ratio (HR) of
1.32 as the upper limit of equivalence for cPFR. Secondary endpoints were physician scored RTOG acute/
late genitourinary (GU) and gastrointestinal (GI) toxicity.
Results: The HF and CF groups were similar for median age, median follow-up, median initial PSA, Gleason
score, and T-category. There were more low-risk patients in the HF group (HF 31.0% vs 22.8%; p = 0.03).
cPFR and late toxicity rates are presented in the table. The difference in cPFR for HF and CF was not
significant after univariate (UVA) and multivariate analyses (MVA). Significant predictors of clinical failure on
UVA were risk category, T-category, initial PSA and Gleason score. After MVA, T-category (HR = 1.81, 95%
CI 1.11 - 2.95; p = 0.02), initial PSA (HR 1.09, 95% CI 1.03 - 1.15; p < 0.01) and Gleason score (HR = 2.79,
95% CI 1.65 - 4.70; P < 0.01) remained significant. HF was not a significant predictor of clinical failure after
UVA and MVA (HR = 1.45, CI 0.00 - 2.11; p = 0.66). A lower risk of late GI toxicity was observed with HF (HR
= 0.41, 95% CI 0.00 - 0.98; p = 0.02), but after including treatment method (IMRT vs 3DCRT) on MVA, this
significance was lost.
HF
CF
5-year cPFR
72%
77%
5-year late GI toxicity
≥2
≥3
5%
1%
12%
1%
5-year late GU toxicity
≥2
≥3
11%
0%
13%
2%
Conclusions: In this series, HF and CF outcomes are similar for cPFR and late toxicities and are comparable to reports of CF for localized prostate cancer. The use of IMRT for HF radiotherapy may be useful in
achieving acceptable late toxicity rates. This study was underpowered to detect non-inferiority of HF to CF,
but support further investigation of HF in ongoing randomized controlled studies.
54
P017
Adjuvant radiotherapy for locally advanced prostate cancer: A retrospective analysis of toxicity
and biochemical control
El Khoury C.1, Nasr E.1, Nahas O.1, Moukarzel M.2, Nehme-Nasr D.1, Bulbul M.3, Ayoub N.2, Nemr E.2, Merhej
S.2, Helou J.4
Hotel Dieu De France University Hospital, Dept. of Radiation Oncology, Beirut, Lebanon, 2Hotel Dieu De
France University Hospital, Dept. of Urology, Beirut, Lebanon, 3American University of Beirut Medical
Center, Dept. of Urology, Beirut, Lebanon, 4Hotel Dieu de France University Hospital, Dept. of Radiation
Oncology, Beirut, Lebanon
1
Material & Methods: 51 cases of locally advanced prostate cancer treated between January 2001 and
November 2010 were reviewed. Eligible patients had pathologically negative lymph nodes and one or more
risk factors: capsule perforation, positive surgical margins, invasion of seminal vesicles. Adjuvant RT consisted of 3D conformal external beam radiation using 18 MV photon beams at a dose of 60-66 Gy delivered
over 6-7 weeks. Prostate-specific antigen relapse was defined as a PSA rise above 0.2 ng/ml, with two consecutive increases over a minimum of 3 months. Acute/late adverse effects of RT were scored according
to the Radiation Therapy Oncology Group (RTOG)/European Organization for Research and Treatment of
Cancer (EORTC) criteria. PFS was estimated using Kaplan-Meier method.
Results: Median follow-up after RT was 42 months. The different clinical stages were: 1 T2b, 9 T2c, 25
T3a, 14 T3b and 2 T4 with Gleason score: 4-6 = 12%, 7 = 65% and 8-9 in 23% of the cases. The median
age was 64 years at the time of RP. Pretreatment PSA level was respectively < 10 ng/ml (49%), 10-20 ng/
ml (37%), > 20 ng/ml (14%). Of the 51 patients, 27 received androgen ablation therapy before RT, 41 had
positive surgical margins, 32 had capsule perforation and 16 had seminal vesicles invasion. The median
interval between RP and adjuvant RT was 4.7 months. 3 patients were kept on hormonal deprivation after
RT for a maximum period of 2 years and remained progression-free. For acute genitourinary (GU) toxicity,
there were 35% grade 1,6% grade 2 and 0% grade 3.16% of the patients had grade 1 gastrointestinal (GI)
toxicity; there were no grade 2 and 3. GU grade 2 and 3 late toxicity was reported in 6% of the patients
and GI garde 2 in 2%. The 5-year biochemical PFS was 78%. On Cox regression analysis, the number of
months of hormonal deprivation prior to RT was a significant predictor of biochemical control.
Conclusions: Radiotherapy in the adjuvant setting of locally advanced prostate cancer yielded 78% 5-year
biochemical control rate with satisfactory outcome in terms of toxicity.
55
Unmoderated Posters
Introduction & Objectives: Assessing acute toxicity and biochemical progression-free survival (PFS) in
patients with pathologic T3 disease and/or positive surgical margins after radical prostatectomy (RP) and
treated with adjuvant radiotherapy (RT).
P018
Does Movicol affect rectal size in patients treated with radical radiotherapy to the prostate?
Rembielak A.1, Jegannathen A.2, Mcgovern J.1, Woodward M.1, Stratford J.3, Swindell R.4, Livsey J.2,
Choudhury A.2
The Christie NHS Foundation Trust, The Christie At Oldham, Manchester, United Kingdom, 2The Christie
NHS Foundation Trust, Dept. of Clinical Oncology, Manchester, United Kingdom, 3The Christie NHS
Foundation Trust, The Wade Centre For Radiotherapy Research, Manchester, United Kingdom, 4The Christie
NHS Foundation Trust, Dept. of Medical Statistics, Manchester, United Kingdom
Unmoderated Posters
1
Introduction & Objectives: The position of the prostate and seminal vesicles is significantly affected
by rectal distension. Highly conformal radiotherapy (RT) requires accuracy to within millimetres, thus
the margin for error is small. A distended rectum at the baseline planning scan (RTP) has been shown to
significantly reduce local control. Accurate knowledge of changes in rectal volume is essential to avoid a
geographical miss and to reduce risk of normal tissue toxicity. An earlier study from The Christie involved
90 patients undergoing RT for prostate cancer (49 with dietary advice and 41 before diet was implemented). There was no evidence that formalised dietary advice affected rectal dimensions at baseline.
Material & Methods: Between December 2010 and March 2011, Movicol (iso-osmotic laxative, 1-2
sachets daily) was initiated 3 days before RTP in addition to formalised dietary advice (avoiding aerated
drinks, low fibre diet and bowel emptying every day). Movicol was continued unless 3 or more loose stools
per day were reported. Measurements of the antero-posterior diameter of the prostate were taken at three
levels from the RTP: seminal vesicles, mid prostate and root of penis. The scans of 26 consecutive patients
who received Movicol were compared to scans of 90 patients from previous study.
Results: Mann-Whitney analysis showed a significant difference in mid-prostate rectal diameter in patients
receiving Movicol when compared to patients from the previous study (Table-1).
Measurement level
No Movicol* (n=90) [cm]
Movicol (n= 26) [cm]
p-value
Mid Body
3.3 cm (1.5-6)
2.8 (2-5.7)
0.02
Root of Penis
2.5 cm (1.5-4.6)
2.6 (1.5-3.3)
0.24
Seminal vesicle
3.6 cm (1.8-6.8)
3.4 (2.1-5.7)
0.2
* diet and no diet group
Conclusions: Our interim analysis of rectal diameters during radical prostate RTPs suggests that the introduction of Movicol in addition to formalized dietary advice is of statistical significance at the mid prostate
level. The inclusion of more patients (target: 50) should further clarify any association.
56
P019
15 Year experience in the treatment of localized prostate cancer with external beam radiation
and hormonal therapy
Boladeras A., Ferrer F., Navarro V., Polo A., Villa S., Pera J., Gutierrez C., Lucas A., Macia M., Guedea F.
Institut Català D’Oncologia, Dept. of Radiation Oncology, Barcelona, Spain
Material & Methods: From 1996 to 2005, 958 patients (pts) were treated with EBRT for prostate cancer.
These data have been analyzed retrospectively. The median age was 70 years (range 39-82). The stage
by risk groups (D’Amico risk group classification system) was low, intermediate and high risk in 127pt
(13%) 371pt (39%) and 422pt (44%), respectively. Mean PSA was 17.3 ng/ml and Gleason score was ≤ 6,
7 and >7 in 417pt (43.5%), 416pt (43.4%), and 125pt (13%) respectively. Perineural invasion was positive
in 199pts (20.7%) EBRT exclusively was delivered in 864pt (90.1%), given dose was between 60 Gy (8.3%)
and 76 Gy (58.6%). Mean dose given in prostate was 72.7Gy. EBRT (60 Gy) plus boost with high-dose-rate
brachytherapy (HDR-BT) 9Gy in 1 fraction was performed in 90pt (9.39%). Complete androgen deprivation
was administered to 601pts (62.73%) for a mean of 21 months. Kaplan-Meier test and log-rank statistic
were calculated. Multivariate Cox analysis was performed to calculate hazard rate ratios (HRR) with 95 %
confidence intervals, and analysing hormonal therapy exposure as a time dependent covariate.
Results: The median follow-up was 81.54 months. Overall survival (OS) was 92% and 80% at 5 and 10
years, respectively. The OS at 5 and 10 years by risk group was 94% and 84% for low, 91% and 81% for
intermediate, and 91% and 78% for high risk (p=0.716) Biochemical relapse-free survival (BRFS) at 5 and 10
years were 94% and 86% for low, 87% and 67% for intermediate and 87% and 72% for high risk (p=0.0687)
DFS at 5 and 10 years were 94% and 86% for low, 87% and 67% for intermediate and 86% and 71% for high
risk.(p=0.0588). Multivariate analysis showed that HT is a protective factor for OS with HRR= 0.11 (0.020.48). Age with HRR=1.04 (1.01-1.08) had a negative impact on OS. Also a trend was detected in patients
with Perineural invasion (HRR=3.24 (0.97-10.8) with p=0.0552). HT is the only protective factor for BRFS
(HRR=0.25 (0.10-0.60). Late grade 3 rectitis (RTOG scale) was observed in 25 pt. (2.6%). No other local
toxicities were relevant.
Conclusions: In our study hormone therapy is a protective factor for OS and BRFS, while age had a
negative impact on OS. Late toxicity in our patients is acceptable and efficacy results are similar to other
series.
57
Unmoderated Posters
Introduction & Objectives: Prostate cancer is the second most common cancer after lung cancer in men
in the European Union and the introduction of PSA testing has led to an increasing proportion of patients
presenting with localised disease. Management options are controversial and include radical prostatectomy, external-beam radiotherapy or brachytherapy. It is no longer clear which treatment is preferable for
localized particularly because the different treatments have shown good results in terms of cancer control.
P021
Preliminary results of outcomes in prostate cancer patients with fiducial marker image-guided
radiotherapy
Ferrer F., Gutierrez C., Boladeras A., Pera J., Argüello J.C., Quispe K., Garcia I., Nuñez M., Del Carpio A.,
Martinez E., González M.N., Guedea F.
Catalan Intitute of Oncology, Dept. of Radiation Oncology, Barcelona, Spain
Unmoderated Posters
Introduction & Objectives: Image guided radiotherapy allows daily correction of prostatic movements.
Biochemical control could be improved with prostatic movement control. To describe intraprostatic marker
post-implantation adverse effects and acute, subacute and early chronic toxicities in prostate cancer
patients treated by radiation with orthogonal image verification as well as disease outcome.
Material & Methods: Fifty consecutive patients were included prospectively. Exclusion criteria were previous medical history of prostatitis, and coagulation disturbances. With mild sedation, transperineal marker
implantation guided by endorectal ultrasound was done. Four 24 k gold markers with star section measuring 5 mm long and 1 mm large were placed 2 laterals in base and 1 or 2 in the prostatic apex. Antibiotics
and non-steroidal anti-inflammatories were administered prophilactically. One week after implantation CT
with full rectum and bladder for planning was obtained. A correction “on line” set-up protocol was establish
Position correction was done if prostatic movement was superior to 3 mm on AP-PA and lateral portal
vision daily images. Descriptive report of acute and late EORTC-RTOG toxicities and disease outcomes are
described with median follow-up of 2,5 years.
Results: Patients mean age was 69 years. mean diagnostic [PSA] was 18 ng/ml (4.45-83). Gleason score
< 6 (or less) 11%, Gleason score 7 of 60% and Gleason score > 8 or superior of 29%. Intermediate and
high risk prostate cancer in D’Amico classification was 72% of patients. External radiation dose went from
60 Gy (plus Ir 192 9 Gy/1 fraction HDR brachytherapy of 9 Gy) to 78 Gy at 2 Gy per fraction in conformal 3-D technique. Seventy percent of patients had been putted on hormonal depletion treatment. One
patient showed acute urinary obstruction (AUO) at the end of radiotherapy. Another patient showed urinary
infections with AUO at 3 months after radiation. One patient showed bleeding caused by rectal ulcer at
5 months after radiation. Acute rectal and urinary toxicities grade 2 were observed in 70% and 80% of
patients respectively. Grade 3 acute urinary toxicity was reported in 4% of patients. Subacute rectal grade
3 toxicity was present in 2% of patients. Urinary toxicity grade 2 or more were seen in 16% of patients.
Grade 2 rectal toxicity was seen in 19% of patients. Early chronic rectal toxicity grade 3 was seen in one
patient. Local relapse was confirmed by biopsy in one patient. Three patients showed distant relapse with
bone metastases after rising PSA. Nobody died because of prostatic disease during this time.
Conclusions: Transperineal implantation of intraprostatic markers is feasible without presenting acute
adverse effects after implantation. Early chronic toxicity is acceptable. Longer follow-up is needed to
evidence late toxicity and to confirm disease control and expected survival.
58
P022
Prostate cancer rectal volume - Staging CT/MRI correlation with radiotherapy planning CT
Cree A.A., Choudhury A., Elliott P.A.
The Christie NHS Foundation Trust, Dept. of Clinical Oncology, Manchester, United Kingdom
Material & Methods: Retrospective analysis of a series of 103 patients who had been treated with external beam radiotherapy to the prostate at The Christie Hospital between 2008-2009 was performed. The
AP rectal diameter at the level of the top and mid prostate was assessed on staging scans (CT/MR) and CT
planning scans.
Results: Full data was available for 73 patients, the remainder were difficult to assess for technical
reasons such as transverse bowel loops at the level of the prostate or inadequate images. The mean AP
rectal diameter at mid prostate was 32.7mm on staging scans and 32.3mm on planning scans and at top
of prostate was 40.2mm on staging scan and 42.8mm on planning scan. The maximum difference between
staging and planning scan was 30mm. There was a moderate correlation between AP rectal diameter
at mid prostate on staging scan and planning scan with a correlation coefficient of 0.55. Using a cut off
of 40mm AP diameter on staging scan to predict a rectal volume greater than 40mm on planning scan
showed a positive predictive value of 0.69 with a sensitivity of 0.52 and a specificity of 0.92. Patients with
large AP rectal diameter on staging scan tended to have a decrease in AP rectal diameter and vice versa.
Conclusions: Rectal diameter on staging scans does not correlate strongly with rectal diameter on
planning scans. It was not possible to determine a cut off on staging scan which would provide a useful
predictor for large rectal diameter on planning scan. The differences in rectal diameter identified between
staging and planning scans could be explained by regression to the mean; i.e. staging and planning scans
record rectal volume diameters at random timepoints during the dynamic process of rectal filling and emptying with gas/faeces. Large rectal volumes on staging scans thus represent an extreme for the patient
rather than being a predisposition to long term large rectal diameter.
59
Unmoderated Posters
Introduction & Objectives: Variation in rectal volume has been identified as a significant factor in prostate movement during external beam radiotherapy. This has become more important with dose escalation
using modern conformal radiotherapy techniques. As rectal diameter and volume increase, rectal wall
dose may increase and prostate planning target volume coverage may decrease. A larger rectal volume on
planning scan has been linked to poorer outcome and greater rectal volume instability during radiotherapy
treatment. In our centre patients with a mid-prostate rectal wall anterior/posterior (AP) diameter greater
than 40mm on planning scan undergo repeat scanning following bowel preparation. We assessed whether
large rectal diameter on staging CT/MRI scan could reliably predict for large rectal diameters at the time of
the radiotherapy planning scan.
P023
Active Surveillance for prostate cancer: A nomogram predicting the risk of upgradig/upsizing
at 1 yr re-biopsy
Rancati T.1, Colecchia M.2, Salvioni R.3, Bedini N.4, Villa S.4, Biasoni D.3, Marenghi C.1, Paolini B.2, Avuzzi B.1,
Magnani T.1, Catania S.1, Valdagni R.5
Fondazione IRCCS - Istituto Nazionale Dei Tumori, Prostate Program, Milan, Italy, 2Fondazione IRCCS Istituto Nazionale Dei Tumori, Dept. of Pathology, Milan, Italy, 3Fondazione IRCCS - Istituto Nazionale Dei
Tumori, Dept. of Urology, Milan, Italy, 4Fondazione IRCCS - Istituto Nazionale Dei Tumori, Dept. of Radiation
Oncology, Milan, Italy, 5Fondazione IRCCS - Istituto Nazionale Dei Tumori, Prostate Program and Dept. of
Radiation Oncology, Milan, Italy
1
Unmoderated Posters
Introduction & Objectives: Since 2005, we have been proposing AS in low-risk PCa. The correlation between clinical variables and upgrading/upsizing at the first re-biopsy (1 yr after AS beginning) is here reported and a preliminary nomogram for the prediction of the probability of upsizing/upgrading is presented.
Material & Methods: AS institutional protocol (SAINT) started in March 2005 and was accepted by 86
pts. Entry criteria were: informed consent, iPSA≤10ng/ml, clinical stage≤T2a, GPS≤3+3, positive biopsy
cores≤20%, max core length containing cancer≤50%. Pts drop out was due to PSADT≤3yrs, PSA>10ng/
ml, upgrading and/or upsizing at re-biopsy or personal choice. In November 2007 PRIAS protocol was embraced: 168 pts were enrolled so far (May 2011). PRIAS vs SAINT differs on: max 2 positive cores and PSA
density<0.2ng/ml/cc. The correlation between clinical variables and upgrading/upsizing at first re-biopsy
was analysed using multivariable logistic regression (MVLR) and a nomogram was developed.
Results: Statistical analysis was performed on 109 pts with complete records and 1 yr min f-up. 20/109
pts had upgrading/upsizing after first re-biopsy and switched to radical treatment. Age, iPSA, PSA density,
number of positive cores, % of positive cores, absolute biopsy tumor length (ABSmm) and clinical stage
were considered as factors potentially affecting upgrading/upsizing. GPS was not considered because
all pts had GPS=3+3. Backward and forward MVLR resulted in a three-continuous variable best fit model
(overall p=0.05): ABSmm (p=0.07, OR=1.20), age (p=0.37, OR=0.97), PSA density (p=0.24, OR=6.9). A
nomogram was built on this result.
Conclusions: Present data suggest that biopsy details coupled to age and PSA density can help in the
identification of pts who have a higher probability of upgrading/upsizing after a short time in AS. More data
are required in order to strengthen the statistical power of this analysis.
This work was partly supported by Fondazione I. Monzino, Milan
60
P024
Preliminary dosimetric analysis of rectal air removal on prostate radiotherapy
Sabater S., Berenguer R., Andres I., Carrizo M.V., Martos A., Jimenez E., Sevillano M., Aguayo M., Rivera M.,
Nuñez A., De La Vara V., Villas M.V., Arenas M.
Hospital General De Albacete (CHUA), Dept. of Radiation Oncology, Albacete, Spain
Material & Methods: 5 prostate cancer patients underwent a CT simulation scan without (basal CT) and
with a rectal tube (deflated CT). CT scan sets without and with rectal tube were rigidly registered; and
prostate, rectum, and bladder volumes from each study were manually segmented. An IMRT plan, with the
same constraints, weights and number of iterations, was built for each CT set using the PLUNC TPS. All
plans were calculated for a dose of 78 Gy in 39 fractions. Global IMRT performance goals, as well as the
performance goals for bladder, rectum, PTV and prostate were recorded. Radiotherapy plans were exported to CERR and dose metrics and DVH were retrieved. For each patient a comparative DVH for rectum and
PTV were calculated subtracting the organ volume receiving a given dose in the deflated CT set from the
basal CT scan. From these results, the area under the curve (AUC) was calculated to determine the most
favorable situation. Mean dose (Dmean), maximal dose (Dmax) and minimal dose (Dmin) for PTV and rectum
were also analyzed. Non-parametric tests were used.
Results: Non-parametrical Wilkcoxon test showed a non-significant rectal volume diminution when tube
was places. Also a borderline non-significant difference towards a better IMRT performance goal when
rectal air was removed (mean PTV 92.13 vs 93.18, p=0.138; mean rectum 42.93 vs 52.02, p=0.08; mean
global 80.23 vs 83.55, p=0.08) was found. Unexpectedly, a translation of these results on a DVH improvement wasn’t observed; the fact is that basal and air removal DVH’s were so matched than AUC equaled to
zero. Obviously all other DVH related metrics had a non-significant difference when analyzed.
Conclusions: Despite some reports have described a significant benefit with rectal air removal, this preliminary results diverge from such way. It could be that we have only operated over one of the components
of rectal volume. Thus more vigorous interventions, like enemas, could be needed to improve dosimetrical
results.
61
Unmoderated Posters
Introduction & Objectives: On radiation therapy, large rectal volumes have been related to prostate
displacements and survival decrease among prostate cancer patients. Rectal volume changes are related
to two components: fences and air poaches. We hypotized that rectal air removal could improve dosimetric
data, so our aim was to evaluate if such intervention involve dosimetric changes related to the basal status.
P025
High dose (>76 Gy) intensity-modulated radiation therapy (IMRT) after prostatectomy:
Toxicity evaluation
Heinrich G.1, Catro Peña P.1, Murina P.1, Sanchez C.2, Caussa L.1, Venencia D.2, Zunino S.1
Instituto De Radioterapia - Fundacion Marie Curie, Dept. of Radiation Oncology, Cordoba, Argentina, 2Instituto De Radioterapia - Fundacion Marie Curie, Dept. of Medical Physics, Cordoba, Argentina
1
Unmoderated Posters
Introduction & Objectives: Retrospective evaluation of gastrointestinal (GI) and genitourinary (GU) toxicity after a treatment of high dose (>76 Gy) IMRT after prostatectomy in prostate cancer patients.
Material & Methods: Between July 2009 and December 2010, 19 patients (PTS) with prostatectomy
where irradiated with IMRT. A Scan-CT with venous contrast, in dorsal decubitus was performed for every
patient. Previously every patient realized a precise bladder filling.The inverse planning system used was
KONRADv2.2.Prostate and seminal vesicles bed (PB) with or without lymph nodes areas (LN) where contoured, according to medical criteria. Organs at risk (OAR): rectum, intestine, femoral heads and bladder
where also contoured in each patient.The 95% of the prescription dose should cover the 95% of the PTV
for each volume.OAR dose tolerance was limited in every case to our institutional constraints.GU and GI
toxicity were analyzed last day of IMRT, at 2 and 6 months after the end of IMRT. Toxicity was defined according to the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0.3.
Results: Initially 19 PTS where included, 1 was lost of follow up (FU). From the 18 PTS analyzed, 12
(66.6%) received IMRT to PB and 6 PTS (33.3%) to PB + LN.Median time of FU was 8.7 months (range 6-18).
Median dose of prescription to 95% of PB was 79.8 Gy (range 76.4 - 83) and 46 Gy for LN. Median time of
complete IMRT treatment was 55 days (range 49-60), with a media of 39 fractions per treatment (range 3741), in a one fraction per day schema.For the only PB group, at the end of IMRT, 3 PTS (16.6%) had Grade
1 (G1) GU toxicity and 2 (11.1%) G2 GU toxicity.Only 3 patients (16.6%) presented G1 GI toxicity. 2 month
after IMRT, 1 patient had G2 GI toxicity. At 6 months any patient presented GU or GI toxicity ≥G2.Between
the group that received IMRT for PB + LN, the results were as follow: A- last day of IMRT, 4 PTS (22.2%)
had G1 GU toxicity; B- at 2 month, 2 PTS (11.1%) with G1 GU toxicity; and C- at 6 month, any patient presented ≥G2 GU & GI toxicity.
Conclusions: With a median time of FU = 8.7 months (range 6-18) we can evidence that the GU and GI
toxicity, for high dose (>76 Gy) IMRT after prostatectomy in prostate cancer patients, was very acceptable.
Prospective studies, with greater number of patients are needed to confirm these results.
62
P026
Management of rectourethral fistulas after prostate cancer surgery
Rijo E.1, Lorente J.A.1, Bielsa O.1, Pera M.2, Fumadó Ll.1, Francés A.1, Arango O.1
Hospital Del Mar, Dept. of Urology, Barcelona, Spain, 2Hospital Del Mar, Dept. of Colo-Rectal Surgery,
Barcelona, Spain
1
Material & Methods: From January 2000 to June 2010, 14 patients with acquired RUF post-RP mean
age: 64 years (range: 56-74 years), were treated at our centre. Aetiology was post-open surgery in 2 cases
and post-laparoscopic surgery in 12. RUF became apparent within a range of 4-60 days. No patients had
a history of radiotherapy treatment. In all cases, after case history and physical examination, the RUF was
confirmed by urethrocystography, opaque enema and urethrocystoscopy. The fistula repair was carried
out between 5 and 10 months months after diagnosis. A loop ileostomy was performed on 8 patients at
the time of definitive surgical repair, whereas an initial fecal diversion with a sigmoid loop colostomy was
performed in 4 other cases.
Results: Two fistulas were small -less than 5 mm- on the urethral side of the anastomosis allowing spontaneous closure after conservative treatment and twelve patients had larger fistulas on the bladder side
of the anastomosis and/or with associated complexity factors that required open reconstructive surgery
(York-Masson approach). Successful fistula closure was achieved in all cases with complete fecal continence. No recurrence was observed after a mean follow-up of 46 (4–90) months.
Conclusions: RUF after RP is a rare but potentially devastating complication of prostate cancer treatment. Management depends primarily on the size, location, and etiology of the fistula. We propose early
reconstructive surgery in large or complex RUF. The posterior trans-sphincteric York-Mason approach has
allowed the repair in all cases. The York Mason Technique provides easy identification of recto-urinary fistulas and excellent surgical exposure with minimal postoperative morbidity and no impairment of continence.
63
Unmoderated Posters
Introduction & Objectives: The recto-urinary fistula (RUF) is a rare complication following treatment for
prostate cancer (surgery, ablative and ionizing therapies). The reported incidence after radical prostatectomy (RP) is 0.4–1.8%. Spontaneous resolution rarely occurs and many reconstructive procedures have been
proposed. Successful repair is often difficult and successful management often requires an aggressive
approach. We report our experience with the management of RUF after RP.
P027
Igrt with on-line kv-cbct and hexapod robotic couch in the prostate cancer: Assessment of
inter-fraction errors
Balestrini D., Palombarini M., Degli Esposti C., Frezza G., Ciuffreda A.
Ospedale Bellaria, Dept. of Radiation Oncology, Bologna, Italy
Unmoderated Posters
Introduction & Objectives: Recent studies have shown that different filling conditions of bladder and
rectum can significantly influence the inter-fraction and intra-fraction position of the prostate during radiotherapy. The aim of this study was primarily to determine the inter-fraction set-up error and organ motion
assessed with a kilovoltage Cone Beam CT (kVCBCT) in patients treated for prostate cancer with radical
radiotherapy.
Material & Methods: The study involved 18 pts treated with radical RT. All patients were instructed to
empty the rectum and fill the bladder, drinking 500 ml of water 30 min. before the planning CT/therapy.
For all pts, prostate position has been assessed before each fraction through kVCBCT image guidance
(XVI, Elekta). Patients were positioned first by using lasers and skin tattoos, then kVCBCT acquisition was
performed. For each fraction, the daily CBCT scan has been registered with planning kilovoltage CT images
and positioning adjustments have been assessed using a robotic table with 6 degrees of freedom (Hexapod Evo). Registration was based on a rigid-body approach and was performed according to the following
procedure:1.A fully automatic registration based on bony anatomy assessed the set-up error. 2.A physician
and a RT technologist adjusted manually the matching on the target through a grey-value algorithm, assessing the total inter-fraction error (set-up + organ motion). 3.After the matching procedures, the final
corrections were automatically applied to the robotic treatment couch for three translational and three
rotational deviation vectors and patient was treated. For each patient, the average deviation μi and the
standard deviations σi for both set-up and organ motion have been calculated in each direction. Moreover,
for the entire population of patients we calculated the global systematic error (M), the distribution of the
systematic errors (Σ) and the distribution of the random errors (σ).
Results: To assess inter-fraction set-up and organ motion errors, data from 680 kVCBCT have been analyzed. Concerning set-up errors, in L-R, C-C and A-P directions deviations for M were found to be 0.9, -0.1
and 0.5 mm with Σ of 2.9, 1.9 and 4.3 mm and σ of 2.4, 2.2 and 3.3 mm, respectively. Rotation deviations
resulted < 1° for M, Σ and σ.Concerning inter-fraction organ motion relative to bony anatomy, deviations for
M were found to be -0.9, -1.2 and 1.5 mm with Σ of 0.2, 0.3 and 2.4 mm and σ of 0.4, 0.3 and 0.3 mm for
L-R, C-C and A-P, respectively. Rotation deviations resulted < 1° for M, Σ and σ.
Conclusions: Daily kVCBCT is a simple and highly efficient procedure that permit an accurate positioning
of the patient and a reliable localizaton of the target. A current task in our centre is to evaluate the opportunity of assess individual margins for patients who undergo prostate treatments with IGRT, setting the stage
also for hypofractionation studies and adaptive radiotherapy.
64
P028
Exclusive hypofractionated radiotherapy with helical tomotherapy for prostate cancer:
Initial outcomes and toxicity results
Isa N., Matute R., Puebla F., Fernandez A., Arguello J.
Clinica La Milagrosa, Dept. of Radiotherapy, Madrid, Spain
Material & Methods: The study sample included all 55 consecutive patients with localized prostate
cancer treated with hypofractionated image-guided radiotherapy at the Clinica La Milagrosa between 2008
and 2011. Efficacy using the clinical, radiologic, and prostate-specific antigen data in each patient was evaluated before RT and at predetermined intervals after RT. The American Society for Therapeutic Radiology
and Oncology (ASTRO) biochemical failure definition was used. Skin, gastrointestinal and genitourinary
toxicity using the Radiation Therapy Oncology Group (RTOG) morbidity scores were used to assess the
acute and late toxicities, respectively.
Results: Between August 2008 and July 2011, 55 patients were treated with hypofractionated RT (Figure
1).The cohort had a median prostate-specific antigen value of 8.3 ng/mL (range, 1-69). The Gleason grade
was 4–6 in 30 cases (54,5%), 7 in 11 (20%) and 8-10 in 14 (25,5%). Clinical T stage was as follows: 28
patients had T1, 22 T2, 3 T3 and 2 T4. Overall, 17 patients (30,9%) had low-risk, 20 (36,4%) intermediaterisk, and 18 (32,7%) high-risk disease. The use of Hormonal therapy is showed in graphic 1 Patients at low
risk with hormone therapy are mandated by the urologist and the high-risk patient without it is because the
patients refused treatment. The median follow-up since the treatment was 10 months (range: 1-35). Biochemical control was 70% at 12 months. The graphic of PSA for risk group is showed in figure 3. The RTOG
acute rectal toxicity scores registered were 0 in 23 patients (41,8%), 1 in 23 (41,8%), 2 in 8 (14,5%), and 3
in 1 (1,8%). The acute urinary toxicity scores were 0 in 11 patients (20%), 1 in 35 (63,6%), 2 in 4 (7,3%), 3 in
4 (7,3%), and 4 in 1 (1,8%). The acute skin toxicity scores were 0 in 50 patients (90,9%), and 1 in 5 (9,1%).
The late toxicity seen in the patients with at least more than 6 months of follow up was rectal toxicity scores were 0 in 49 patients (96%), 1 in 2 (4%) and late urinary toxicity scores were 0 in 39 patients (76,5%), 1
in 12 (23,5%). No grade 3 events and late skin toxicity was observed.
Conclusions: Moderate Hypofractionated RT with megavoltge image guidance is feasible and is associated with low rates of acute toxicity. At early follow-up, biochemical outcome is comparable to that reported
for conventionally fractionated controls and rates of late toxicity are promising. Further research is necessary to assess definitive late toxicity and tumor control outcome.
65
Unmoderated Posters
Introduction & Objectives: Purpose: to study the outcomes in patients treated for localized prostate
cancer with 68,04-70,2 Gy delivered at 2.52-2.6Gy/fraction within 27 fractions and report acute and late
toxicity data of the first 55 patients treated with moderate hypofractionation by image-guided helical
tomotherapy.
P029
Evaluation of late toxicities and treatment results of image guided intensive modulated
radiosurgery boost combined with conformal radiotherapy prostate cancer patients
Urbańczyk H.A.1, Hawrylewicz L.2, Majewski W.1, Misztal L.2, Brąclik I.2, Rembak-Szymkiewicz J.3,
Ciechowicz J.4, Ślosarek K.2, Miszczyk L.1
MSC Memorial Cancer Centre and Institute of Oncology, Gliwice Branch, Dept. of Radiotherapy, Gliwice,
Poland, 2MSC Memorial Cancer Centre and Institute of Oncology, Gliwice Branch, Dept. of Radiotherapy
Planning, Gliwice, Poland, 3MSC Memorial Cancer Centre and Institute of Oncology, Gliwice Branch, Dept.
of Radiology, Gliwice, Poland, 4Medical University In Łódź, Computer Laboratory, Łódź, Poland
1
Unmoderated Posters
Introduction & Objectives: Radiobiological data shows that radiosurgery Prostate Cancer (PC) Patients
could be therapeutic option better then Conformal Radiotherapy (CRT). The aim of study is to evaluate
late toxicities and treatment results of Image Guided Intensive Modulated Radiosurgery Boost (IGIMRS)
combined with CRT at PC Patients.
Material & Methods: 22 patients irradiated because of PC between August 2007 and October 2008. All
patients were in low and intermediate risk group (T1c-T2b, starting PSA level less than 20 ng/ml, Gleason
score less than 7). Nodal and distant metastases were excluded. Patients were irradiated using 20 MV
photon beams. Prescribed doses were 7 Gy of IGIMRS, followed by 50 Gy/25 fractions of CRT and finally,
the second 7 Gy of IGIMRS. Calculated equivalent doses for prostate were 78-84 Gy (depend on the a/b for
prostate varying from 1.5 to 3 Gy) Calculated equivalent doses for rectum were 71.8-75.6 Gy (depend on
the a/b for rectum varying from 4 to 7 Gy) in part of rectum obtaining 100% of planed delivered dose. CTV
was prostate. PTV for CRT was CTV + 7-15 mm of margin. PTV for IGIMRS was CTV + 3 mm of margin. During IGIMRS prostate position was evaluated using CBCT on Clinac 2300 linear accelerator. RTOG/EORTC
scales for acute post irradiated effect were used. For evaluation of acute post irradiated effect.
Results: Observation time is ranged between 21 and 42 months (median 31.8). Two patients were lost of
observation, 21 and 25 months after the treatment. We confirmed the death of one of these patients 25
months after irradiation without any recurrence. 3 patients had late rectum effect score 1. One of patients
has been started by those effect 12 months after the treatment and he has been continued by it for next 9
months. This is just the second patient lost of observation. The other two patients have rectal late toxicities symptoms observed between 18 and 24 months after treatment followed by normalization symptoms
for next 12 months and sporadically 21 and 30 months after irradiation. We did not observed late bladder
toxicity at any patient. There are not any clinical or biochemical relapses.
Conclusions: Image guided intensive modulated radiosurgery boost combined with conformal radiotherapy seems to be well tolerance and safe treatment modality of PC patients. We start randomized study
just now.
66
P030
Dose escalation with High-dose 3D-Conformal radiotherapy (HD-3D-CRT) or Low-dose 3D-Conformal radiotherapy plus HDR brachytherapy (LD-3D-CRT+HDR-B) for intermediate–or high-risk
prostate cancer: Higher PSA control with lower toxicity
Guix B.1, Bartrina J.M.2, Tello J.I.1, Quinzaños L.1, Lacorte T.1, Guix I.1, Galdon G.1, Espino M.1
IMOR Foundation, Dept. of Radiation Oncology, Barcelona, Spain, 2JM, Dept. of Radiation Oncology,
Barcelona, Spain
1
Material & Methods: Between 12/1999 and 10/2005, 445 patients (pts) with PSA›10, Gleason score›6
and/or T2b-T3 N0 M0 prostate cancer entered the study. Pts were prospevtively assigned to one of the
two treatment groups: 76 Gy HD-3D-CRT to the prostate in 38 fractions (group 1; 223 patients) or 46 Gy
LD-3D-CRT+ 16 Gy HDR-B given in 2 fractions of 8 Gy (group 2, 222 patients), limiting the maximum rectal
dose to 85% of the prescribed dose. Both groups were well balanced taking into account patient’s as well
as tumors’ characteristics. Toxicities were scored by the EORTC /RTOG morbidity grading scales. Special
attention to local, regional or distant recurrence, survival, late effects, PSA and testosterone levels and
quality of life was done.
Results: All pts completed treatment. None pts included in the group 1 or 2 experienced grade 3 rectal
toxicity. 28 pts of group 1 (12.5%) and 6 pts of group 2 (2.7%) developed grade 2 rectal toxicity (rectal
bleeding or urgency). 15 pts in group 1 (6.7%) and 3 pts in group 2 (1.3%) developed grade 1 rectal bleeding (less than 2 times/week). In group 1 and 2, 81.8%and 95,9% of pts were free from rectal reactions
respectively (p<0.005). Free from failure survival at 5-year was 82.3% and 98.1% respectively (p<0,05).
Conclusions: High-dose 3D-EBRT + HDR brachytherapy was a safe and effective method of escalating the
dose to the prostate without increasing the risk of late effects. Acute as well as late rectal complications
were significantly reduced with the combined treatment, compared with what was observed with high-dose
conventional, 3D-conformal radiotherapy. Short-term PSA control rates was better with in the HDR-boosted
patients as expected by higher effective-dose.
67
Unmoderated Posters
Introduction & Objectives: To report early and late toxicity and preliminary biochemical outcome in in a
prospective serie of 445 patients with intermediate- or high-risk clinically localized prostate cancer treated
with either HD-3D-CRT or with LD-3D-CRT+HDR-B.
P031
Exclusive image guided IMRT vs. radical prostectomy followed by postoperative IMRT for localized prostate cancer: A matched-pair analyzis based on risk-groups
Azelie C.1, Gauthier M.2, Mirjolet C.1, Cormier L.3, Martin E.1, Peignaux-Casasnovas K.1, Truc G.1, Maingon P.1,
Créhange G.1
Centre Georges François Leclerc, Dept. of Radiation Oncology, Dijon, France, 2Centre Georges François
Leclerc, Dept. of Biostatistics, Dijon, France, 3C.H.U. Le Bocage, Dept. of Urology, Dijon, France
1
Unmoderated Posters
Introduction & Objectives: To investigate whether patients treated for a localized prostate cancer
require a prior radical prostatectomy followed by postoperative radiotherapy or exclusive radiotherapy, in
the modern era of image guided IMRT.
Material & Methods: One hundred and seventy eight patients with a localized prostate cancer were referred for exclusive image guided IMRT (IG-IMRT) using daily on-line 3D ultra-sound based system. In the same
period, 69 patients were referred after radical prostatectomy for adjuvant or salvage IMRT without image
guidance (RP+IMRT). The median radiation dose in the IG-IMRT group was 77.4Gy [73.0-79.8 Gy] whereas it
was 66.0 Gy [31.4-70.3 Gy] in the RP+IMRT group. Patients were matched in a 1:1 ratio according to their
baseline risk group before any treatment (as defined using the classification of d’Amico). We aim to report
on biochemical relapse-free survival (bRFS) using the Kaplan Meier method. Biochemical failure was defined
as a postoperative PSA >= 0.1 ng/mL followed by 1 consecutive rising PSA for the postoperative group
of patients and by the Phoenix definition (nadir+2 ng/mL) for the group of patients treated with exclusive
radiotherapy.
Results: A total of 98 patients were matched (49:49). Unsurprisingly, patients treated with surgery were
more likely to be younger than patients treated with exclusive radiotherapy (mean age 63.7 years (SD= 5.9)
vs. 69.8 years (SD= 6.4), p< 0.001). The median pretherapeutic PSA value was 8.7 ng/mL [1.7 - 32.0] in
the IG-IMRT group and 8.7 ng/mL [2.7-29.0] in the RP+IMRT group (p= 0.632). Ten patients (20.4%) in each
group underwent concomitant hormonal therapy (HT) while 6 patients (12.2%) in the RP+IMRT group and 8
patients (16.3%) in the IG-IMRT group had adjuvant HT (p= 0.564). The duration of HT was similar between
both groups (p= 0.438). In the RP+IMRT group, 28 patients (57.1%) were upstaged to T3 after evaluation on
the pathological specimen and 30 patients had a microscopic involvement of the margin (65.2% type R1).
The median time between surgery and the start of radiotherapy was 11.4 months [2.9-69.6]. From the start
of any treatment, the median follow-up was 56.6 months (CI 95%= [49.6-61.2], range [18.2-115.1]) for all
the patients. The 5-year bRFS in the IG-IMRT group and in the RP+IMRT group were 93.1% [80.0-97.8] and
76.5% [58.3-87.5], respectively (p= 0.031).
Conclusions: Patients with a localized prostate cancer treated with IG-IMRT had better oncological outcome in comparison with RP+IMRT. Further improvements in postoperative IMRT using image guidance and
dose escalation need to be evaluated to figure out whether it could stack up against IG-IMRT.
68
P032
Stereotactic body radiotherapy for low- and intermediate-risk clinically localised prostate
cancer
Park J., Song K., Jo M.
Korea Cancer Center Hospital, Dept. of Urology, Seoul, South Korea
Material & Methods: Between May 2003 and June 2008, 20 patients received Cyberknife SBRT for
clinically localised, low- and intermediate-risk prostate cancer at our institution. Six intermediate-risk
patients received pre-treatment hormone therapy for 1 month and no adjuvant hormone therapy was given
after SBRT. Prescribed radiation dose was 32 to 36 Gy in 4 fractions. The biochemical recurrence by the
Phoenix definition and RTOG toxicity outcomes were assessed.
Results: Mean age was 67 (range, 54~77) years. Mean pre-treatment PSA was 7.2 (range, 1.7~19.6) ng/
ml. Median Gleason score was 6. Mean post-treatment PSA nadir was 0.42ng/ml. At a mean follow-up of
3 years, biochemical recurrence occurred in only 1 patient at 38 months after SBRT. The patient received
salvage maximal androgen blockade and is followed till now with no evidence of recurrence or metastasis. No patient died of the disease. RTOG grade 2 acute rectal toxicity was seen in 1 patient at 1 month
and grade 1 and 2 late rectal toxicities persisted in 2 patients until 7 months and 13 months after SBRT,
respectively. RTOG grade 2 and 1 acute urinary toxicities occurred in 2 patients and 6 patients. There were
no severe toxicities of grade 4 or worse.
Conclusions: SBRT with Cyberknife could be a feasible method for treatment of low- and intermediate-risk
prostate cancer. Long term, randomised trial with larger patient cohort is needed to confirm its efficacy.
69
Unmoderated Posters
Introduction & Objectives: Hypofractionated, stereotactic body radiotherapy (SBRT) is a novel treatment
option for prostate cancer. The Cyberknife, a linear accelerator mounted on a robotic device, enables
excellent dose conformation to the target and minimizes dose to surrounding normal tissue so that it can
reduce normal tissue toxicity and shorten treatment course. We present our results of Cyberknife SBRT for
low- and intermediate-risk prostate cancer patients with a mean follow-up of 3 years, focusing on disease
control and toxicity.
P033
Evaluating organs at risk in prostate cancer: Comparison between conformal 3D radiotherapy
and volumetric modulated arc radiotherapy
Pereira A., Barreiros M., Martins Da Silva A., Silva R., Faria D., Antunes M.I., Videira A., Chinita P.
Hospital Do Espirito Santo De Evora/Lenicare, Dept. of Radiotherapy, Évora, Portugal
Unmoderated Posters
Introduction & Objectives: Prostate cancer is the first noncutaneous cancer in men and is the second
cause of cancer mortality after lung cancer. External Radiotherapy is recommended for prostate cancer
treatment in all risk patients either as a radical approach, adjuvant for surgery, in recurrence or in palliative
setting. Volumetric modulated arc radiotherapy (VMAT) with Rapidarc (Varian Medical Systems) is a recent
technique that provides intensity-modulated radiation therapy. Unlike conformal 3D Radiotherapy (3DCRT),
Rapidarc is delivered in a single field with dynamic gantry, multi-leaf collimator and dose rate. The purpose
of this study was to evaluate the differences in the dose received by the major organs at risk for both
3DCRT and Rapidarc techniques for prostate cancer patients.
Material & Methods: The treatment planning system used was Eclipse (Varian Medical Systems) with
Anisotropic Analytical Algorithm. Both planning techniques with the same prescribed dose were applied to
each patient. The dose volume histograms of the rectum, bladder, femoral heads, small bowel and penis
were analyzed and compared. Because Rapidarc is an arc technique, the dose received by the body (excluding the planning target volumes) was also compared.
Results: The most significant differences were found for femoral heads, bladder and rectum. With Rapidarc, the maximum dose and 10% of the total volume of the femoral heads received on average less 18%
and 16% of the total dose, respectively. Also 55% of the bladder received on average 19% less dose. As for
the rectum, a total volume of 25% up to 50% received on average 15% less dose. Smaller differences were
found for the small bowel with 33% receiving on average less than 4% of the total dose. Results showed an
increase in dose received by the body of 5% and 1% at 33% and 66%, respectively.
Conclusions: The total dose administered in radiotherapy is often limited by the organs at risk. Better
sparing of the OARs could allow dose escalation with greater tumor control probability and reduced acute
and late reactions of normal tissues. Regarding the evaluation of organs at risk, results show that VMAT
with Rapidarc has a better performance when irradiating the same planning target volumes and is therefore
a powerful tool in radiotherapy.
70
P035
Seminal vesicle invasion at the time of prostatectomy: Correlation of prostate cancer specific
survival with clinical and pathologic findings
Call J.A.1, Davis B.J.1, Hillman D.W.2, Carlson R.E.2, Choo C.R.1
1
Mayo Clinic, Dept. of Radiation Oncology, Rochester, Mn, United States of America, 2Mayo Clinic, Dept. of
Statistics, Rochester, Mn, United States of America
Material & Methods: Between 1991 and 1993, 416 consecutive radical RP specimens were submitted for
total embedding and whole mounting. A prospectively maintained database was used to collect the data on
clinical outcomes. Cause of death was verified at the time of this analysis. Length of the largest focal area
of SVI (SVI Ca focus), SVI cancer volume (SVI CaV), laterality of SVI (unilateral vs. bilateral), pattern of SVI
spread (continuous vs. non-continuous), Gleason score (GS), perineural invasion (PNI), extraprostatic extension (EPE), and lymph node involvement (LNI) were recorded. These features were examined with respect
to prostate cancer specific survival (PCSS). Comparisons between groups were made using log-rank tests.
Of 51 patients found to have SVI, 36 were available for analysis.
Results: Mean age of the group was 66 years (range: 47 – 76). A total of 28 patients had GS 7, 5 had GS
of 8 and 3 had GS of 9. Median preoperative PSA was 10.6 ng/mL with a range of 2 to 122 ng/mL. Mean
SVI Ca focus length was 0.85 cm, SVI Ca volume mean was 0.85cc and mean SVI Ca area was 0.90 cm2.
Bilateral SV involvement was found in 39% of patients, 72% had EPE and 25% had lymph node involvement.
The pattern of SVI spread was contiguous with prostate in 53% and noncontiguous in 47% of cases. The
10-year overall survival and PCSS was 68% and 89%, respectively. Factors that were significantly associated with worse 10 year PCSS included presence of perineural invasion (80% vs. 100%, P=0.02), LNI
(57% vs. 96%, P=0.05), SVI focus length greater than 0.80 cm (81% vs. 100%, P=0.03), SVI CaV >0.24 cc
(80% vs. 100%, P=0.02), and SVI area > 0.30 cm2 (81% vs. 100%, P=0.03). None of the other factors were
significantly associated with PCSS, although there was a trend toward worse PCSS with contiguous SVI
spread (p=0.06) and bilateral SV involvement of SVI (p=0.07).
Conclusions: In patients found to have SVI at RP, several pathologic factors are predictive of PCSS including PNI, lymph node status, SVI focus length, SVI area and SVI Ca volume. These findings may aid in the
stratification of future clinical trials for patients with T3b prostate cancer.
71
Unmoderated Posters
Introduction & Objectives: Three recent randomized trials have established a benefit for adjuvant
radiotherapy (RT) for high risk patients after radical prostatectomy (RP) including improvements in overall
survival, metastasis free survival and biochemical relapse free survival. Among other adverse pathologic
features, patients with seminal vesicle (SV) invasion (T3b) have derived benefit from adjuvant RT. This study
was performed to identify additional pathologic features that are prognostic for prostate cancer specific
survival (PCSS) in patients with documented SVI at the time of RP.
P036
Our experience in the treatment of localised advanced prostate cancer
Haxhiu I.1, Quni Xh.1, Aliu H.1, Haxhiu A.2, Haxhiu E.2
1
University Clinical Center of Kosovo, Dept. of Urology, Prishtina, Kosovo, 2University of Prishtina, Dept. of
Medical Faculty, Prishtina, Kosovo
Unmoderated Posters
Introduction & Objectives: Kosovo is the country with the youngest population in Europe, with over 50%
of them under the age of 28, and this may be the reason why the prostate cancer is the third most common cancer, after the bladder and kidney, in our Clinic , beside the fact that in USA, Europe and many other
countries around the World, prostate cancer is the second most common cancer in males, right after the
lung cancer. Our purpose was to give a full information about the incidence of prostate cancer in Kosova,
the methods of treatment, especially those for locally advanced prostate cancer, focusing more on the
radical prostatectomy as a favorable choice.
Material & Methods: This is a perspective - retrospective study. The material gives information about
the incidence and the type of surgical intervention applied to the patients diagnosed with prostate cancer
which were admitted to our Urological Center (the only tertiary center in Kosova). 117 cases with prostate
cancer are processed, considering their age, the Gleason score and the type of intervention. We have been
more focused on monitoring and the course of disease to the patients with localised advanced prostate
cancer.
Results: Before these interventions the sextant biopsy was performed and the Gleason score resulted
from 1-10. In three of them Gleason score was 10, with the infiltration of the seminal vesicles, and in two
of them this score was 9 respectively. So, it means that we have to deal with T3c and T3a stage or with
locally advanced prostate cancer. In 2 cases radical prostatectomy with orchiectomy was performed,
meanwhile in 3 other cases radical prostatectomy was performed with two cycles of Androcur. The course
of disease was followed for three, respectively two years and it is seen that the first two cases had the
levels of PSA normal inside two months and there was no tendency for these values to increase, meanwhile
in two other cases treated with Androcur, the levels of PSA started to increase after two years.
Conclusions: Our patients resulted with high levels of PSA, 120, 85, and 60, for the patients with Gleason
score 10 and PSA level of 60 and 45 ng/ml, for the two with score 9, respectively. All these four patients
were operated three, respectively two years ago. Their course of disease was followed by performing the
CT and measuring the PSA levels every four months, which showed us that there was no relapse, and their
condition was good (being able to do their daily activities, and not complaining for pain), so we came to
the conclusion that radical prostatectomy can be considered as a favorable choice even for the patients
with highly lacalised advanced prostate cancer, and even when the Gleason score is 9 or 10, and should be
followed with antiandrogen-deprivation therapy or with subcapsular orchidectomy.
72
P037
Prostate cancer as a cellular dynamic system of the first order
Waliszewski P., Hegele A., Olbert P., Hofmann R.
Philipps University, Dept. of Urology, Marburg, Germany
Introduction & Objectives: PSA doubling time is a predictor of prognosis or biochemical recurrence in
prostate cancer; however, available software calculates different values of the parameter, the minimum
number of PSA measurements needed, the optimal time interval between measurements and a kind of
mathematical model remain to be defined.
Results: Temporal evolution of PSA during growth (b>0) or decay (b< 0) describes the exponential function
of the algebraic form p(t) = p0exp(bt) with the coefficient of non-linear regression R > 0.95 and the Poisson
probability distribution, in which p(t) stands for PSA concentration, p0 is the initial PSA concentration in
time t0, b stands for the coefficient, t denotes scalar time. The most reliable fitting with the complete statistical evaluation was obtained if at least 5 consecutive measurements of PSA concentration performed in
the intervall of 3-4 weeks were available. Each cancer dynamics in the set was characterized completely by
the parameters p0, b and the value of the derivative p’. Interestingly, there were only two types of response
to treatment, e.g., continuation of exponential growth or exponential decay of apoptotic nature. No fractal
dynamics of growth, as in in vitro or animal systems, was observed.
Conclusions: Those results define prostate cancer unequivocally as the first order dynamic system. The
novel approach based upon the parameters p0, p’ and b can be used to compare objectively dynamics of
growth of different prostate cancers or to identify cancer recurrence.
73
Unmoderated Posters
Material & Methods: We analyzed the long-term evolution of PSA in 50 patients. The growth or decay
phases were analyzed separately. Statistical fitting was performed by a software Sigma Plot version 10
using two parametiric exponential growth or decay function.
P038
Salvage radiotherapy in biochemical recurrence (BR) after radical prostatectomy,
an experience of one center
Carvajal C.C., Gómez Iturriaga A., Del Hoyo O., Bóveda E., Muruzabal I., Casquero F., Bilbao P.
Hospital De Cruces, Dept. of Radiation Oncology, Barakaldo, Spain
Unmoderated Posters
Introduction & Objectives: External beam radiation therapy (EBRT) is the standard treatment for BR
after radical prostatectomy (RP). Biochemical control in long-term series has been reported to be between
20-40%. Purpose was to determine biochemical response and biochemical control in a serie of patients
treated with salvage EBRT after RP, for BR.
Material & Methods: Between July 2002 and July 2010 have been treated 78 patients with salvage EBRT
at our institution. After EBRT, biochemical failure was defined as a value of PSA ≥ 0.4ng/ml for patients
achieving complete response, and two consecutive increases in PSA over pre – treatment PSA, in patients
who did not have a complete response. All patients were treated with 3D conformed EBRT. Median dose
was 66Gy (46-74Gy). 33 patients (42.3%) received hormone therapy (HT). All patients were followed up with
PSA and digital rectal examination.
Results: The mean age was 65.6 years (SD 5.65). Preoperative PSA was <10, 10-20 or> 20 in 54.3%,
35.7% and 10% respectively. 57.7% of patients were pT2, 17.9% pT3a, 15.4% pT3b and 9% pTx. Surgical
margins were negative in 43 patients (55.8%), and positive in 31 (40.3%). 38 (62.3%) patients had a
Gleason score ≤ 6, 13 (21.3%) Gleason 7 and 10 (16.4%) Gleason 8-10. The median PSA pre-EBRT was
1.17 ng/ml (range 0.12 to 19). The median follow-up was 23 months (range 5-98). Although biochemical
response was seen in 63 (80.7%) patients, biochemical progression-free survival after 5 years was 57.6%.
Time to BR after RT was shorter in patients with PSA> 10 vs. PSA ≤ 10 (mean 33 months vs. 74 months)
with pT3 vs pT2 (38 vs. 75), Gleason> 7 vs ≤ 7 (42 vs. 70) and negative vs positive margins (43 vs. 71).
In univariate analysis, none of these factors, or the use of hormone therapy were significant predictors of
biochemical failure.
Conclusions: Despite excellent rates of biochemical response (80.7%) were achieved in patients treated
with salvage EBRT, biochemical failure-free survival at 5 years was 57.6%. It is necessary to explore
strategies such as combination with antiandrogen treatment or dose escalation to improve results with
current treatments.
74
P039
Characterization and health outcomes of prostate cancer in a radiation oncology unit
García Cabezas S.1, Palacios Eito A.1, Font Ugalde P.2, Rivin Del Campo E.1, Béjar Luque A .1, Rodríguez Liñán
M.1, Romeo Olmedo J.L.1, Martínez Paredes M.2
1
Reina Sofia University Hospital, Dept. of Radiation Oncology, Cordoba, Spain, 2University of Cordoba,
Dept. of Medicine, Cordoba, Spain
Introduction & Objectives: Research in health outcomes allows evaluation of efficacy and effectiveness
of treatments in clinical practice. Objectives: Characterization of patients treated for PC with curative
intent in our department (population area with a single radiotherapy supplier).Analysis of overall survival
(OS), cancer-specific survival (CSS), disease-free survival (DFS), biochemical relapse-free survival (BRFS)
and metastasis-free survival (MFS).
Unmoderated Posters
Material & Methods: Between 1989 and 2008, 879 patients with PC were treated in our department.
13% had undergone radical prostatectomy, 3% had received brachytherapy. The remaining 84% received
EBRT±hormonal therapy (HT). Only patients treated with external beam radiation therapy (EBRT) were
included.741 patients were analyzed. Many patients were lost due to follow-up or discharge. Databases,
external medical records and phone contact were used to obtain clinical information. If this information
was not acquired, the case was excluded. One limitation was that the last disease status evaluation was
performed in 25% of cases by phone. This action validates OS, but does not provide precise evolution of
BRFS. Statistical analysis:Mean and standard deviation for quantitative variables and absolute frequency
and percentage for qualitative variables were obtained. A Kaplan-Meier analysis of survival was used to
calculate OS, CSS, DFS, BRFS and MFS. All contrasts were bilateral and differences with p <0.05 were
considered significant.
Results: The average age was 68±6 years. 50% were ≥ 70 years old. 88% had started HT. The average
interval diagnosis-start of EBRT was 5.2±4.9 months.Patients were divided into risk groups (D’Amico
1999): low (15.2%), intermediate (33.3%) and high risk (50.3%). Mean PSA was 17±32 ng/ml (10.5 ng/ml
median,12 ng/ml mode). Gleason score frequency: 7 (39%); 6 (32.2%); 8 (13.4%). Stage distribution: T1c
(42%); T2c (27%); T2a (12%). 89% were stage II. 1.5% were stage IV (lymph node involvement). Biochemical
relapse occurred in 6%. 2.6% had distant metastases. Mortality was 5.4%, cancer-specific mortality 1.2%
(8/9 patients: high risk).With a 16 year median follow-up (95%CI,14-15), OS at 5 and 10 years was 92%
and 88% respectively. CSS was 97.4% and 96.9% in the same periods. DFS at 5 and 10 years was 86%
and 73%, 12.8 year median follow-up (95%CI,11.4-14.2). The BRFS was 88.3% and 82.7%, median follow
up of 13.7 years (95%CI,13-14.5) and the MFS was 96% and 87%, median of 14.4 years (95%CI,13.3-15.6).
Statistically significant differences have been found in CSS between high and low risk groups (p=0.034)
and in MFS between intermediate and high risk groups (p=0.024). No other significant differences were
found.
Conclusions: Radical EBRT in localized PC achieves optimum results in terms of survival and biochemical
control.The results obtained in our series are similar to those described in the literature.
75
P041
PSA kinetics after treatment with I-125 brachytherapy (BT): Relevance of rebound phenomena
and its differentiation with biochemical failure
Cabeza Rodriguez M.A., Cascales García M.A.C, D’amdrosi R., Martinez R., Hernandez Arteaga O.M.,
Guardado S., Lechuga C., Lanzos E.
Hospital Universitario 12 De Octubre, Dept. of Radiation Oncology, Madrid, Spain
Unmoderated Posters
Introduction & Objectives: PSA rebound (rPSA) is a temporary mild elevation of PSA returning to its
previous value without requiring any therapeutic intervention. It is a specific phenomenon of radiotherapy,
not yet well known, unrelated to the disease.Objectives: to evaluate PSA kinetics in patients with low
risk prostate cancer (NCCN) treated with BT I-125; their prevalence of rPSA and its characteristics.
To determine the association of clinical and/or dosimetric factors with rPSA, and its correlation with
biochemical failure free survival (bDFS).
Material & Methods: 169 patients were treated with BT-I125 (July 03–June 08) with a minimum follow
up of 30 months. Mean age was 67years. We performed an intraoperative technique; prescription dose
was 145Gy to 100% isodose. 32 patients received cytoreductive Hormonal Therapy (HT) for 6 months.
rPSA was defined as a temporary elevation of PSA≥0.2ng/ml, which fell to a nadir PSA value (nPSA) of
≤to before the rebounce without therapeutic intervention. nPSA was defined as a PSA<0.1ng/ml or 3
consecutive PSA stable determinations (ranging ≤0.1ng/ml between them). Biochemical failure(BF) was
defined according to Phoenix criteria (NPSA+2ng/ml).
Results: Median follow-up was 50 months (r:30-93). The mean number of post-BT PSA determinations per
patient was 8 with a 6-month interval. rPSA was detected in 32%, dubious rPSA(gradual decrease after a
PSA increase,without even according to rPSA criteria)in 5%, and BF in 8%. 90% of the episodes occurred
within the 36 months after BT. Median duration of rPSA was 12.4 months(r:4-60). Median magnitude of
rPSA was 0.59ng/ml (r:0.2-8.13ng/ml). 15% of the rPSA (8 patients) had criteria for false BF. Median time
to achieve nPSA is 45.7months (5-89). 37% of patients have achieved nPSA without BF. 90% of them had
nPSA≤0.07ng/ml(r <0.04-0.36ng/ml). The best feature to differentiate between BF and rPSA; is the time
interval in which PSA elevation occurs, despite the overlap between these two events. Median onset of
rPSA is 17 months (IQ 1-3:11-22months) whereas the median onset of BF is 35 months (IQ 1-3:32-62), with
a statistically significant difference between the occurrence time of both phenomena (p <0.0001 U-Mann
Whitney test). rPSA was a better predictor of 5-year actuarial bDFS, showing 100% bDFS in those who
had rPSA while bDFS was 88% in those who did not. In the logistic regression analysis neither clinical
factors (age, prostate volume, Gleason score, pretreatment PSA) nor treatment ones (HT,D90) were rPSA
phenomenon predictive.
Conclusions: rPSA phenomenon is common after BT I-125; it can be observed in ≥30% of patients. An
increase in PSA value ≥2ng/ml may occur in 15% of patients with rPSA. Presentation time is useful to
distinguish a phenomenon of a true BF rPSA but not absolute. Patients with ≥0.2ng/ml rPSA phenomenon
have a better bDFS.
76
P042
Lifestyle habits during and after prostatic radiotherapy influences the risk of late toxicity
Thomas J.1, Holm M.2, Bellamy P.3, Steele C.4
Addenbrooke’s and Bedford Hospitals Cambridge University, Dept. of Oncology, Cambridge, United Kingdom, 2Oxford University, Dept. of Biochemistry, Oxford, United Kingdom, 3Cranfield University, Dept. of
Statistics, Cranfield, United Kingdom, 4MacMillan Cancer Support, Dept. of Survivorship, London, United
Kingdom
1
Material & Methods: This retrospective study evaluated an entire cohort of men who were treated with
radical radiotherapy at Addenbrooke’s Hospital within 2000-2010, via the Bedford Hospital pathway (n alive
at time of study=470). 440 (94%) completed a questionnaire consisting of the Vaizey Rectal Toxicity score,
the NCI common toxicity scores for rectal bleeding, erectile function and urinary incontinence, a General
Practical Physical Activity Questionnaire and questions concerning BMI and smoking. The effect of each
lifestyle criteria on rectal toxicity was investigated using a non-parametric ANOVA (Kruskal-Wallis) test and
other side effect scores using a chi-squared test (significance level α=0.05).
Results: 7.5% men smoked during their radiotherapy. At the time of the survey, 63% were over-weight or
obese (BMI >25); 58% were inactive, 27% moderately inactive and 15% active. Active men had significantly
lower rectal toxicity and significantly better erectile and urinary function. Men smoking >5/day had
significantly worse rectal toxicity as did overweight men There were no significant effects of the measured
lifestyle criteria on PSA relapse.
Conclusions: This is the first comprehensive evaluation of lifestyle habits during and after radical
radiotherapy for prostate cancer. In this large cohort, most men were inactive and overweight, but few
smoked. Although a retrospective analysis, the data strongly suggests higher late toxicity among smokers,
inactive and overweight men. We have modified our information materials and consent process (see
cancernet.co.uk/prostate.htm) to include lifestyle counselling and if necessary refer men to smoking
cessation clinics, nutuitionalists and local gyms via the national exercise referral scheme.
77
Unmoderated Posters
Introduction & Objectives: More men are surviving prostate cancer yet living with the late adverse
effects of treatment. Although improvements in radiotherapy techniques are reducing risks, little is know
about the benefits of self help lifestyle measures. This analysis aimed to discover if lifestyle factors such
as smoking, exercise, body weight influenced the rate of radiotherapy side effects.
P043
Predicting rectal bleeding with neural networks: Late effects on patients treated for prostate
cancer with 3DCRT
Unmoderated Posters
Tomatis S.1, Rancati T.2, Fiorino C.3, Vavassori V.4, Fellin G.5, Cagna E.6, Flora Anna M.7, Girelli G.8, Monti A.9,
Baccolini M.10, Bianchi C.11, Menegotti L.12, Pasquino M.13, Stasi M.14, Valdagni R.2
1
Fondazione IRCCS Istituto Nazionale Tumori Di Milano, Dept. of Medical Physics, Milan, Italy, 2Fondazione
IRCCS Istituto Nazionale Tumori Di Milano, Prostate Program, Scientific Directorate, Milan, Italy, 3Ospedale
San Raffaele, Dept. of Medical Physics, Milan, Italy, 4I.C. Humanitas Gavazzeni, Dept. of Radiotherapy,
Bergamo, Italy, 5Ospedale Santa Chiara, Dept. of Radiotherapy, Trento, Italy, 6Ospedale Sant’Anna, Dept.
of Radiotherapy, Como, Italy, 7Ospedale Villa Maria Cecilia, Dept. of Radiotherapy, Lugo Di Romagna, Italy,
8
Ospedale ASL 9, Dept. of Radiotherapy, Ivrea, Italy, 9Ospedale Sant’Anna, Dept. of Medical Physics, Como,
Italy, 10Ospedale Villa Maria Cecilia, Dept. of Medical Physics, Lugo Di Romagna, Italy, 11Ospedale Di Circolo,
Dept. of Medical Physics, Varese, Italy, 12Ospedale Santa Chiara, Dept. of Medical Physics, Trento, Italy,
13
ASL TO4, Dept. of Medical Physics, Ivrea, Italy, 14Istituto Di Ricerca E Cura Del Cancro, Dept. of Medical
Physics, Candiolo, Italy
Introduction & Objectives: Toxicity is a crucial issue in the management of prostate cancer with
radiotherapy. The pre-treatment estimation of the related risk has gained a place of growing interest in
the scientific literature in the last few years. The aim of this study is, first, to develop a model exploiting
artificial neural networks (ANN) to correlate dosimetric and clinical variables to late rectal bleeding (lrb) in
prostate cancer patients undergoing radical radiotherapy (RT). Further, to compare the ANN results with a
standard linear logistic regression (LR) analysis.
Material & Methods: Seven hundred eighteen men included in the AIROPROS 0102 trial were analyzed.
This multicenter protocol was characterized by the prospective evaluation of rectal toxicity through
self-assessed questionnaires (minimum follow-up: 36 months). RT doses were between 70 and 80 Gy.
Information was recorded on co-morbidity, previous abdominal surgery, use of drugs and hormonal
therapy. Rectal dose-volume histogram of the whole treatment was recorded for each patient and the
percent volume of rectum receiving more than 20,30,40,50,60,70,75 Gy (named V20Gy→V75Gy) were
considered. Equivalent uniform dose (EUD) was also evaluated as an effective descriptor of the whole
DVH. Late rectal bleeding of grade ≥2 was considered to define positive events in this study (52 over
718 patients). The overall population was split into train and verify set, which were both involved in model
instruction, and test set, used for evaluating the predictive power with independent data. A four fold cross
validation was also applied to provide realistic results for the full data set. Setup of LR was performed on
the same data.
Results: Five variables were selected for lrb prediction: EUD, abdominal surgery, presence of
haemorrhoids, use of anticoagulants and androgen deprivation. Following ROC analysis on the independent
test set, Area Under Curve (AUC) resulted to be 0.704 and 0.655 for ANN and LR, respectively. When
evaluated with cross validation, AUC was 0.703 for ANN and 0.636 for LR, with a corresponding
significance level of the difference p = 0.08. By selecting a practical discrimination threshold, ANN was
able to classify data with same sensitivity and specificity equal to 66.5% to be compared to the figure of
61.5% of LR.
Conclusions: There is reasonable evidence that results obtained with ANNs are superior to the ones
achieved with LR. ANNs might help radiation oncologists in predicting RT-related late rectal bleeding. For
the future, the introduction of patient-related personal characteristics, such as genetic expressions, might
improve the predictive power of statistical classifiers. More refined morphological aspects of the dose
distribution such as dose surface mapping could also be exploited to enhance the overall performance of
ANN-based predictive models.
78
P044
Modelling fecal incontinence 6 years after high-dose radiation for prostate cancer: Clinical and
dosimetric predictors
Fellin G.1, Rancati T.2, Fiorino C.3, Vavassori V.4, Cagna E.5, Mauro F.A.6, Malinverni G.7, Valdagni R.8
Ospedale Santa Chiara, Dept. of Radiation Oncology, Trento, Italy, 2Fondazione IRCCS - Istituto Nazionale
Dei Tumori, Prostate Program, Milan, Italy, 3Istituto Scientifico San Raffaele, Dept. of Medical Physics,
Milan, Italy, 4Humanitas - Gavazzeni, Dept. of Radiation Oncology, Bergamo, Italy, 5Ospedale Sant’Anna,
Dept. of Radiation Oncology, Como, Italy, 6Ospedale Villa Maria Cecilia, Dept. of Radiation Oncology, Lugo
Di Romagna, Italy, 7A.O. Ordine Mauriziano, Dept. of Radiation Oncology, Torino, Italy, 8Fondazione IRCCS Istituto Nazionale Dei Tumori, Prostate Program and Dept. of Radiation Oncology, Milano, Italy
1
Material & Methods: Self-reported questionnaires of 515 pts with a minimum follow up of 6 yrs were
analyzed with respect to linc. G1 linc was scored if unintentional stool discharge was “sometimes”
experienced, G2 linc if unintentional stool discharge was “often” experienced or if pts sporadically used
sanitary pads; G3 if pts reported daily unintentional stool discharge or use of sanitary pad >2 times/
week. The correlation between pre-treatment morbidities, hormonal therapy, drug prescription, presence
of diabetes or hypertension, abdominal surgery prior to RT, presence of G2-G3 acute fecal incontinence,
pelvic nodes and seminal vesicles irradiation, mean rectal dose, dose-volume histograms constraints (from
V20Gy to V75Gy) and linc was investigated by uni- and multivariate (MVA) logistic analyses. 347/515 pts
had at least 3 toxicity questionnaires in the first 36 mos after the end of RT. Correlation between the mean
score of fecal incontinence in the first 36 mos and linc at 6 yrs was also investigated.
Results: 50/515 G1, 3/515 G2 and 3/515 G3 linc were reported. In MVA, V40Gy (continuous variable,
p=0.09, OR=1.015), use of antihypertensives (protective factors, p=0.005, OR=0.38), presence of
abdominal surgery before RT (p=0.004, OR=4.7), presence of haemorrhoids (p=0.008, OR=2.6) and
presence of G2-G3 acute incontinence (p=0.007, OR=4.4) resulted to be correlated to linc. The figure
shows the nomogram which was developed starting from MVA results. Linc at 6 yrs was also correlated to
the mean incontinence scores in the first 36 mos (p<0.0001): pts without linc at 6 yrs had a mean score
of 0.1 during the first 36 mos, while pts with G1 and with G2-G3 linc at 6 yrs had a mean score of 0.5 and
0.78 during the first 36 mos, respectively.
Conclusions: Mean score for incontinence during the first 36 mos after RT can be used as a surrogate
endpoint for late (>6yrs) fecal incontinence. Linc is correlated to clinical and dosimetric risk factors and
individualised toxicity prediction can be performed through the proposed nomogram.
79
Unmoderated Posters
Introduction & Objectives: To evaluate the incidence of late fecal incontinence (linc) after high-dose
radiotherapy (RT) in prostate cancer patients (pts) accrued in AIROPROS 0102 trial (RT doses: 70-80Gy,
1.8-2Gy/fr) and to model the relationship between linc and clinical/dosimetric factors.
P045
Hypogonadism related to androgen blockade is unable to induce adipose tissue changes in
prostate cancer patients
Martos A., Sabater S., Andres I., Jimenez E., Carrizo M.V., Berenguer R., Sevillano M., Aguayo M., Rivera M.,
Nuñez A., De La Vara V., Villas M.V., Arenas M.
Hospital General De Albacete, Dept. of Radiation Oncology, Albacete, Spain
Unmoderated Posters
Introduction & Objectives: Patients treated with androgen blockade (AB) develop hypogonadism, which
is a known factor related to an increase in the adipose tissue amount. CT scans have shown the ability to
quantify this fat redistribution. So our hypothesis was that serial CT scans could display a progressive fat
increase as longer the AB was.
Material & Methods: CT scans from 33 patients were analyzed. All patients had a CT study done at
the time of the AB start and, at least, another study done between 1 and 2 years later. Using the MIPAV
abdomen segmentation plugin and the grow region tool (v.4.4.1, U.S. National Institutes of Health)
abdominal and pelvic diameters and areas; as well fat and loan areas and mean Hounsfield units (HU)
were recorded from abdominal total, subcutaneous and visceral fat tissue. To quantify tissues the next
thresholds were used: fat pixels -190/-30; muscle pixels 0 / 100. Nonparametric statistics were used.
Results: 7 patients were treated without an AB and were used as a control. For 12 patients such treatment
was planned for less than 9 months and the remaining was planned as a long-term blockade for 3 years.
No differences were obtained when comparing basal CT to 1 or 2 years CT. Also no differences were seen,
at 1 or 2 years, among patients exposed to different AB duration.
Conclusions: Despite published reports have proved a relation between other sources of hypogonadism
with fat redistribution, we were unable to demonstrate it among prostate cancer patients. Our results show
some data variations that could be connected with the induced hypogonadism but without a statistical
significance. The results are intriguing because other kind of pharmacological interventions have been able
to induce CT changes in similar time periods and we wonder if AB must last more than our study to induce
the expected CT changes.
80
P046
12 years experience of toxicity associated with low dose rate brachytherapy in over 1800
patients
Javed S., Chadwick E., Laing R.W., Langley S.E.M.
Royal Surrey County Hospital, Dept. of Urology and St. Luke’s Cancer Centre, Guildford, United Kingdom
Material & Methods: Between 1999 and 2011, a total of 1813 patients were treated with LDR BXT
either alone (1178, 65%); in combination with hormones (391, 22%); in combination with external beam
radiotherapy ERBT (37, 2%); or in combination with ERBT and hormones (207, 11%). A bespoke, prospective
database was used to collect clinical data.
Results: In 1813 patients, mild leakage (no pads required) was reported by 3 (0.17%) patients and none
experienced moderate or severe leakage. 116 patients (6.4%) developed rectal bleeding (grade 3/4). Rectal
fistula occurred in 4 patients (0.2%) due to rectal/transrectal biopsies or in patients with prior anterior
resection. 65 (3.8%) developed urethral stricture which required intermittent self catherisation (ISC) and 89
(5%) patients used ISC for urinary retention (acute/chronic). 813 patients have 5 years follow up data. At 5
years of follow up, patients with baseline IPSS 0−7 (n=545), median IPSS was 5 (range 0−24), those with
baseline IPSS 8−19 (n=204), median IPSS was 8 (range 0−24) and patients with baseline IPSS ≥20 (n=4)
had median IPSS of 7 (range 1−21). The median quality of life score in relation to bowel function (EORTC
QLQ-C30/PR25) was 4 (range 4−10) at 5 years. In patients deemed potent pre-treatment (IIEF score ≥11),
the median IIEF at 5 years was 23 (range 2−25). 115 (62%) out of 186 patients maintained their potency at
5 years and beyond.
Conclusions: Our findings demonstrate that urinary incontinence is rare and good sexual function is also
maintained following LDR BXT. Our results demonstrate the advantage of LDR BXT with respect to its
toxicity profile. When considering treatment for patients with localised prostate cancer, LDR BXT should be
considered as an option in appropriate groups.
81
Unmoderated Posters
Introduction & Objectives: Low dose rate (LDR) prostate brachytherapy (BXT) is now an established
treatment option for organ confined prostate cancer with a favourable side effect profile particularly with
respect to incontinence and potency. We report our findings of toxicity in a large prospective series of
patients treated with LDR BXT in the UK.
P047
Shifting to preference-based prostate cancer screening: A cost of illness assessment of
screening program options
Thomas V.S.
Roche Professional Diagnostics, Dept. of Medical & Scientific Affaris, Rotkreuz, Switzerland
Unmoderated Posters
Introduction & Objectives: After nearly three decades of diffusion and uptake, the use of PSA testing
appears to be in decline. The decline in usage is likely precipitated by the high rate of false positive results
which are observed. Expert consensus statements have for more than a decade concluded that the
harms of PSA screening outweigh the benefits in men with a life expectancy of ten years or less, but PSA
testing remains nearly ubiquitous. The aim of the analysis is to estimate the monetary impact of various
testing alternatives for “at-risk” men, comparing no screeing to PSA screening, and also to an “idealised”
screening test.
Material & Methods: A cost of illness modelling approach is developed in order to analyse the economic
and quaility-of-life effects of defining the ideal performance characteristics of a prostate screening
marker. Published data on screening and detection rates as well as subsequent treatment rates from large
population-based studies are employed. Cost data on screening and treatment primarily from the UK and
the USA are utilized and utility values are drawn primarily from UK sources.
Results: We review the published literature to 2010 in an effort to comprehensively capture the available
data on resource costing of prostate cancer (screening, diagnosis, as well as staging) to aid the robust
estimation of economic effects. Generally, where PSA screening rates are high, the total cost of care is
high.We compute the costs of screening, diagnosis, and treatment for a hypothetical cohort of 100000
men, specifying unnecessary costs due to overdetection and indolence. Employing consensus guidelines
on recommendations for testing, we further specify that many men should not even undergo testing
based on remaining life expectancy alone, thereby potentially alleviating further unnecessary costs.
Given currently available technologies, the benefits to testing for men under 65 are small, and there is no
evidence of benefit to testing for men over age 65.
Conclusions: Given the significant side effects often associated with, particularly PSA testing, active
screening should depend on individual patient decision-making wherein quality-of-life and life expectancy
tradeoffs are explicitly assessed. The ideal screening test would be one that distinguishes between highrisk and low-risk prostate cancers, thereby allowing therapeutic options and resources to be focussed on
the former group.
82
P048
Intermittent Androgen Deprivation Therapy (IADT) in the treatment of prostate cancer (PCa)
after biochemical failure
Mermershtain W., Zalcberg Y., Rouvinov K., Gusakova I., Ariad S.
Soroka University Medical Center, Dept. of Oncology, Beer Sheva, Israel
Material & Methods: 65 PCa pts previously treated with Radical Prostatectomy, EBRT, or BT with
biochemical failure were treated with IADT. Treatment included Bicalutamide 50mg/d, days 1-28 and one
injection of LHRH–agonist (usually Suprefact depot 9.9mg or Zoladex 10.8mg). The average age was 76
years (range 62-86). The average follow-up time was 39.5 months (range 4-80).
Results: The average interval to biochemical failure was 15.4, 14.1 and 12.3 months for the first, second
and third relapses, respectively. The average PSA serum level before IADT was 4.08ng/ml; at first nadir 0.15ng/ml, at first and second reinitiation - 1.8ng/ml, - 2.7ng/ml, and at first and second nadirs - 0.21ng/
ml and 0.29ng/ml, respectively. Total testosterone serum levels between treatment cycles (randomly
investigated in 50% of pts) were normalized in many, but not all patients.
Conclusions: IADT is a valid treatment option in non-metastatic PCa patients with locally-advanced
disease, and improves QoL during off-therapy periods.
83
Unmoderated Posters
Introduction & Objectives: Androgen-deprivation therapy (ADT) has progressed since 1941 when
surgical castration was shown to improve PCa outcomes. Gonadotropin-releasing hormone agonists were
discovered in 1971 and are now the mainstay of PCa treatment. The well-known side effect profile of ADT
has significant quality-of-life (QoL) implications such as sexual dysfunction, hot flushes, and fatigue. The
strategy behind IADT, therefore, is to alternate androgen blockade with treatment cessation, allowing
hormonal recovery between treatment periods. Objective: to evaluate the efficacy and tolerability of IADT
and assess its value in the treatment of PCa.
P049
Estimation of the CRPC incident case population that will receive first and second-line
chemotherapy treatment in 2011 (5 European countries)
Heidenreich A.1, Oudard S.2, Bellmunt J.3, Parnaby A.4, Mason M.5
University Aachen, Dept. of Urology, Aachen, Germany, 2Hôpital Européen Georges Pompidou, Dept. of
Medical Oncology, Paris, France, 3Hospital Del Mar, Dept. of Medical Oncology, Barcelona, Spain, 4Sanofi
Aventis, Global Evidence Value Development, Massy, France, 5Cardiff University, School of Medicine,
Cardiff, United Kingdom
1
Unmoderated Posters
Introduction & Objectives: Epidemiology data on the number of castration-resistant prostate cancer
(CRPC) patients are limited. Therefore inferences must be derived from available data for prostate cancer
diagnosis and progression.
Material & Methods: Based on national sources of cancer statistics, European and National guidelines
and an exhaustive literature review, the following data were used or estimated to populate a model and
generate estimates of the incident CRPC population in 2011 for France, Italy, Germany, Spain and the
UK; - Incidence, distribution of clinical stage and D’Amico risk groups at diagnosis reported since 2000
and expected until 2010 - Actuarial biochemical recurrence rates after primary therapy within 1 to 10
years - Use and progression rates after salvage therapy within 3 years - Survival of patients diagnosed at
metastatic stage. We then applied country specific indicators of chemotherapy (CT) use in first and secondline that were derived from either expected survival after first-line chemotherapy or qualitative surveys
recently performed among urologists and oncologists. Published and commercial data of CT were used as
a proxy of the prevalent population of CRPC patients receiving first-line CT to assess the model’s external
validity.
Results: Estimated ranges of incident case population in 2011
country
incident number of CRPC patients
Incident number of CRPC patients
receiving first-line CT
candidate for second-line CT
France
11 000
6 100 – 7 100
3 000 – 3 500
Germany
13 500
7 200
3 500 – 4 100
Italy
10 300
3 100 – 4 100
1 700 – 2 200
Spain
5 000
1 800 - 2 700
1 100 - 1 600
UK
7 800
3 100 – 4 700
1 700 – 2 500
total 5KEU
47 200 – 48 900
21 300 - 25 800
10 900 – 14 000
The factors that would affect the model output are mainly the proportion of CRPC patients receiving
first-line CT and among those, the proportion who would receive a second-line treatment right after the
first-line.
Conclusions: Our model predicts that in 2011, about 265 200 new prostate cancer cases will be
diagnosed and about 48 400 patients would reach the CRPC stage in the 5 largest European countries.
When applying a range of estimates for the most impactful factors, the model estimated that, in these
countries, between 11 000 and 14 000 new patients would be eligible in 2011 for a second-line treatment.
84
P050
Phase 2, open-label, single-arm study measuring efficacy and safety of MDV3100 in patients
with hormone-naive prostate cancer
Baskin-Bey S.1, Holtkamp G.M.2, Smith M.R.3, Ouatas T.4, Phung D.5, Tombal B.6
Introduction & Objectives: MDV3100 is a novel oral androgen receptor antagonist in clinical development for the treatment of prostate cancer (PCa). Compared with bicalutamide, MDV3100 had higher
androgen receptor–binding affinity, significantly prevented nuclear translocation, showed no DNA binding
or coactivator recruitment, and induced apoptosis in vitro. MDV3100 also displayed no evidence of partial
agonist activity (Tran C, et al. Science. 2009;324:787). Phase 1–2 data demonstrate antitumor activity with
MDV3100 in advanced metastatic castration resistant PCa (CRPC) (Scher HI, et al. Lancet. 2010;375:14371446). Phase 2 and 3 studies in men with progressive CRPC are ongoing. Here, we present the design of a
phase 2 study of MDV3100 in men with hormone-naive PCa who are candidates for ADT.
Material & Methods: This 25-week, open-label, single-arm, efficacy and safety study of MDV3100 (160
mg/d) was initiated at approximately 20 investigational sites in 2011 (planned countries: Austria, Belgium,
Czech Republic, Denmark, Germany). Inclusion criteria include histologically confirmed PCa (all stages);
noncastrate testosterone ≥230 ng/dL and prostate-specific antigen (PSA) ≥2 ng/mL at screening; Eastern
Cooperative Oncology Group score of 0; and life expectancy ≥1 year. Key exclusion criteria include
previous/current hormonal therapy or chemotherapy for PCa. The primary endpoint is PSA response,
defined as a ≥80% decrease from baseline to week 25. A binary PSA response per patient at week 25 will
be determined, allowing for generation of a PSA response rate (95% CI) from all patients for the study.
Secondary endpoints include PSA dynamics/PSA doubling time; pharmacokinetics; change in luteinizing
hormone, follicle-stimulating hormone, testosterone, dihydrotestosterone (DHT), androstenedione, dehydroepiandrosterone (DHEA), estradiol, sex-hormone binding globulin (SHBG), prolactin levels, and safety/
tolerability. Exploratory endpoints include changes in bone mineral density, bone turnover markers (bone
turnover N-telopeptide [NTx], bone alkaline phosphatase [bALP]), metabolic effects (eg, changes in lipids,
insulin sensitivity, lean body mass), and quality of life.
Results: The planned enrollment is 60 patients. Assuming a 20% dropout rate, the study will have 80%
power to reject the unwanted PSA response rate of ≤50% at a 5% level of significance. Efficacy and safety
data will be published at a later date.
Conclusions: Previous MDV3100 data were collected from patients with advanced PCa who had castrate
levels of testosterone (≤50 ng/dL). This clinical trial represents the first investigation of the use of
MDV3100 as monotherapy in hormone naive PCa.
85
Unmoderated Posters
1
Astellas Pharma Europe, Ltd., Dept. of Medical Affairs Urology, Middlesex, United Kingdom, 2Astellas
Pharma Europe BV, Dept. of Global Clinical Science, Leiderdorp, The Netherlands, 3Massachusetts General
Hospital Cancer Center, Dept. of Hematology/Oncology, Boston, United States of America, 4Astellas
Pharma Europe BV, Dept. of Translational and Development Pharmacology, Leiderdorp, The Netherlands,
5
Astellas Pharma Europe BV, Dept. of Global Data Science, Leiderdorp, The Netherlands, 6Cliniques Universitaires Saint-Luc, Dept. of Urology, Brussels, Belgium
P051
A phase III randomised, open-label, French multicentre trial to evaluate the benefit of leuprorelin acetate (Eligard® 45 mg) for 24 months after radical prostatectomy in patients with high
risk of recurrence (AFU-GETUG 20)
Rozet F.1, Habibian M.2, Berille J.2, Roca L.3, Salomon L.4, Soulié M.5, Culine S.6
Institut Montsouris, Dept. of Urology, Paris, France, 2Unicancer, R&D, Paris, France, 3Val D’aurelle, Dept. of
Biostatistics, Montpellier, France, 4Mondor, Dept. of Urology, Creteil, France, 5Rangueil, Dept. of Urology,
Toulouse, France, 6Saint Louis, Dept. of Oncology, Paris, France
Unmoderated Posters
1
Introduction & Objectives: Patients post radical prostatectomy (RP) that have extraprostatic extension
or high Gleason grade are considered to have a high risk of local treatment failure. Randomized trials
have demonstrated a benefit from adjuvant androgen deprivation therapy (ADT) in patients with high risk
prostate cancer treated with external beam radiation. the actual role of LH-RH agonists after RP in patients
with high risk of recurrence remains unclear, except for the patients with positive lymph nodes. For pN0
patients, randomized studies with flutamide or bicalutamide showed no improvement in overall survival. No
randomized prospective study has been published with LH-RH agonists in the PSA era. The recent report of
the SWOG 9921 study shows a 5-year overall survival of 96% for high-risk patients treated with 24 months
of ADT after surgery. This result shows that combination of RP and ADT is associated with favorable
disease-free and overall survival. However, this study does not define the optimal protocol of adjuvant ADT,
and does not demonstrate the superiority of immediate vs delayed treatment. The Objective of the study
is to evaluate the benefit of leuprorelin acetate (Eligard® 45 mg) (kindly provided by ASTELLAS) for 24
months after RP in patients with high risk of recurrence.
Material & Methods: Academic Phase III randomised, open-label, multicentre trial starting in late 2011.
Inclusion criteria include: RP with or without extended pelvic lymphadenectomy in the 3 months preceding
inclusion, postoperative Gleason score > 7, or ≥ 7 with the presence of high-grade Gleason patterns and
N0-Nx, M0, patients pT3b, R0, N0 or Nx, M0, postoperative PSA < 0.1 ng/mL. Exclusion criteria: previous/
current therapy for PCa. Primary endpoint is the evaluation of metastatic progression free survival. Secondary endpoints include overall survival, disease-specific survival, PSA evolution, evaluation of testosterone
level, and quality of life.
Results: A total of 700 patients (350 in each arm) and 250 events are required to have 80% ability to
detect a difference with a bilateral Logrank test with α= 0.05 and β= 0.20. The decision rules will be
determined by the O’ Brien-Fleming sequential boundaries at the time of the analysis. The interim analysis
is planned at the 125th event (50% of events) for 6.5 years after the start of the trial. The final analysis is
planned for 12 years after the inclusion of the first patient.
Conclusions: The AFU-GETUG 20 is a pioneering French multicenter trial aiming to verify the actual role of
leuprorelin acetate (Eligard ® 45 mg) after RP for patients with high risk prostate cancer.
86
P052
Trial design of TERRAIN, a randomized, double-blind, phase 2 study comparing MDV3100 vs
bicalutamide in men with metastatic castrate-resistant prostate cancer
Baskin-Bey E.S.1, Shore N.2, Barber K.3, Ouatas T.4, Karunaratne M.5, Heidenreich A.6
Introduction & Objectives: Bicalutamide has demonstrated limited antitumor activity in patients with
castration-resistant prostate cancer (CRPC). MDV3100 is a novel oral androgen receptor (AR) antagonist in
clinical development for treatment of prostate cancer (PCa). Compared with bicalutamide (Bic) in preclinical
studies using CRPC models, MDV3100 had higher AR binding affinity, prevented nuclear translocation, had
no DNA binding or coactivator recruitment activity, and showed no evidence of AR agonism (Tran C, et al.
Science 2009;324:787-790). MDV3100 has shown antitumor activity in men with advanced PCa (Scher
HI, et al. Lancet. 2010;375:1437-1446), including a subset of patients who progressed following Bic. We
present the study design for a phase 2 trial comparing the administration of either MDV3100 or Bic to men
with metastatic CRPC who have progressed following initial gonadotropin-releasing hormone (GnRH) analog
therapy or surgical castration.
Material & Methods: This is a phase 2, double-blind, parallel-group, efficacy and safety study comparing patients randomized 1:1 to once daily MDV3100 160 mg or Bic 50 mg currently enrolling a planned
370 patients in North America and Europe. Inclusion criteria include histologically confirmed metastatic
(≥2 documented bone lesions or soft tissue disease at screening) progressive CRPC (≥3 rising prostate
specific antigen [PSA] levels or new bone/soft tissue disease), ongoing stable GnRH analog therapy or bilateral orchiectomy, castrate serum testosterone levels (<50 ng/dL), Eastern Cooperative Oncology Group
performance status 0–1, and life expectancy ≥1 year. Exclusion criteria include previous chemotherapy for
PCa, current or prior treatment with antiandrogens (except if administered for <12 wk and discontinued no
less than 6 mo before randomization). Patients will be stratified by time of bilateral orchiectomy or GnRH
analog initiation (before/after diagnosis of metastases) and will receive treatment until occurrence of radiographic progression or a skeletal-related event, initiation of new antineoplastic therapy, or development of
an adverse event or toxicity resulting in discontinuation. The primary endpoint is progression-free survival;
secondary endpoints are safety, PSA response (% change from baseline to week 13), and time to PSA
progression. Exploratory endpoints include circulating tumor cell conversion rate and quality of life.
Results: Efficacy and safety data will be published later.
Conclusions: This ongoing phase 2 clinical trial, based on a prior phase 1–2 trial of MDV3100 that
showed clinical benefit in advanced PCa patients, was designed to be the first head-to-head comparison of
MDV3100 versus Bic in men with metastatic CRPC.
87
Unmoderated Posters
1
Astellas Pharma Europe, Ltd., Dept. of Medical Affairs Urology, Middlesex, United Kingdom, 2Carolina Urologic Research Center/Atlantic Urology Clinics, Dept. of Urology, Myrtle Beach, United States of America,
3
Astellas Pharma Global Development, Inc., Dept. of Global Clinical Science, Deerfield, United States of
America, 4Astellas Pharma Europe BV, Dept. of Translational and Development Pharmacology, Leiderdorp,
The Netherlands, 5Inventiv Clinical Solutions, Dept. of Research Data Science, Deerfield, United States of
America, 6University Hospital Aachen, Dept. of Urology, Aachen, Germany
P053
Whole pelvis and concomitant boost to the prostate with moderate hypofractionation using
helical tomotherapy
Monaco A., Caruso C., Chiostrini C., Cianciulli M., Donato V.
S. Camillo-Forlanini, Dept. of Radiotherapy, Rome, Italy
Unmoderated Posters
Introduction & Objectives: To evaluate the feasibility and tolerance of hypofractionation using Helical
Tomotherapy in high grade prostate cancer.
Material & Methods: From January 2010 to April 2011 40 patients with stage I-III prostate cancer which
don’t underwent radical prostatectomy, with or without hormone therapy, were treated in our institute with
Helical Tomotherapy. Among these patients, 11 were considered high risk based on Gleason score (>7),
primary tumour (T>=3) and PSA value (>= 20 ng/ml): in these patients whole pelvis was treated while
receiving a concomitant boost to the prostate and seminal vesicles within a moderately hypofractionated
regimen. PTV 1 consisting of pelvic lymph-nodal area received 50.4 Gy in 28 fractions with 1.8 Gy per
fraction; PTV2 consisted of prostate and seminal vesicles plus a margin of 0.6-0.8 cm and received a total
dose of 70 Gy in 28 fraction with 2.5 Gy per fraction. All patients received neoadjuvant and concurrent
androgen deprivation.
Results: The treatment was well tolerated in all patients. RTOG rectal and urinary toxicity was evaluated
during treatment: acute rectal toxicity scores were G1 in 7 patients, G2 in 2 patients; acute urinary toxicity
scores were G1 in 6 patients and G2 in 3 patients. No G2 or higher acute gastrointestinal toxicities were
seen. No acute Grade 3 RTOG toxicity was recorded.
Conclusions: Prostate hypofractionation with helical tomotherapy for high risk prostate cancer represents
an efficient and promising method for achieving dose escalation of the prostate with modest acute toxicity.
Based on these preliminary results further dose increase is possible.
88
P054
Long-term efficacy results from the phase 1-2 study of MDV3100 in pre- and post-docetaxel
advanced prostate cancer
Higano C.S.1, Beer T.M.2, Yu E.Y.1, Taplin M.E.3, Efstathiou E.4, Anand A.5, Hirmand M.6, Fleisher M.7, Scher
H.I.8, The Prostate Cancer Clinical Trials Consortium
University of Washington School of Medicine, Fred Hutchinson Cancer Research Center, Dept. of Medicine,
Division of Oncology, Seattle, United States of America, 2Oregon Health and Science University, Dept. of
Hematology and Medical Oncology, Portland, United States of America, 3Dana-Farber Cancer Institute,
Dept. of Medical Oncology / Solid Tumor Oncology, Boston, United States of America, 4University of
Texas, M.D. Anderson Cancer Center, Dept. of Genitourinary Medical Oncology, Houston, United States of
America, 5Memorial Sloan-Kettering Cancer Center, Dept. of Medicine, Genitourinary Oncology Service,
New York, United States of America, 6Medivation, Inc., Dept. of Clinical Development, San Francisco,
United States of America, 7Memorial Sloan-Kettering Cancer Center, Dept. of Clinical Laboratories, New
York, United States of America, 8Memorial Sloan-Kettering Cancer Center, Dept. of Genitourinary Oncology
Service, New York, United States of America
Introduction & Objectives: MDV3100 is a novel orally administered androgen receptor (AR) antagonist.
In pre-clinical models, MDV3100 slows growth and induces cell death in bicalutaminde-resistant tumors
via 3 complementary actions: AR antagonism, inhibition of nuclear translocation of the AR complex, and
inhibition of AR binding to DNA (Tran C et al. Science. 2009; 324: 787). In vitro, MDV3100 is a pure AR antagonist, devoid of agonist activity. Clinical antitumor activity and tolerability data from a Phase 1-2 study
evaluating MDV3100 in patients with advanced prostate cancer (PCa) have been previously reported (Scher
HI et al. Lancet. 2010;375:1437). Long-term follow-up data from this study are presented including time to
prostate-specific antigen (PSA) and radiographic progression.
Material & Methods: Patients with progressive castration-resistant PCa (CRPC) were enrolled in sequential cohorts of 3 to 6 patients receiving MDV3100 doses of 30, 60, 150, 240, 360, 480, or 600 mg/day.
After confirming tolerability, each cohort at MDV3100 ≥ 60 mg/day was expanded to include approximately
24 patients.
Results: Of the 140 patients enrolled, 65 were chemotherapy naïve and 75 were previously treated with
docetaxel-based chemotherapy. At the time of this analysis 18 patients (13%) continue on active treatment
(chemotherapy-naïve, n = 16; post-chemotherapy, n = 2) with a median treatment duration of 131 weeks.
Long-term follow-up results are presented below:
Assessment
Patient population
Chemotherapy-naïve (N = 65)
Post-chemotherapy (N = 75)
Median time to per protocol PSA progression1
Not reached
8 months
Median time to PCWG22 defined PSA progression
10 months
5 months
Median time to radiographic progression3
13 months
6 months
1. ≥25% increase in PSA from baseline that represented a ≥ 5 µg/mL increase2. Prostate Cancer Working
Group 23. RECIST and PCWG2 criteriaCirculating tumor cell counts remained favorable (<5 cells/7.5 mL)
between baseline and post-treatment in 91% (70/77) of patients, and 49% (25/51) converted from unfavorable pre-treatment to favorable post-treatment.
Conclusions: In this study, MDV3100 demonstrated durable antitumor activity in both chemotherapy-naïve
and post-chemotherapy patients with CRPC. MDV3100 is currently being evaluated in two ongoing multi-national phase 3 studies in patients with advanced progressive PCa: the AFFIRM study in patients previously
treated with docetaxel, and the PREVAIL study in asymptomatic or mildly symptomatic chemotherapy-naïve
patients who have progressed following androgen deprivation therapy.
89
Unmoderated Posters
1
P055
Leuprolide acetate with Atrigel®, an androgen deprivation therapy for advanced prostate
cancer: Economic evaluation of three formulations in nine European countries
Retsa P.1, Sidhu M.1, Odeyemi I.1, Tombal B.2, Wex J.3
1
Astellas Pharma Europe, Dept. of Urology, Staines, United Kingdom, 2Cliniques Universitaires Saint-Luc,
Centre Du Cancer, Brussels, Belgium, 3PharmaArchitecture Ltd, HEOR, Camberley, United Kingdom
Unmoderated Posters
Introduction & Objectives: Leuprolide is an established luteinising hormone-releasing hormone agonist
used for the treatment of advanced prostate cancer. We evaluated the economic impact of different dosing
schedules of leuprolide in Austria, Belgium, Czech Republic, Hungary, Italy, Latvia, Netherlands, Poland and
Portugal.
Material & Methods: Database searches identified 10 clinical trials of leuprolide 1- (1M), 3- (3M) and
6-monthly (6M). Due to comparable efficacy, safety and adherence between schedules, a cost-minimisation
analysis was conducted from the perspective of public payers. Costs of leuprolide, specialist consultations
and diagnostics (converted to 2010 Euro values) were considered for up to 12 months of follow-up.
Results: Leuprolide 1M, 3M and 6M suppressed serum testosterone with mean (SD) levels of 6.1 (4.3),
10.1 (0.7), and 12.3 (2.1)ng/dL, respectively (p>0.05). The respective percentage of patients achieving
testosterone ≤50ng/dL was 100%, 100% and 99% (p>0.05). 6M was the least expensive schedule with
average total annual costs from 788€ (Poland) to 1,839€ (Portugal). The 3M option was between 2.5%
(Hungary) and 37.6% (Belgium) more expensive than 6M; the 1M formulation was the most expensive:
15.6% and 151.6% more than 6M for Hungary and Belgium, respectively. The 3M option was between
11.2% and 45.3% less expensive than 1M. Total costs were associated with the frequency of visits for injection and monitoring. 1M required 12 visits, 3M 4.4–4.8, and 6M 2.1–2.3. Up to 50% additional visits could
be funded with the savings resulting from switching eligible patients from 1M and 3M to 6M. Results were
stable in one-way sensitivity analyses. In the probabilistic sensitivity analysis the 95% uncertainty intervals
for total costs and percentage of additional visits did not overlap.
Conclusions: These current leuprolide formulations offer comparable efficacy and safety. Different dosing
schedules require different numbers of visits. The 6-monthly Leuprolide acetate with Atrigel® formulation
offers the greatest cost-savings for prostate cancer patients in the European countries studied.
90
P056
An observational study to assess the safety and efficacy of Eligard® 7.5 mg and 22.5 mg for
treatment of advanced prostate cancer
Stanculeanu D.L.1, Ullmann F.2, Sefchi C.3
1
Oncology Clinical Institute “Prof. Dr. Alexandru Trestioreanu” Bucharest, Dept. of Oncology, Bucuresti,
Romania, 2Astellas Pharma International B.V. , Medical department, Leiderdorp, The Netherlands, 3Astellas
Pharma International B.V., Medical department, Bucharest, Romania
Materials & Methods: In this non-interventional survey with a duration of 12 months, Eligard 7.5mg
(1-month depot formulation) or 22.5 mg (3-month depot formulation) were administered to patients with advanced hormone-dependent prostate cancer. The study was conducted in the setting of routine out-patient
medical care. Data were collected after 6 and 12 months of treatment and were analyzed descriptively.
Results: The population comprised 120 patients from 12 facilities in Romania. Mean (SD) age was 73 (8.8),
median time since diagnosis was 3 months (range: 0.3-70). 58% of patients had a TNM stage ≥T3 and 73%
had been previously treated with hormone therapy, radiation therapy and/or radical prostatectomy. All
patients had been prescribed Eligard 7.5 mg or 22.5 mg; 38% had been converted from another hormone
therapy. Initially, 52% of patients were started on the 7.5mg and 48% on the 22.5mg dose. This changed
at month 6 to 36% receiving the 7.5mg and 64% the 22.5mg dose and at month 12 to 32% receiving the
7.5mg and 68% the 22.5mg dose. 32% of patients were on monotherapy with Eligard at month 6 increasing
to 41% at month 12. The mean (SD) duration of treatment was 11 (3.3) months. Median PSA concentration
at baseline was 9.1 (range, 0.07-460) ng/mL decreasing to 0.7 (0.01-74.8) at 6 months and 0.4 (0.001397.5) at 12 months. Median testosterone concentration decreased from 5.3 (0.1-862) ng/dL at baseline
to 0.2 (0.1-28.3) at month 6 and 0.2 (0.1-58.6) at month 12 (data available for 11 patients). Treatment was
discontinued in 3.4% of patients due to inadequate therapeutic response. 9 patients died from causes
related to their primary diagnosis of cancer, 2 patients experienced an adverse event which was not
related to study drug. Clinicians indicated that their primary reason for prescribing Eligard was its efficacy
profile (89 of 165 respondents). Nursing and assistive medical personnel indicated that the preparation and
administration of Eligard was practical (93 of 120 respondents).
Conclusions: Eligard showed efficacy in reducing PSA concentration to below normal level at 6 and 12
months. The higher dose of Eligard was more often prescribed and the number of patients receiving
Eligard as a single therapy increased over time. Health care professionals identified the handling and administration of the Eligard syringe as practical. Patient tolerability of treatment was good as indicated by very
low incidences of adverse events and premature study withdrawal. This study was supported with a grant
from Astellas Pharma Europe Ltd.
91
Unmoderated Posters
Introduction & Objectives: Despite the effectiveness of orchiectomy to treat prostate cancer, treatment
with LHRH agonists is often preferred by physicians and patients. This observational study assessed the
safety, efficacy, and handling of two formulations of Eligard (Astellas Pharma Europe Ltd).
P057
Feasibility of treatment planning on megavoltage CT images in prostate cancer patients with
femoral prostheses
Fodor A.1, Deli A.M.1, Mangili P.2, Cozzarini C.1, Fiorino C.2, Dell’oca I.1, Calandrino R.2, Di Muzio N.G.1
San Raffaele Scientific Institute, Dept. of Radiotherapy, Milan, Italy, 2San Raffaele Scientific Institute, Dept.
of Medical Physics, Milan, Italy
1
Unmoderated Posters
Introduction & Objectives: Prostate cancer is generally diagnosed in older patients which may have
metallic hip implants generating artifacts on kilovoltageCT(kVCT) images, resulting in difficulty in target
definition and in the calculation of the treatment plan. MegavoltageCT(MVCT) images provides acceptable
image quality for the delineation of soft tissue structures, and the dose calculation using the merged
images on the planned adaptive software is accurate when compared to the same plan using kvCT images.
In the present study we analyzed the results obtained in pts treated with a MVCT simulation.
Material & Methods: Between 03/2007- 05/2011, 9 prostate cancer pts with hip prostheses were
treated in radical(6 pts), adjuvant(2 pts) or salvage(1 pts) setting. The patients’ median age was 71.4
years(65.4- 76.7 yrs). Three of the pts with radical radiotherapy were defined as intermediate risk due
to the presence of one of the following characteristics: clinical stage T2, PSA>10 ng/ml at diagnosis,
GS≥7; the other 3 pts were considered high risk, due to the concomitant presence of 2 risk factors. The
2 adjuvant pts were pT3a and pT3b, with GS 8(5+3) and 9(4+5) respectively, and the salvage treatment patient was a pT3 with GS 8(4+4) and iPSA 15.5 ng/ml. According to our guidelines, whole pelvis
radiotherapy(WPRT) was always prescribed for intermediate and high risk groups of pts in radical setting,
in node-positive patients and in node-negative patients submitted to limited lymphadenectomy (<8 removed
nodes) and/or in presence of adverse prognostic factors (Gleason Score >7 and/or pre-operative PSA > 10
ng/mL) in adjuvant or salvage setting. Median dose to the pelvic nodes was 51.8 Gy in 28 fractions while
concomitantly delivering 65.8-74.2 Gy to prostatic bed/prostate with simultaneous integrated boost.
Results: With a median follow up of 14.7 mts ( 0-50.8 mts) no biochemical relapse was registered. The
acute RTOG toxicity was: 8 pts presented G1 genito-urinary (GU) toxicity and 1 patient G2 GU toxicity.
Three pts presented G1 gastro-enteric (GE) toxicity and 6 pts had no GE toxicity during the treatment.
Three pts presented G1 and 1 patient G2 rectal toxicity; the other 5 pts were G0. Late toxicity in the 8
pts with more than 90 days of follow up was as follows: 2 pts presented late G1 GU toxicity and 1 patient
G3 GU toxicity(urethroplastic surgery for urge-incontinence). The other 5 pts had no GU late toxicity. One
patient presented late G3 rectal toxicity(argon laser for hemorrhagic radiation proctitis) and 7 pts had G0
late GI toxicity. No late GE toxicity was registered.
Conclusions: This study shows good results with regard to acute and late toxicity in hip prosthesis
patients and demonstrates the feasibility of the treatment with MVCT simulation. None of the patients presented a relapse but the follow up of 14.7 months is short and a longer period is needed to assess control
outcome.
92
P058
Combined radiotherapy of prostate cancer in patients with intermediate and poor prognosis:
LDR boost vs. HDR boost
Albitskiy I.1, Solodkiy V.A.2, Kharchenko V.P.3, Panshin G.A.1, Datsenko P.V.1, Vinikovetskaya A.V.4, Golub S.V.1
1
Russian Scientific Centre For RoentgenRadiology, Dept. of Radiation Oncology, Moscow, Russia, 2Russian
Scientific Centre For RoentgenRadiology, The Director, Moscow, Russia, 3Russian Scientific Centre For
RoentgenRadiology, The Scientific Leader, Moscow, Russia, 4Russian Scientific Centre For RoentgenRadiology, Dept. of CT, Moscow, Russia
Material & Methods: We studied the results of treatment in two groups of patients. Group 1 - 112
patients after combined irradiation with LDR boost, group 2 - 110 patients after combined irradiation with
HDR boost. All of them were under hormonal deprivation for 3-6 months before irradiation. Brachytherapy
was the first part of treatment with additional EBRT in both groups. All patients are standard by age, stage
and prognostic (intermediate and poor) factors. The median follow-up is 44 months. The median age of patients is 64 years. The schedule was: 110Gy of LDR boost and 10 Gy of HDR boost, then 44-50Gy of EBRT.
Results: The 4-years BFFS is no significantly higher in the HDR group 74,6±5,0% vs 77,2±4,7%, and there
were no loco-regional progression in the group 2, versus 4 – 2 local, 2 pelvic lymph node metastasis in
LDR group. The significant predictor factor of poor surveillance was PSA level higher than 0,1 ng/ml before
EBRT in both groups. Late irradiation damages in groups 1 and 2: rectitis 48,9±4,3% vs 37,7±4,1%, grade
2 - 28,6±3,7% vs 13,33±3,9%, cystistis 46,2±2,6% vs 44,4±2,9%, grade 3 38,4±3,2% vs 10±2,8%. The
differences in damage expressiveness are significant in two groups.
Conclusions: So, we consider combined irradiation technique with HDR boost more preferable in prostate
cancer patients because of better results – lower complication level
93
Unmoderated Posters
Introduction & Objectives: To compare different combined irradiation techniques by effectiveness,
frequency and expressiveness of irradiation damages in patients with advanced prostate cancer.
P059
The effect of age on expectations of treatment decisions and information support for patients
with prostate cancer
Tombal B.1, Baskin-Bey E.S.2, Schulman C.C.3
1
Cliniques Universitaires Saint-Luc, Centre Du Cancer, Brussels, Belgium, 2Astellas Pharma Europe, Dept.
of Urology, Staines, United Kingdom, 3Clinic Edith Cavell and University of Brussels, Dept. of Urology, Brussels, Belgium
Unmoderated Posters
Introduction & Objectives: Patients with prostate cancer can face multiple treatment choices over many
years, and need to be adequately informed about the options available. Evidence from cancer patients
indicates that age is a determining factor in the desire for collaborative versus passive roles in treatment
decision-making. We conducted an analysis of data from the ‘Silent Voice’ survey of prostate cancer
patients in Poland, Italy, France, Germany and Spain to examine overall information requirements and
expectations according to patient age (≤ 70 vs 71–80 years).
Material & Methods: The Silent Voice survey (2009) involved interviews with 252 patients diagnosed with
prostate cancer. Interviews were conducted by telephone (except in Italy which were face- to-face) using
the local language. Survey questions were either multiple choice or rank- based, and additional information
was available to assist patient comprehension. Data were collected on survey forms and processed via a
database.
Results: Of the patients surveyed, 44.5% were aged ≤ 70 years; the remainder were 71–80. More
patients aged ≤ 70 years (41.6%) desired a collaborative role in treatment decision-making than those
aged 71–80 years (23.4%). On a scale of 1–5 (1=dissatisfied; 5=very satisfied), more than half of each age
group (58.4% and 53.2%, respectively) rated the information provided by their GP as 4 or 5; for specialist
physicians, these percentages were much higher (94.4% and 91.9% respectively). Among patients aged
≤ 70 years, 44.6% used the internet as their secondary source of information, but internet use was only
cited by 15.1% of patients aged 71–80 years, who preferred newspapers and hospital brochures. Patients
aged ≤ 70 years generally cited family life, socialising, remaining active as the most important factors to
them; patients aged 71–80 years had the same list, with the exception of socialising. Sex was important to
33.7% of patients aged ≤ 70 years, but only 11.7% of those aged 71–80 years. Patients discussed these
concerns with their physician in less than half of cases (≤ 70 years 43.8%; 71–80 years, 33.3%). The most
common reasons for not doing so were privacy and belief that the issues were not relevant to therapy.
Conclusions: This survey shows that many patients with prostate cancer wish to be involved in decisions
regarding their treatment, but this desire lessens with advancing age. Regardless of age, the information
provided by specialists meets the demands of prostate cancer patients, but GPs may be able to do more
to educate them. Internet use is widespread among younger prostate cancer patients, while older patients
rely on printed matter. Across the age range studied, concerns about impact on lifestyle varied, and a
large proportion of patients failed to discuss these concerns with their doctor. Survey financed by Astellas
Pharma Europe Ltd.
94
P060
An assessment of patient reported outcome (PRO) instruments used in prostate cancer (PCa)
drug trials
Peeters P.1, Casamayor M.2, Moïse P.1, Holmstrom S.3
1
Quintiles Consulting, Consulting Department, Paris, France, 2Quintiles Consulting, Consulting Department,
Barcelona, Spain, 3Astellas Pharma Global, HEOR Department, Leiden, The Netherlands
Material & Methods: ClinicalTrials.gov, Medline and Centre for Reviews and Dissemination (CRD) were
extensively reviewed for clinical trials published since 1 January 1999 on drugs for PCa recently approved
by the FDA and EMA or Heads of Medicines Agencies (CMDh) (those drugs being cabazitaxel, docetaxel,
degarelix, histrelin, bicalutamide, leuprolide, leuprorelin, triptorelin or sipuleucel-T), used at any PCa stage.
The search terms used were “quality of life OR QOL OR patient reported outcome” (outcome measure) and
“prostate cancer” (for condition). Phase I clinical trials and studies using PROs to assess other therapeutic
options such as surgery, brachytherapy or cryotherapy were not considered. We supplemented the search
with reviews of EMA or CMDh drug labels for PRO information.
Results: In total, 413 phase II–IV clinical trials were identified. Of these, 70 clinical trials were identified
with PROs or HQoL measures: 33 with docetaxel, 14 bicalutamide, 13 leuprolide/leuprorelin, 5 degarelix,
3 cabazitaxel and 2 triptorelin. The MOTIF trial, aimed to determine the efficacy of modafinil in alleviating
fatigue in PC patients undergoing docetaxel-based chemotherapy, was the only trial to assess fatigue: the
Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F) and the six-item somatic subscale
(SOMA) were the PRO instruments used. Two docetaxel trials and one cabazitaxel trial were the only ones
to use a pain-specific PRO (Present Pain Intensity (PPI) item from the McGill Pain Questionnaire).
Conclusions: Despite the ubiquity of fatigue as a possible side effect of both hormonal therapy and
chemotherapy for PCa, only one trial assessed fatigue with a dedicated PRO instrument. Although pain
can be one of the most debilitating symptoms associated with PCa, only three trials used a dedicated PRO
instrument to assess it. When selecting clinical trial endpoints, sponsors and investigators can address
this information gap by considering the use of PRO instruments, both to capture the effects of the disease
itself and to better understand the clinical benefits and the risks associated with treatment.
95
Unmoderated Posters
Introduction & Objectives: The health-related quality of life (HRQoL) of patients with PCa is important
because patients can be living with the disease and on treatment for many years. Clinical trials for PCa
drug approvals do not currently use HRQoL measures as primary efficacy endpoints, and instead typically
rely on overall survival, overall response rate, time to treatment failure and time to tumour progression.
Our objective was to understand what fatigue and pain-specific PRO instruments are being used in clinical
trials for recently approved PCa drugs.
P061
Assessing the impact of early hormonal therapy in prostate cancer (PC) on cognoscitiveemotional parameters and quality of life (QoL)
Cascales García M.A.1, Cabeza Rodriguez M.A.1, Romero Otero J.2, Rodriguez Antolin A.2, Clavel Claver M.3,
Perez Regadera J.1, Lanzos E.1
Hospital Universitario 12 De Octubre, Dept. of Radiation Oncology, Madrid, Spain, 2Hospital Universitario
12 De Octubre, Dept. of Urology, Madrid, Spain, 3Centro De Cuidados Laguna Obra Social La Caixa, Dept.
of Equipo Psicosocial, Madrid, Spain
1
Unmoderated Posters
Introduction & Objectives: Castration using LHRH analogues (LHRHa) in PC treatment is associated with
a wide range of metabolic, psychological and body alterations. The evaluation of these metabolic-psychological consequences is not adequately documented; neither time of onset, nor its severity; meanwhile in
these patients age and comorbidity may obscure these aspects. Objectives: Evaluating, in patients with PC
treated with aLHRH, the early onset of changes in the areas of psycho-cognitive, emotional and QoL.
Material & Methods: Prospective, descriptive study in patients undergoing RT and long-course HT with
aLHRH, included consecutively from September 2009. All patients were evaluated the months 0, 3, 6, 12,
24 and 36. The follow-up is conducted by qualified personnel. Administered questionnaires are validated
for: 1. Androgen Deficiency: AMSS, 2.Cognoscitive: Mini-mental test, 3.These mood and depression: BDI,
4.QoL: SF-12. We performed a statistical analysis comparing the change in the same patient from visit
home until the second visit. Wilcoxon test was used.
Results: 25 patients completed 6 months follow-up. The AMSS shows progressive deterioration in the
score (28 in V0, 32 and 33 V6m V3m, p <0.05). In the cognitive sphere (Mini-mental test) no significant
alteration is evident. In the emotional arm, when assessing depression, the BDI showed a worsening from
0 (3.5) to 3m (4.9) (p = 0.08) which is consolidated to 6m (5.8) ( p = 0.030). However, assessing QoL
by SF-12, if it is found a deterioration in the mental health field at 6m (p = 0.03), while other parameters
evaluated did not show changes.
Conclusions: Treatment with LHRHa shows deleterious effects from an early follow-up (3m); mainly in
the sexual sphere. At 6 months, a slight deterioration in mood starts, which is confirmed in the section on
mental health to assess the QoL. Neither cognitive ability nor the other parameters of overall QoL seem to
be decreased.
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P062
Changes in body composition, development of metabolic syndrome (X) and pathological
fractures in men on long term androgen deprivation therapy
Žiaran S., Goncalves F.M., Breza Sn. J.
University Hospital In Bratislava, Dept. of Urology, Bratislava, Slovakia
Material & Methods: Ninety-seven patients with locally advanced PCa (mean age 73,4 yrs, SD+-3,94)
were treated with ADT for at least 12 months. Body mass index (BMI), waist hip ratio (WHR), lipid profile,
serum fasting glucose and bone mineral density (BMD) of lumbar spine (L1-L4), femoral neck and total hip
BMD were examined before the initiation of ADT (baseline examination) and then every 10- 12 months.
These measurements were also made to the control group of eighty-nine patients (mean age 71,9 yrs SD+3,68). Overall follow-up was 20-24 months.
Results: After 10-12 months of ADT, BMI, WHR, LDL, overall cholesterol increased significantly (p<0,001),
serum fasting glucose increased (p=0,03), HDL increased insignificantly (p=0,245), total hip BMD and BMD
L1-L4 decreased significantly (p<0,001 p<0,004) respectively, in the study group. Pathological fractures of
lumbar spine were diagnosed in four pacients in the study group. No pathological fractures were found in
the control group. After 20-26 months of ADT in the study group, BMI, WHR increased significantly (p=0,03)
when compared to the examination after 10-12 months. All other parameters increased insignificantly, but
remained significantly increased when compared to the baseline examination. BMD was significantly lower
in L1-L4, femoral neck, and total hip (p=0,001, p=0,037, p< 0,001 respectively). Five lumbar fractures
(6,1%), two femoral fractures (2,4%) were detected in the study group. Overall, the incidence of fractures
after 20-26 months of ADT was 8,5%. One lumbar fracture (1,1%) was detected in the control group.
Conclusions: ADT leads into unfavourable changes in body composition, unfavourable lipoprotein profile,
increase in serum fasting glucose level and decrease in bone mineral density. These data suggest that patients on long term ADT are at higher risk of cardiovascular morbidity, of developing insuline resistance and
pathological fractures. Physicians should be aware of these adverse effects which may increase morbidity
and mortality. Dual X ray absorpciometry (DXA) for assesment of BMD should be made before the initiation
of ADT and after 12 months. Preventive (lifestyle) actions should be considered to reduce cardiovascular
risk.
97
Unmoderated Posters
Introduction & Objectives: Androgen deprivation therapy (ADT) is considered the standard therapy for
advanced prostate cancer (PCa), but its use may be associated with several adverse effects. There is
increasing interest in the effects of chemical castration on body composition, lipid metabolism, serum
fasting glucose level and skeletal metabolism. These changes can lead into metabolic syndrome (X) and
increased risk fractures which might increase morbidity and mortality of patients on ADT. The aim of
this study is to asses the effects of ADT on body fat distribution, body weight, lipid profile, serum fasting
glucose and bone mineral density (BMD) in patients with PCa.
P063
Whole genome expression changes in metastatic human prostate cancer before and after
castration - paired analysis of fine needle biopsies
Hoejgaard M.1, Balslev I.2, Vikeså J.3, Nielsen F.C.3, Mikines K.J.1
Herlev Hospital, Copenhagen University Hospital, Dept. of Urology, Herlev, Denmark, 2Herlev Hospital,
Copenhagen University Hospital, Dept. of Pathology, Herlev, Denmark, 3Rigshospitalet, Copenhagen
University Hospital, Center of Genomic Medicine, Copenhagen, Denmark
1
Unmoderated Posters
Introduction & Objectives: First line treatment of metastatic prostate cancer (metPC) is castration
causing a temporary regression of both metastases and primary tumour growth. The clinical effect of
castration is primarily caused by decreased androgen receptor (AR) signalling but the in vivo whole genome
gene expression changes in metPC are poorly understood. The aim of this study was to investigate whole
genome mRNA gene expression changes in samples of human metPC before and after castration.
Material & Methods: Patients diagnosed with untreated metPC were prospectively enrolled and had
primary tumour biopsies taken before castration (hormone naive metPC (hn-metPC)) and at PSA nadir
(androgen-ablated metPC (aa-metPC)). Tumour cells were laser capture microdissected from fine needle
biopsies and RNA was isolated with PicoPure RNA Isolation Kit, reverse transcripted and amplified with
NuGen Ovation Pico Kit and hybridized to Affymetrix Human Gene ST1.0 arrays. Paired t-test analysis at
Q<0.2 in Qlucore Omics Explorer was used for comparison between hn-metPC and aa-metPC.14 paired
samples from 12 patients were available for analysis.
Variable
Value (stdev/range)
Gleason Score (median)
8 (0,7/7-9)
PSA µg/dl (mean)
721 (998/71-3566)
Time to PSA nadir, days(mean)
120 (134/28-508)
Table 1: Patient characteristics at diagnosis
Results: Fig.1: Heatmap of gene expression changes; hn-metPC (red) vs. aa-metPC (green) patientsA
total of 64 probesets representing 57 annotated and 1 unannotated genes were differentially expressed
at p<0.0004 at q<0.2 between hn-metPC and aa-metPC.A number of genes associated with immune
response(Gene Ontology:0006955) were overexpressed in aa-metPC (table 2). The metastasis-progression
and inflammation associated S100A4 and the S100A4-transcriptionally regulated MMP-2 and OPTN were
also overexpressed in aa-metPC.
98
Gene symbol
Fold change
p-value
CD74
2,6
1,07E-5
CCL5
2,39
0,0001
HLA-DRB3
2,04
4,84E-5
GBP2
2,01
7,37E-5
ARHGDIB
1,79
2,38E-5
IFITM3
1,75
0,0002
CXCL12
1,7
9,69E-5
Table 2: Overexpressed immune response genes in aa-metPC compared to hn-metPCThe AR regulated
KLK3 (PSA) and PMEPA1 were downregulated in aa-metPC.
Unmoderated Posters
Conclusions: Serial analysis of whole genome expression response to castration identifies upregulation of
genes involved in immune response and metastatic progression related to S100A4. The androgen regulated KLK3 and PMEPA1 were, as expected, downregulated in response to castration.
99
P064
Testosterone and hormonal study of patients with prostate cancer and benign prostatic
Valle-Diaz De La Guardia F.1, Jimenez-Pacheco A.2, Arrabal-Polo M.A.3, Lahoz-Garcia C.3, Arrabal-Martin M.3,
Nogueras-Ocaña M.3, Zuluaga-Gomez A.3
1
”Santa Juan De La Cruz” Hospital, Dept. of Urology, Jaen, Spain, 2”Santa Ana” Hospital, Dept. of Urology,
Granada, Spain, 3”San Cecilio” University Hospital, Dept. of Urology, Granada, Spain
Unmoderated Posters
Introduction & Objectives: In recent years relationships between testosterone levels in men and
predisposition, diagnosis or progression of prostate cancer have been investigated. The aim of our study
is to analyze the hormonal behaviour of patients with prostate cancer, the testosterone-PSA ratio and
relationship testosterone-clinical stage.
Material & Methods: We selected 30 patients diagnosed with prostate cancer and 15 controls with BPH.
Exclusion criteria in both groups were receiving, before determining, any hormonal treatment. We calculated the mean hormone levels and examined whether there was an association between the values within
each group as well as significant differences. Statistical analysis by SPSS 17.0 software.
Results: Patients with prostate cancer had a mean age of 70.8 years. PSA: 51.5 ng / ml, testosterone: 4.5
ng / ml, SHBG-testosterone: 47.5 nmol / L, estradiol: 36.5 pg / ml, progesterone: 0.5 ng / ml, prolactin:
340, 5; LH: 11.5 mul / ml, FSH: 13.23 MUL / ml. The control group, patients with BPH, showed average
age: 65.5 years; PSA: 5.89 ng / ml, testosterone: 3.9 ng / ml, SHBG-testosterone: 45.8 nmol / L, estradiol: 43 , 8 pg / ml, progesterone: 0.67 ng / ml, prolactin: 295.7; LH: 8.6 mul / ml, FSH: 7.8 MUL / ml,
albumin: 4.08 g / dl. PSA values (p = 0.03) and SHBG (p = 0.01) were significantly higher in patients with
cancer. In the prostate cancer group it was found a negative correlation between PSA and testosterone
levels (p = 0.03), positive PSA with estradiol and progesterone (p <0.01), and positive relationship between
LH and FSH ( p <0.01). In patients with BPH positive correlation between PSA and prostate volume (p =
0.01). We divided the prostate cancer patients into two groups according to degree of aggressiveness and
extention of the tumor, showing no differences in hormone levels.
Conclusions: Patients with prostate cancer had higher values of testosterone, SHBG, LH and FSH, and
lower estradiol and progesterone, SHBG remained significant. It will be required greater sample size and
grouping patients by various criteria (age, tumor stage, grade) to achieve results with possible clinical
implications in the prevention or prognosis of cancer.
Fig. 1
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P065
Second primary tumors in urology – A hospital-based survival analysis
Pacheco-Figueiredo L.F.1, Carvalho I.C.2, Antunes L.A.3, Bento M.J.B.3, Lunet N.L.4
Hospital São João, Dept. of Urology, Porto, Portugal, 2Hospital São João, Cancer Registry, Porto, Portugal, 3Portuguese Oncology Institute, North Region Cancer Registry (RORENO), Porto, Portugal, 4University
of Porto Medical School, Dept. of Hygiene and Epidemiology, Porto, Portugal
1
Material & Methods: We identified 1281 cancer cases registered in the Hospital S. João Cancer Registry,
during 2001-2005, with PRT, BLD and KID topographies. The identification of SPC was performed crossing
data with population-based North Region Cancer Registry (RORENO). The description of SPC cases was
done considering age, gender, previous cancer topography, date of diagnosis and treatment options. A
retrospective cohort analysis (1:2 topography and date of diagnosis matching) was performed to evaluate
crude and adjusted relative survivals. Chi-square and kruskal-wallis statistical tests were used to compare
categorical and continuous variables, respectively. Cox-regression analysis was performed to evaluate
survival.
Results: Within 2001-2005, we identified 50 (3.9%) SPC cases [PRT n=22 (44%), BLD n=15 (30%), KID
n=13 (26%)]. Topography-based proportion of SPC was 2.9%, 4.0% and 8.6%, respectively for PRT, BLD
and KID. The most frequent topographies of FPC were: bladder (31.8%) and stomach (22.7%) for PRT
SPC; prostate (26.7%) and lung (26.7%) for BLD SPC; prostate (20.0%) and colon/rectum (20.0%) for KID
SPC. Median time (months) between diagnosis were 41.2 (12.6-104.7), 9.1 (4.5-35.8) and 42.1 (9.9-107.6),
respectively for PRT, BLD and KID cases. There were no significant differences concerning age between
SPC and FPC. Gender distribution was similar regarding BLD cancer, with a higher proportion (p=0.05) of
male in KID FPC cases. There were no significant differences considering stage and type of treatment,
although there was a tendency to lower TNM grade tumors in SPC. Although not statistically significant,
there was also a tendency to greater age- and gender-adjusted survival [PRT: HR=0.28 (0.08-1.04); KID:
HR=0.19 (0.03-1.21)] in SPC, except for BLD cancer [HR=1.78 (0.73-4.36)]. The same analysis with stage
adjustment, revealed no significantly differences.
Conclusions: Our results showed that SPC cases corresponded to a not negligible proportion of all incident cases, despite the scope for increasing in the next years. SPC cases seem to have a greater survival,
possibly due to a lower stage at diagnosis, although the results were not statistically significant, possibly
due to small sample power.
101
Unmoderated Posters
Introduction & Objectives: Cancer survivorship has dramatically increased in the latest decades, with
the most recent overall 5-year relative survival estimates of 49.6% in Europe and 64.4% in the USA. Worldwide, the increasing survival of oncologic patients results in approximately 22 million cancer survivors
(CSs), with a myriad of medical problems, such as second primary cancers.The main goal of this work
is to perform a hospital-based description of the three most frequent urological second primary cancer
(SPC) cases [prostate (PRT), bladder (BLD) and kidney (KID)] and to do a survival analysis against same
topography first primary cancers (FPC).
P066
Concentration of plasma vitamin D in patients with prostate cancer
Wieczorek K.1, Braczkowski R.S.S.2, Duda W.1, Białozyt M.1, Huzarska M.3, Braczkowska B.B.4
E.Michalowski Memory Specialistic Hospital, Dept. of Urology, Katowice, Poland, 2Silesian Medical University, Dept. of Public Health, Katowice, Poland, 3Silesian Medical University, Dept. of Clinical Pharmacology,
Katowice, Poland, 4Silesian Medical University, Dept. of Epidemiology, Katowice, Poland
1
Unmoderated Posters
Introduction & Objectives: Results from laboratory studies show that vitamin D impacts multiple
pathways involved in oncogenesis. Epidemiological data have shown that low plasma metabolite levels
increase risk of many cancers. One of them is prostate cancer. Question is particularly important because
last begin appearing opinions about opportunity of vitmin D supplementation in prostate cancer chemoprevention.The aim of our study was to compare 25(OH)D serum concentration in patients with prostate
cancer and with benign prostate hiperplasia.
Material & Methods: The study enrolled patients aged 35 - 70 years admitted to E.Michalowski Memory
Hospital to implement prostate electroresection or biopsy. After receiving the result of histopathological
examination patients were divided into 2 groups: the study group, patients diagnosed with cancer and
controls diagnosed with benign prostate hiperplasia. Both grups consisted of 100 patients. Patients with
hypercalcemia, sarcoidosis, sysytemic connecive tissue diseases and other types of cancer were excluded
from the study. Patients who had PSA above 4 ng / ml but whose study hist-pat is not confirmed cancer,
also were excluded from the study. Concentration of 25 (OH) D in serum was determined by ELISA.Statistical analysis of results was performed using Student’s T test an U -Mann-Whitneytest. Permission of local
Ethic Commitee was obtained for the study, like the written consent of the individuals tested.
Results: Concentration of 25 (OH) D was low in both groups. Concentration in the group with prostate
cancer was statistically significantly lower than in the group of benign prostatic hyperplasia.
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P067
Expression of of IGFs genes clear cell renal cell carcinoma
Białożyt M.1, Braczkowski R.S.2, Plato M.3, Duda W.1, Mazurek E.3
E.Michałowski Memory Speciałistic Hospital Hospital, Dept. of Urology, Katowice, Poland, 2Silesian Medical University, Dept. of Public Health, Katowice, Poland, 3Silesian Medical University, Dept. of Molecular
Biology, Katowice, Poland
Introduction & Objectives: Renal cell cancer, which accounts for 85% of kidney cancers, represents
3 – 4 % of all human malignant neoplasms. Clear cell renal cell carcinoma (cRCC) is a distinct and the most
frequent subtype of renal cell carcinoma. There are still no specific biomarker for this type of cancer.
Insulin like growth factors I and II (IGFs) have strong promitotic and antiapoptotic effect. There are number
of evidence indicative that IGFs can promote growth of many cancers. IGFs have strong mitogenic and
antiapoptopic effects on normal and transformed kidney cell. All these facts suggests that IGFs may play
important role in the development and growth of renal cancer.To find the differences in expression of IGFs,
IGFs receptors and IGFBBP-3 genes is the aim of our study.The second aim is to find differnces in these
expressions in kidney cancer tissue in patients with different stage of TNM classification.
Material & Methods: Patients qualified to radical nephrectomy in age 25 – 65 were included to the
study. 64 patients suffered from kidney cancer were included to examined group and 18 patients (age 32
-63) nephrectomized from other than cancer reasons were included into control group. Al patients have
been conducted according to the protocol approved by the institutional committee on ethics in human
investigation. Only materials obtained from patients with tumors qualified as cRCC were included to further
examination. Finally 52 patients were qualified into examined group. Expression of genes for IGFs, IGF receptors and IGFBP were evaluated by QRT-PCR in specimens coming from tumors, tissue of tumor area and
from kidney nephrectomized because of other than cancer reason. Studied parameters were calculated for
the mean and standard error of the mean (SEM), median and dispersion. Since the distributions of the parameters did not exhibit the characteristics of normality (checked-Smirnov normality test of Kolmogorov), the
results were compared to non-parametric test of Mann-Whitney U.Calculated frequency of expression of
the parameters were compared Chi-square test with Yates’s correction, depending on the calculated value
of the expected. The accepted level of statistical significantly p <0.05.
Results: There is no statisticaly significant difference in IGFs mRNA expression in specimens from cancer
and non cancer tissue. Expression of IGF-IR mRNA in cRCC tissue were higher than the same in samples
from non cancer tumor area (p < 0,01), and from kidney without cancer (p < 0,001). Expression of IGF-IIR
mRNA is present only in 3 tumors (with Furhman grade, and in all specimens from non cancer kidney.
Expression of IGFBP-3 mRNA is present in all cRCC samples. IGFBP gene expression has not been present
in any sample from non tumor kidney. There is no difference in IGFs expression in specimens from cancer
patients with different TNM stage.
Conclusions: Expression of IGFII receptor and IGFBP-3 is different in cRCC and in no cancer kidney.
103
Unmoderated Posters
1
P068
Towards the objective system of prostate cancer grading with fractal correlation dimension
Waliszewski P.1, Abu Eid R.2, Kribus S.3, Hofmann R.1, Schafhauser W.4
Philipps University, Dept. of Urology, Marburg, Germany, 2University of Aberdeen, Dept. of Urology,
Marburg, Germany, 3Pathology Office, Dept. of Pathology, Hof, Germany, 4Prostate Cancer Center, Dept. of
Urology, Marktredwitz, Germany
1
Unmoderated Posters
Introduction & Objectives: Tumor grade is one of the most important criteria for a prostate cancer
patient stratification or a choice of treatment. Tumor grading is determined according to the subjective
Gleason system. Since the scoring is influenced by a large intra- and interobserver variability, there is a
need for an objective measure of tumor grading.
Material & Methods: To reach that goal, we analyzed a spatial distribution of a set of normal or cancer
cell nuclei using both the idea of fractal correlation dimension and the Grassberger-Procaccia algorithm.
Some morphometrical features of single cells, such as the area-perimeter dimension, cell area, Feret
angle, cell breadth, convexity and sphericity were investigated in the two dimensional tissue slides stained
with hematoxylin/eosin after applying a colour deconvolution algorithm. Definiens Tissue Map 2.0 was used
for the automatic identification of cell nuclei. Fractal analysis was done with Benoit 1.3 and ImageJ 1.42q.
Results: A geometrical object possesses fractal structure if there is a linear relationship between the
logarithm of a box size and the logarithm of a number of the boxes covering that object. Such the linear
relationship was found in all cases analyzed. The spatial fractal correlation dimension for the normalappearing prostate tissue is 1.451 (018) (n=18), for the Gleason 3 pattern 1.469 (022) (n = 15), for the
Gleason 4 pattern 1.601 (019) (n=18), and for the Gleason 5 pattern 1.769 (011) (n=10). With regards to the
morphometric cell analysis, the minimal cell radius, aspect ratio, cell roundness and compactness were all
statistically different across all Gleason score cases (ANOVA p.
Conclusions: The spatial fractal dimension allows the numerical grading of prostate cancer without invalidating the Gleason system.
104
P069
Methylacyl coenzyme a racemase (AMACR/P504S) inhibitor, trifluoromethylibuprofen, reduces
prostate cancer proliferation
Festuccia C.1, Gravina G.L.1, Marampon F.1, Kirk R.2, Muzi P.1, Ricevuto E.1, Jannini E.A.1, Tombolini V.1,
Carnell E.J.2
University of L’Aquila, Dept. of Experimental Medicine, L’Aquila, Italy, 2University of Liverpool, Dept. of
Chemistry, Robert Robinson Laboratories, Liverpool, United Kingdom
Introduction & Objectives: P504S, or α-methylacyl-CoA racemase (AMACR), was first discovered in 2000
as a specific marker for CaP. This is an essential peroxisomal and mitochondrial enzyme that assists in the
oxidation of branched chain fatty acids and the catabolism of two cholesterol metabolites, dihydroxycholestanoic acid (DHCA) and trihydroxycholestanoic acid (THCA). AMACR is also implicated in the activation of
the COX-inhibiting form of ibuprofen. AMACR mRNA transcript and protein are consistently overexpressed
in prostate cancer and are important for optimal prostate cancer cell growth. The exact mechanisms are
unknown. We intend to verify the effects of an AMACR potent inhibitor (trifluoroibuprofen) on proliferation
and apoptosis in prostate cancer cell lines in vitro.
Material & Methods: We focused on the expression of AMACR in a series of prostate cancer cell lines
expressing or not expressing the Androgen Receptor, resulting in androgen dependent, sensitive or
independent cells. The AR positive LnCaP cells were compared for AMACR expression with cells following
prolonged androgen ablation or grown in castrated nude mice (LnCaP-104S, -105-R1, -C81 and C4-2B).
AMACR expression was also analyzed in a long-term bicalutamide (BCLTR) cultured 22rv1 cell line during
the generation of BCLT-resistant clones. We investigated the biological relevance of AMACR expression
in the acquisition of androgen-independent cancer growth, analyzing the effects of an AMACR inhibitor,
trifluoroibuprofen.
Results: Western blot and immunocytochemical analyses revealed that AMACR expression was much
stronger in androgen independent LnCaP cell derivatives when compared to those observed in the parental
LNCaP cell line. Similarly, during the generation of BCLTR 22rv1 cells, AMACR expression was induced by
BCLT. Inhibition of AMACR activity using trifluoroibuprofen induced the suppression of the survival Akt/
mTOR signaling pathway with induction of GSK3b activity and the inhibition of CRM1-mediated nuclear
export of different proteins such as AR and survivin. The lack of cytoplasmic translocation is associated
with increased caspase 3 activity and apoptosis. In addition we showed reduced expression levels of Her2
and IGF1R. Trifluoroibuprofen was also able to reduce the generation BCLTR cells.
Conclusions: Taken together our data suggest that AMACR inhibition may induce a characteristic conversion of prostate cancer cells from hormone independency to hormone dependency suggesting AMACR
inhibition as a new strategy for treatment of patients with hormone-refractory prostate cancer.
105
Unmoderated Posters
1
P070
Polymorphism on prostate-specific antigen (PSA) gene, rs266882, in prostate cancer patients
Samzadeh M.1, Hasanzad M.2, Haghdoost A.A.3, Afshari M.3, Sedighi S.S.4, Jamaldini S.H.5, Ziaei S.A.M.1
Shaheed Labbafinejad Hospital, Shaheed Beheshti University of Medical Sciences, Dept. of Urology,
Tehran, Iran, 2Islamic Azad University, Tehran Medical Branch, Dept. of Genetics, Tehran, Iran, 3School of
Health, Kerman University of Medical Sciences, Dept. of Epidemiology and Biostatistics, Kerman, Iran, 4St.
Matthew’s University, School of Medicine, Grand Cayman, United States of America, 5University of Social
Welfare and Rehabilitaion Sciences, Genetics Research Center, Tehran, Iran
Unmoderated Posters
1
Introduction & Objectives: A number of polymorphisms in the PSA gene are associated with changes
in serum PSA levels and a recent editorial has emphasized the importance of these polymorphisms as
predictive biomarkers. The PSA AREI harbours a polymorphism that results in a substitution of a guanine by
an adenine 158 bases upstream of the transcription start site. The purpose of this study was to investigate
the association between grade & stage of disease, age of diagnosis, vascular or perineural invasion, prediagnostic plasma PSA levels and prostate cancer risk with rs266882 polymorphisms.
Material & Methods: We recruited 206 subjects in this study; including 95 patients with prostate cancer
and 111 patients with benign prostatic hyperplasia (BPH). After PCR, a restriction fragment length polymorphism (RFLP) method was used with NheI restriction enzyme. The validity of these PCR-RFLP analyses was
confirmed by direct sequencing of several PCR samples with each genotype.
Results: The mean of total PSA in those who had GG and AA polymorphisms was around 1.2 and 0.2 ng/l
more than that in those who had A/G (p = 0.9 and 0.2 respectively); adjusting for other factors did not
changed this difference considerably. The OR between GG polymorphism and AG polymorphism is 1.76; It
means that presence of GG polymorphism increased the risk of cancer more than 70 percent compare to
AG polymorphism. Although it was not significant. Prostate cancer patients allele frequency of the PSA polymorphism at position -158 (A 0.49, G 0.51) was similar to African American men, non-Hispanic white men,
and Hispanic white men and different from Turkish (A 0.63, G 0.36) and Japanese men. The percentages of
G alleles of polymorphisms in prostatic cancer patients were more than that in BPH ones, although it was
not statistically significant. The OR between G Allele and development of Prostate cancer was 1.22 which
means that this allele increases the risk of prostate cancer more than 20 percent compare to the A Allele.
But that was not statistically significant.
Conclusions: We found no association between the PSA polymorphism and cancer risk, overall or by
grade, stage or age of diagnosis. Similarly, the rs 266882 genotype was not associated with cancer risk.
Finally, there was no association between the rs266882 genotype and PSA plasma levels among cases
or controls. The difference in results for PSA ARE-I polymorphisms between studies may be minimized by
using larger study groups. The present study was the first in an Iranian population. Several studies, including in Japanese men and in a white American population found no significant association between the PSA
polymorphism and risk of prostate cancer. Further evaluations with larger samples from our population
may illuminate the effects of polymorphisms on prostate cancer risk and thus help early diagnosis, followup and prognostic determinations for prostate cancer patients.
106
P071
Association of Angiotensin-Converting–Enzyme (ACE) and Endothelial Nitric Oxide Synthase
(eNOS) polymorphisms as genetic risk factors in benign prostatic hyperplasia and prostate
cancer
Hasanzad M.1, Sam Zadeh M.2, Haghdoost A.A.3, Afshari M.3, Sedighi S.S.4, Jamaldini S.H.5, Ziaei S.A.M.2
Islamic Azad University; Tehran Medical Branch, Dept. of Genetics, Tehran, Iran, 2Shaheed Labbafinejad
Hospital, Shaheed Beheshti University of Medical Sciences, Dept. of Urology, Tehran, Iran, 3School of
Health, Kerman University of Medical Sciences, Dept. of Epidemiology and Biostatistics, Kerman, Iran, 4St.
Matthew’s University, School of Medicine, Grand Cayman, United States of America, 5University of Social
Welfare and Rehabilitaion Sciences, Genetics Research Center, Tehran, Iran
Introduction & Objectives: Angiotensin II levels have been associated with cancer. The ACE insertion/
deletion (I/D) gene polymorphism influences serum angiotensin II action. The endothelial cell-specific form
of nitric oxide synthases (eNOS) plays an important role in tumor growth in human prostate cancer. Nitric
oxide production can be influenced by polymorphisms of the eNOS gene. The purpose of this study was to
investigate the association between prostate cancer risk and Glu298Asp & I/D polymorphisms of the eNOS
and ACE genes respectively.
Material & Methods: DNA was extracted from 95 patients with prostate cancer and 111 patients with
BPH. The genotypes were determined by PCR- RFLP analysis.
Results: The mean of serum Total PSA was 467 ng/dL more than that in BPH patients (P-value <0.001).
The polymorphism had a decreasing effect on the different level of disease stages, indicated that this polymorphism could decrease the risk of advance stages but again it was not statistically significant. The OR
between II polymorphism and ID polymorphism (reference) is 1.38. The mean of total PSA in the patients
with the II Polymorphism was 20 ng/l more than that in those who had DD Polymorphism. The adjusted
mean difference was 30 but none of them were statistically significant (P-value=0.4). These results showed
that there is a positive association among II, ID Polymorphisms and total PSA levels of serum, i.e. these
kinds of polymorphisms can increase the total PSA although that was not statistically significant. The OR
between D Allele and cancer was 0.83. It means that this allele has a protective effect on prostate cancer
development, although it was not significant (P-value=0.4). The OR between GT and GG polymorphism of
eNOS gene was 0.76 that means presence of GT polymorphism decreases the risk of prostate cancer
more than 20% compare to GG polymorphism. Although it was not significant. GT polymorphism had a
reverse association with grade of cancer compare to reference group (OR=0.47, P-Value=0.2) The results
showed that there is not a statistical association between polymorphisms and vascular or perineural
invasion. The OR between G Allele and cancer was 0.86. It means that this allele has a protective effect
on prostate cancer development, although it was not significant (P-value=0.5). There were no significant
differences between the control and patient groups for any of the eNOS3 genotypes.
Conclusions: No association between variant genotypes and risk of developing prostate cancer was
observed with the ACE & eNOS variant genotypes in Iranian patients with prostate cancer. Our survey
shows that large population based studies can be extremely helpful in unravelling the genetic risk markers
for benign prostatic hyperplasia or prostate cancer.
107
Unmoderated Posters
1
P072
Prostate cancer: A newly discovered route for testosterone to reach the prostate directly from
the testes
Gat Y.1, Gornish M.2, Rosenbaum E.3, Joshua S.2
Braun Center for Sub Micron Research, Weizmann Inst Of Science, Dept. of Condensed Matter Physics,
Rehovot, Israel, 2Mayanei Hayeshua Medical Center, Dept. of Andrology-Inerventional Radiology, Bnei Brak,
Israel, 3Davidoff Research Center, Rabin Medical Center Petach, Dept. of Oncology, Tikva, Israel
Unmoderated Posters
1
Introduction & Objectives: The prostate, an integral part of the male reproductive system, is an androgen regulated exocrine gland. Free testosterone (FT) is the obligatory regulator of the prostate cell that
known to promotes the evolution of prostate cancer (PCa). Researchers have been puzzled by the paradoxical behavior of PCa in relation to serum Testosterone (T). Though PCa evolution depends on testosterone,
in over seven decades of research, no causal relation between serum T and PCa has been established and
few enigmas still associate the disease; Serum T declines with age - PCa increases; low serum T correlates
with high grade PCa; Androgen deprivation therapy (ADT) is initially effective, however, in a ‘boomerang
effect’ leading to ‘castration resistance’ stage. Here we report on multidisciplinary study based on Physics
- Fluid mechanics, Thermodynamics, Strength of materials; Molecular Biology and Molecular Biochemistry; Andrology and Interventional radiology, that result in the discovery of unrecognized route of flow of
testosterone, to reach the prostate at extreme concentration, some 130 above physiologic, bypassing
the systemic circulation, undetected in the peripheral blood tests, directly to the prostate. This condition,
derives from the wearing out and destruction of the one way valves in the vertical internal spermatic veins
due to gravitational forces, that exist in the erect posture of the humans only, and elevate the hydrostatic
pressures (P = ρ x h; - Pascal’s equation) in the testicular venous system leading to diversion of back-flow
of FT, “illegally”, from the testes, via the testicular and prostate drainage systems directly to the prostate.
(Bernoulli’s principle of ‘communicating vessels’).
Material & Methods: 11 prostate cancer patients were treated by super selective intra-prostatic
androgen deprivation (SIPAD). The treatment which is performed by venography and sclerotherapy of the
malfunctioned ISVs including its associated network of venous bypasses eliminates the pathologic pressure in the testicular venous system and restore the normal-physiological directions of flow in the prostate
drainage systems. Hence the retrograde back-flow of pathologic huge concentration of free testosterone
directly from the testes to the prostate is stopped.
Results: The treatment has resulted in decrease in prostate volume, and prostate symptoms and disappearance of cancerous cells on repeat biopsies in 7 out of 11 patients with localized prostate cancer. Early
observations indicate that using ADT parallel to SIPAD yield better results.
Conclusions: The findings may explain the mechanism for the development of prostate cancer and may
resolve several enigmas associate the disease. We suggest a time-window of opportunity for possible
eradication of localized PCa cells that exists when prostate cancer cells are still dependent on systemic
testosterone for survival that may retard, and stop the evolution of prostate cancer.
108
P073
Impact of the primary local treatment on pelvic progression in castration-resistant prostate
cancer (CRPC)
Tombal F.1, Deome P.1, Butoescu V.1, Van Thienen A.1, Machiels J.P.2
Cliniques Universitaires Saint Luc, Dept. of Urology, Brussels, Belgium, 2Cliniques Universitaires Saint Luc,
Centre Du Cancer, Brussels, Belgium
1
Material & Methods: We have retrospectively reviewed the files of 178 patients who were diagnosed and
primarily treated in our department and subsequently became CRPC between 1/2001 and 5/2010. Only
patients whose treatments were fully administered in house were included in the trials. CRPC was defined
according to PCWG2 definition. For local progression, we looked at incidence of transurethral resection
and JJ stents.
Results: From the 178 patients included in the study, 126 (70%) were initially diagnosed with locally
advanced or high-risk localized disease. The initial treatment was radical prostatectomy (RP) for 59 (46,8%)
patients, external beam radiation therapy (EBRT) ± ADT for 26 (20,6%), and ADT alone for 41 (32,5%). The
median (95%CI) overall survival at the entry of CRPC was 34 (29-38) months, 95% of death being from PCa.
There was no impact of the primary treatment on the OS from CRPC. A total of 66 TUR were performed in
42 (33,3%) patients for a symptomatic local progression; 24 patients underwent 1 TUR, 14 underwent 2
TUR and 4 ≥ 3 TUR. This has generated a total of 375 days of hospitalization; mean total hospitalization
stay was 8,93 ranging from 3 to 23. Only 6,8% of patient treated initially by RP underwent TUR, in contrast
to the 38,5% and 39% of the patients treated initially with EBRT±ADT or ADT, respectively (P for CHI2 <
0,001) (figure). JJ stents were inserted for ureteral obstruction causing pain or renal insufficiency in 22
(13,4%) patients. Only 6,8% of patient treated initially by RP need a JJ stent, in contrast to the 23% and 24%
of the patients treated initially with EBRT±ADT or ADT, respectively (P for CHI2 < 0,001)(figure).
Conclusions: Local complications are relatively frequent in CRPC patients. Interestingly, RP was the only
treatment that protected patients from local progression, as demonstrated by the similar outcome of
EBRT± ADT and ADT patients. This should be taken into account when counseling patients with high-risk
localized disease.
109
Unmoderated Posters
Introduction & Objectives: The treatment of locally advanced prostate cancer (PCa) is still a matter of
controversy, especially when it comes to the benefit of adding local control on top of androgen deprivation
therapy (ADT). Here we have analyzed the impact of initial local control on the rate of local progression in
patients progressing to a CRPC stage.
P074
Impact of ischemic heart disease and stroke on survival of prostate cancer patients
Jespersen C.G.1, Mette M.2, Søgaard M.2, Johansen T.E.B.3, Borre M.3
Aarhus University Hospital, Dept. of Urology and Clinical Epidemiology, Aarhus, Denmark, 2Aarhus
University Hospital, Dept. of Clinical Epidemiology, Aarhus, Denmark, 3Aarhus University Hospital, Dept. of
Urology, Aarhus, Denmark
1
Unmoderated Posters
Introduction & Objectives: To determine the impact of pre-existing ischemic heart disease (IHD) and
stroke on overall survival in prostate cancer patients.
Material & Methods: We conducted a nationwide cohort study of patients with incident prostate cancer
who were registered in the Danish Cancer Registry from 1997 through 2008. We identified patients in the
Danish National Patient Registry with IHD or stroke diagnosed in the ten years prior to the date of prostate
cancer diagnosis. We constructed Kaplan-Meier curves to analyze time to death and Cox regression was
used to estimate 1- and 5-year mortality rate ratios (MRRs) to compare mortality rates by pre-existing IHD
or stroke status, adjusting for age, stage, comorbidity, and calendar period.
Results: Of 30,721 prostate cancer patients, 4,276 (14%) had a history of IHD and 1,331 (4%) a history
of stroke. Crude 1- and 5-year survival rates were 85% and 44% in men without pre-existing IHD or stroke,
81% and 36% in men with pre-existing IHD, and 78% and 27% in men with pre-existing stroke. Adjusted
1- and 5-year MRRs were 1.03 (95% confidence interval (CI) 0.95–1.12) and 1.05 (95% CI 1.00–1.10) for patients with IHD and 1.12 (95% CI 1.00–1.27) and 1.20 (95% CI 1.12–1.30) for patients with stroke compared
with patients without pre-existing IHD or stroke.
Conclusions: A history of IHD had minimal impact on mortality following prostate cancer, whereas 5-year
mortality was 20% higher in prostate cancer patients with pre-existing stroke compared to those without
IHD or stroke. These results highlight the importance of differentiation between various comorbidities.
110
P075
Multidisciplinary (MD) clinic for prostate cancer (PC) – Is it feasible and effective?
Magnani T.1, Valdagni R.2, Salvioni R.3, Villa S.4, Bellardita L.5, Caraceni A.6, Colecchia M.7, Giardino F.1,
Procopio G.8, Rancati T.1, Ripamonti C.9, Zaffaroni N.10
Introduction & Objectives: In 2004 the PC Program at Istituto Nazionale Tumori started experimental
and clinical research, created a MD team, shared guidelines and set up a PC MD clinic.
Material & Methods: MD clinics started in March 2005: 1) clinic for PC patients in all states: urologist,
radiation oncologist, medical oncologist, psychologist synchronously meet 10 patients/week; on demand:
psychological counseling, supportive, rehab and palliative care; univocal cases are proposed strategies;
non univocal or complex cases are referred to case discussion meetings 2) follow up clinic for patients
on AS and watchful waiting: urologist and radiation oncologist meet 14 patients/week (psychologist on
demand) 3) weekly case discussion (CME activity): cases seen multidisciplinarily plus complex cases seen
monodisciplinarily discussed, decisions shared, adherence to guidelines and quality assurance checked.
The model has been modified to meet with new needs (MD follow-up clinics considering the growing number of patients on AS, a patient dedicated secretary from 2007, from September 2010 a nurse organizing
the MD Clinic according to the state of disease).
Results: March 2005 to May 2011, 2475 MD clinics were run. Low risk PC patients increased from 40% in
2006 to 42% in 2007 to 48% in 2008 to 61% in 2009 to 59% in 2010 probably due to the anticipation of
diagnosis and to the objective proposal of AS within a research protocol. Considering the distribution of
therapies and observational strategies in the low risk group, patients accepting AS went from 44% in 2006
to 59% in 2007 to 75% in 2008 to 81% in 2009 probably due to the new attitude toward AS and our credit
as a reference center for AS. The % decreased to 73% in 2010 probably due to the option of robot-assisted
prostatectomy in Milan hospitals and the start up of a national AS protocol coordinated by the PC Program.
Considering the % of patients with metastatic, advanced and recurrent disease (5.9% in 2010), the nurse
is reorganizing the clinic lists according to the state of disease, having the medical oncologist on call for
selected patients. Case discussion meetings are helpful to share decisions, find a consensus on complex
cases, check adherence to guidelines and quality of the MD team working. 11% treatment plans prescribed
by physicians working outside our institute were changed. 6% indications formulated in the MD clinics were
changed in the case discussion after checking adherence to our guidelines.
Conclusions: Our MD clinic is proving efficient to manage PC patients. Having all the specialists involved
together in the same room gives the opportunity of informing the patients on all the therapies and observational options. Strategies are objectively proposed, indications agreed on, and the responsibility on
critical issues shared. The psychologists add their knowledge to the evidence-based approach. Thanks to
Fondazione Monzino and ProADAMO for their support.
111
Unmoderated Posters
1
Istituto Nazionale Dei Tumori, Prostate Cancer Program, Milan, Italy, 2Istituto Nazionale Dei Tumori, Prostate Cancer Program, Radiation Oncology 1, Milan, Italy, 3Istituto Nazionale Dei Tumori, Dept. of Urology,
Milan, Italy, 4Istituto Nazionale Dei Tumori, Dept. of Radiation Oncology 1, Milan, Italy, 5Istituto Nazionale
Dei Tumori, Prostate Cancer Program, Psychology, Milan, Italy, 6Istituto Nazionale Dei Tumori, Dept. of
Palliative Care, Pain Therapy and Rehabilitation, Milan, Italy, 7Istituto Nazionale Dei Tumori, Dept. of Histopathology, Milan, Italy, 8Istituto Nazionale Dei Tumori, Dept. of Medical Oncology 2, Milan, Italy, 9Istituto
Nazionale Dei Tumori, Support For Oncology Patients, Milan, Italy, 10Istituto Nazionale Dei Tumori, Dept. of
Molecular Pharmacology, Milan, Italy
P076
Is replanning required to account for inter-fraction catheter movement in high dose rate
brachytherapy treatment of prostate cancer?
Lim K.H.C.1, Tan P.W.1, Li L.2, Tey J.C.S.1, Earnest A.3
National University Cancer Institute, Dept. of Radiation Oncology, Singapore, Singapore, 2National University of Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore, 3Duke-NUS Graduate Medical
School, Centre For Quantitative Medicine, Singapore, Singapore
1
Unmoderated Posters
Introduction & Objectives: High dose rate prostate brachytherapy (HDR), usually delivered over 2 fractions, achieves tumour control while reducing dose to adjacent organs at risk (OAR) i.e rectum, bladder and
urethra. Of concern is the intrafraction caudal displacment of the catheters which prior studies have demonstrated, results in a reduction in tumor dose coverage with increased dose to OARs. It is unknown what
the best corrective action is. Our study aims to determine whether manual readjustment of the catheters is
sufficient or is replanning mandatory for all patients.
Material & Methods: Plans for 25 patients treated with HDR were reviewed. 12-14 catheters were inserted along the prostate capsule and 4 cathers were inserted around the urethra.Fraction 1 was performed
on Day 1 using CT guided inverse treatment planning (D1P) after the implant was inserted under trans rectal ultrasound guidance. Prior to Day 2 treatment, the catheters for all patients were manually readjusted
in order to approximate their Day 1 postion. The prostate and OAR volumes were recontoured and repeat
CT planning was done (D2P).For this study, the impact of catheter movement was retrospectively assessed
by applying D1P to the Day 2 post adjustment CT set in order to create a study plan (DSP). Plan quality was
evaluated based on American Brachytherapy Society Guidelines and compared to D1P and D2P. A 2 factor
repeated ANOVA model was used to examine the catheter displacements and a t-test was done to compare
the dosimetric differences in the plans.
Results: After readjustment, for both D1P and D2P, the mean displacement of all the catheters relative to
the prostate base was similar (p=0.632). Mean prostate V100 (Volume receiving 100% or more of prescribed dose) (95.4%, 95.1%), bladder V75 (0.74cm3, 0.77 cm3), rectum V75 (0.45cm3, 0.41 cm3), urethra
V125 (0.29cm3, 0.32 cm3) and urethra V150 (0.01cm3, 0.02cm3) were similar for D1P and D2P respectively
(p >0.05). For DSP, the mean prostate V100 (85.8%) and bladder V75 (2.48 cm3) were worse (p <0.02)
compared to D1P or D2P. There was however no difference (all p>0.1) in rectum V75 (0.58 cm3), urethra
V125 (0.41 cm3) or urethra V150 (0.04 cm3).
Conclusions: This study demonstrates that despite careful manual readjustment of the catheters, repeat
planning is still required in order to obtain an optimal treatment plan.
112
P077
Multidisciplinary versus one-on-one setting: Clinicians’ perceptions of their relationship with
prostate cancer patients
Bellardita L.1, Donegani S.1, Magnani T.1, Salvioni R.2, Valdagni R.3
Fondazione IRCCS Istituto Nazionale Dei Tumori, Scientific Director’s Office, Prostate Program, Milan, Italy,
Fondazione IRCCS Istituto Nazionale Dei Tumori, Dept. of Urology, Milan, Italy, 3Fondazione IRCCS Istituto
Nazionale Dei Tumori, Scientific Director’s Office, Prostate Program; Dept. of Radiation Oncology 1, Milan,
Italy
1
2
Material & Methods: In 2005, a patient-centered multidisciplinary clinic (MDC) was implemented as a
clinic where the patient meets a urologist, a radiation oncologist, a medical oncologist and a psychologist
simultaneously and a as weekly meeting for case discussion (2475 MD run from March 2005 to May 2011).
Our research group performed a qualitative observational study based on semi-structured interviews that
were administered by a psychologist to three radiation oncologists, three urologists, three medical oncologists, and one psychologist involved in the MDC. Interviews were recorded and then transcribed verbatim.
A content analysis was performed using paper-and-pencil methodology. Clinicians were asked to compare
the one-on-one clinic with the MDC and express the setting they believed to be more advantageous in
terms of optimizing their relationship with the patient.
Results: Qualitative analyses showed that clinicians preferred MDC as far as providing clear and accurate
information to the patient (“We can provide broader information”, “More people listen to the patient”,
“The patient receives the information he needs without delay and can immediately clarify any doubts”).
Conversely, they reported to prefer one-on-one setting as far as: a. listening to the patient and managing
communication and the relationship (“A one-on-one relationship with the patient helps me to get to know
him better”, “I can better concentrate when I listen to the patient”; b. building trust (“He (the patient) has
only one person to refer to and so it is easier for him to invest in that relationship”).
Conclusions: Overall, interviews showed that clinicians acknowledge that the MDC may offer a consistent
and overall solution to different issues that emerge in relation to the treatment of prostate cancer patients,
such as patients’ information and informed decision-making, and the patient’s physical and psychological
co-morbidities (together with cultural factors) potentially relevant for available treatment options and
compliance. Nonetheless, clinicians often feel more comfortable in dealing with patients on a one-on-one
basis, probably due to the fact that specialistic medical culture does not provide a specific training on
multidisciplinary approach, above as far as interpersonal challenges and issues. In order to develop and implement MDC organizational and teamwork issues need to be addressed.Acknowledgements to Foundation
ProADAMO Onlus and Foundation I. Monzino
113
Unmoderated Posters
Introduction & Objectives: Existing literature highlights the benefits of a multidisciplinary approach for
cancer management but few studies have examined the providers’ perspective on multidisciplinary care
and little attention has been given to physician-patient relationship. The aim of our study was to evaluate
the clinicians’ perspective on the relationship with their patients in a multidisciplinary context, in comparison with one-on-one setting.
P078
Who and what affects patients’ choice of active surveillance
Bellardita L.1, Villani D.1, Rancati T.1, Magnani T.1, Biasoni D.2, Stagni S.2, Nicolai N.2, Avuzzi B.3, Bedini N.3,
Villa S.3, Valdagni R.4, Prostate Program Multidisciplinary Clinic Team
Fondazione IRCCS Istituto Nazionale Dei Tumori, Scientific Director’s Office, Prostate Program, Milan, Italy,
Fondazione IRCCS Istituto Nazionale Dei Tumori, Dept. of Urology, Milan, Italy, 3Fondazione IRCCS Istituto
Nazionale Dei Tumori, Dept. of Radiation Oncology 1, Milan, Italy, 4Fondazione IRCCS Istituto Nazionale Dei
Tumori, Dept. of Radiation Oncology 1; Director of Prostate Program, Milan, Italy
1
2
Unmoderated Posters
Introduction & Objectives: Limited data exist on localized prostate cancer patients’ decision-making
process leading to the choice of Active Surveillance (AS). Some evidence highlights that an informed and
shared decision is predictive of patient’s satisfaction and perception of Quality of Life (QoL). The aim of this
study is to investigate what factors men consider important, and are influenced by, when choosing AS.
Material & Methods: From November 2007 to May 2011, 146/168 patients in PRIAS protocol accepted
to take part to PRIAS Quality of Life study. 64 patients (median age= 66yrs; range 43-77yrs) completed
the open-ended questionnaire asking questions related to their choice (more than one answer could be
selected) at AS enrolment (T0). After about 10 month from the first biopsy, and before the first re-biopsy
(T1), patients were administered a questionnaire to evaluate adjustment to disease (Mini-Mental Adjustment
to Cancer Scale - Mini-MAC, subscales: fighting spirit, anxious preoccupation, helplessness/hopelessness,
fatalism and avoidance). Kruskall Wallis test was performed to investigate the association between motivations for AS and adjustment to disease.
Results: As far as who influenced their decision, 49,2% reported they had relied on themselves. Physicians’ role was also considered very important (46% of patients). Only 4,8% of patients reported other
people’s influence, such as their family or friends’. Patients’ most frequently selected answers about
motivations that lead to AS are listed in Table 1.
Motivation
% of patients
N1. It is the best procedure to avoid possible side effects and maintain QoL
78
N2. I trust in the physicians I have met
72
N3. I trust the medical centre
60
N4. It is a reversible choice and I can go back
56
Table 1. Patients’ motivation
Among patients who reported choosing AS because they trusted physicians, 29,7% stated they had not
been influenced by physicians and that their decision had been made based on their own will. A significant
correlation was found between motivation N1 and adjustment to cancer at T1, as patients who had selected that answer showed: a) lower anxious preoccupation (mean rank -mr- 25.14 vs 37.44); b) lower helplessness/hopelesness (mr 25.34 vs 36.31); c) lower avoidance (mr 24.59 vs 40.56) and d) lower fatalism (mr
25.04 vs 38).
Conclusions: Results highlight that patients’ own will is critical when choosing AS even if their decision is
also influenced by physicians. Avoiding side effects is the most important leverage toward AS, followed by
trust in physicians and/or in the medical centre. In 90% of cases, AS was presented to patients, together
with other available options, during the multidisciplinary clinic conducted in our centre (involving the
simultaneous presence of a urologist, a radiation oncologist, a medical oncologist and a psychologist) and
we argue that patients who are offered AS in a multidisciplinary clinic seem to make a well informed and
shared decision.
114
P079
PCA: prostate cancer, patient-centred approach or both?
Joniau S.1, Denis L.2, Bossi A.3, Baskin-Bey E.4, Fitzpatrick J.5
University Hospitals Leuven, Dept. of Urology, Leuven, Belgium, 2Europa Uomo, Oncology Centre Antwerp,
Antwerp, Belgium, 3Institut Gustave Roussy, Department of Radiotherapy, Villejuif, France, 4Astellas Pharma
Europe Ltd., Medical Affairs Urology, Staines, Middlesex, United Kingdom, 5Mater Misericordiae Hospital
and University College Dublin, Surgical Professional Unit, Dublin, Ireland
1
Material & Methods: Two surveys on patient-specific opinion and expectations in PCa management were
done in February 2011 among European PCa specialists and PCa patients.
Results: 303 PCa specialists and 48 PCa patients completed the surveys. The majority of specialists
spent 15-29 min on bringing the diagnosis, and about the same amount of time on explaining the treatment
options. This time was considered insufficient by 35% and 48% of patients, respectively. There was a large
discrepancy between physicians’ and patients’ opinion regarding the type of provided prognostic and therapeutic information (Fig.1). This indicates that patients may not have completely understood the provided
information. Consequently, 63% and 39% of patients were not satisfied with the amount of information
they received on diagnosis/prognosis and on treatment options, respectively. Shared decision making was
preferred by both patients (49%) and specialists (77%). Treatment efficacy was the most important factor
determining the treatment choice for physicians (76%) and patients (66%), while the physician’s opinion or
experience also had a huge impact on patients (29%). Patient support groups such as Europa Uomo have
an important role in providing relevant information and in exchanging experiences between patients. The
supportive role of partners/relatives was more appreciated when discussing the treatment options than
during diagnosis.
Conclusions: Although patients’ needs and expectations are generally matched by their caring
physician(s), physicians may still improve quality of care by taking adequate time for their patients, by using
terminology tailored to the patient’s level of understanding, by providing both oral and written information
during multiple consultations and by encouraging shared decision making, both between patients and
physicians and between patients and partners/relatives. A multidisciplinary team may be an important part
of the treatment paradigm, with the individual patient’s needs and preferences as the centre of care.
115
Unmoderated Posters
Introduction & Objectives: As patients with prostate cancer (PCa) are often confronted with an overload
of information, good and clear physician-patient communication is crucial, especially in this area of multidisciplinary treatment. The aim of this study was to evaluate differences and similarities in opinion and
expectations on prostate cancer (PCa) management between physicians and patients.
P080
Can the prostate-specific antigen (PSA) level always be a reliable index for salvage radiotherapy after radical prostatectomy in men with biochemically failed prostate cancer?
You S.H.1, Lee C.G.2, Lee I.J.2, Cho J.H.2, Suh C.O.2
1
Yonsei University Wonju Christian Hospital, Dept. of Radiation Oncology, Wonju, South Korea, 2Yonsei
University Health System, Dept. of Radiation Oncology, Seoul, South Korea
Unmoderated Posters
Introduction & Objectives: Generally, prostate-specific antigen (PSA) is important decision-making
indicator for salvage or adjuvant radiotherapy after radical prostatectomy. However, there are some cases
which show biochemical failure (BCF) after salvage or adjuvant radiotherapy despite low PSA value. From
this point of view, the correlation between BCF-free survival and salvage radiotherapy after radical prostatectomy was analyzed in terms of clinical, pathological, and treatment factors.
Material & Methods: We retrospectively reviewed medical data of 34 consecutive patients who underwent salvage or adjuvant radiotherapy for biochemically failed or biochemically incomplete-resectioned
prostate cancer in our institution between July 2004 and March 2010. Initially, all patients received radical
prostatectomy and PSA value reached below 0.2 ng/mL within 2 months in 19 patients (55.9%). BCF after
radical prostatectomy (1st BCF) was defined as a PSA level of >0.4 ng/mL. Radiotherapy was performed by
median dose 64.8 Gy of external beam with conventional fractionation schedule and 30 patients (88.4%) received whole pelvic irradiation (median 45 Gy). Hormone therapy was combined concurrently in 3 patients
(8.8%) and before radiotherapy in 10 patients (29.4%). BCF after radiotherapy (2nd BCF) was also defined as
a PSA level of >0.4 ng/mL and median follow-up period was 20 months (range, 7 ~ 68 months).
Results: The overall 3-year 2nd BCF-free survival rates were 58.9%. By log rank test, patient age, PSA at
diagnosis, Gleason score, positive resection margin, capsule extension, T-stage, radiation dose did not
significant impact on 2nd BCF-free survival. However, radiotherapy alone resulted in better 2nd BCF-free
survival than combined with hormone therapy (p=0.002). Surgery to 1st BCF interval was predictably
associated with 2nd BCF-free survival (3-year 2nd BCF-free survival 100% for ≥12 months; 46.8% for <12
months, p=0.050). Lower 2nd BCF-free survival rates were observed in patients without 1st BCF (p=0.035)
and their mean maximum PSA value right before radiotherapy was 0 ng/mL and 0.34 ng/mL in patients
with preferential hormone use and with radiotherapy alone, respectively.
Conclusions: As a salvage or adjuvant treatment, radiotherapy should be considered preferentially. Worse
2nd BCF-free survival rate in patients without 1st BCF is due to missing the proper radiation timing related to
relatively stable PSA value. The PSA level to define BCF needs to be lower together with careful follow-up.
116
P081
Volumetric Modulated Arc Therapy (VMAT) for high risk prostate cancer: Acute toxicity and
improvement in dosimetry
Quispe K.Y.1, Del Carpio A.F.1, Ferrer F.1, Garcia I.1, Boladeras A.1, Gutierrez C.1, De Blas R.2, Modollel I.2,
Mateo D.2, Londres B.1, Barbero S.2, Garcia E.3, Ordoñez D.1, Pera J.1, Guedea F.1
Instituto Catalan De Oncologia, Dept. of Radiation Oncology, Barcelone, Spain, 2Instituto Catalan De
Oncologia, Dept. of Radiation Physics, Barcelona, Spain, 3Instituto Catalan De Oncologia, Dept. of Radiation
Oncology, Barcelona, Spain
1
Material & Methods: Between December 2010 and April 2011, 10 patients with high risk prognostic
factors were treated with definitive VMAT. The prescribed dose consisted of three sequential phases: PTV1,
46 Gy (2 Gy/fraction) to the pelvic nodes (obturator, external and internal iliac regions); PTV1.1, 14 Gy
(2Gy/fraction) to the prostate and seminal vesicles; and finally a conformal radiotherapy boost to increase
the dose to the prostate to 76 Gy. PTV1 was treated with 2 arcs using 6 Mv photons. Plan quality was assessed by means of dose volume histogram (DVH) analysis. Dosimetric parameters were recorded. Acute
toxicity was scored weekly and at the end of treatment according to RTOG scale for genitourinary(GU) and
gastrointestinal(GI) domains. Biochemical outcome was measured in terms of PSA(6 weeks after RT).
Results: Median patient age was 67 years (range, 61-75). Of the 10 patients, 3 were stage T2 and 7 stage
T3. Mean diagnostic PSA was 26.96ng/ml (range,6-45.71). Gleason scores were 7 (2 cases) or ≥8 (8 cases). Median PTV1 volume was 541.63cc (range, 365.9-616.3cc) and median PTV11 volume was 135.15cc
(range, 116.63-210.71cc). Treatment was feasible with target coverage for PTV1 V95≥98.7% ± 1.3% and
for PTV11 V95 ≥98.7% ± 1.6% and V107~0.0% for both volumes. Our institutional dose-volume constraints
to the bladder and rectum (V40≤60-80%, V60≤40-60% and V70≤25%) were met in most cases: mean
bladder values were V40=59.2%±4.1%, V60=28%±4.7%, V70=12.9%±3.1%, and mean rectum values were
V40=54.1%±4.5%, V60=15.4%±2.8%, and V70=6%±1.5%. Mean dose to femur was 32.7%±1.4% against an
objective of 45Gy. The maximum dose to the small bowel was 52.6±2.6 and V60~0cc (versus objective of
V60≤2cc). Mean PSA at 6 weeks after RT was 1.6ng/ml. Eight patients(80%) experienced acute grade 1 GU
toxicity and alpha-blockers were required in 5 patients. Three patients presented grade 2 GI toxicity. No
grade 3 symptoms were observed.
Conclusions: VMAT for small pelvis lymph node irradiation in high-risk prostate cancer patients is dosimetrically and clinically feasible. The low rates of acute toxicity found in our study suggest that VMAT may
make it possible to extend the field to include common iliac nodes and pre-sacral nodes. VMAT seems to be
a promising technique but additional, long-term assessment is necessary.
117
Unmoderated Posters
Introduction & Objectives: Pelvic lymph node radiotherapy may improve disease-free and overall survival for patients with high-risk prostate cancer. The use of VMAT appears to reduce acute toxicity in these
patients. The aim of this study is to report our early institutional experience with this technique.
P083
Recent trends in Gleason Grading of prostate cancer
Botelho F.J.S., Pina F.M., Lopes T., Cruz F., Lunet N.
Hospital S. João, Dept. of Urology, Porto, Portugal
Unmoderated Posters
Introduction & Objectives: Histologic grading remains the most useful tissue-based predictor of prognosis of prostate cancer. The Gleason system is now the only grading system recommended by the World
Health Organization (WHO) for prostatic carcinoma. In recent years, there has been a gradual shift of how
the Gleason grading is applied in practice with unknown implications. Our objective was to evaluate the
variation of the Gleason score in the last five years in all patients submitted to a prostate biopsy in S. João
Hospital.
Material & Methods: Between January 2005 and June 2010 we consecutively enrolled 1817 candidates
referred to ultrasound guided trans-rectal prostate biopsy, on the basis of abnormal rectal examination
and/or elevated total Prostate Specific Antigen (tPSA) levels, in the department of urology of S. João
Hospital. The final prostate pathology and the prostate cancer cases Gleason score were defined by biopsy
results. All prostatic biopsies were reviewed by two different pathologists that were blinded to the patients’
characteristics. Gleason scores results were compared between groups using chi-square test.
Results: Patients had a median age of 67 years and a median tPSA of 7.05ng/mL. Prostatic biopsies
revealed prostate cancer in 719 cases (39.6%). Among patients with prostate cancer there were 0.3%,
17.1%, 55.4%, 16.2%, 10.3% and 0.6% with Gleason 5, 6, 7, 8, 9 and 10 in the biopsy, respectively. The
percentages of patients with Gleason score of 7 and 8 or higher were 42.7% and 27.1%, 59.8% and 27.3%,
60.0% and 28.3%, 57.2% and 29.7%, 53.7% and 27.3%, 58.2% and 19.4% from the year 2005 to the year
2010, respectively (p=0.017).
Conclusions: Gleason grade results have varied in recent years in patients submitted to a prostate biopsy
but without a clear trend. Urologists and pathologists should be aware of these variations. This study is
limited by the small time frame and possible confounder effect of patient tendency.
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P084
Clinical outcomes and predictive factors of response multiple re-challenges (ReCs) with
docetaxel (DOC) in castration-resistant prostate cancer (CRPC) patients (pts):
A mono-institutional experience
Caffo O.1, Brugnara S.1, Caldara A.1, Di Pasquale M.C.1, Ferro A.1, Frisinghelli M.1, Murgia V.1, Soini B.1,
Valduga F.1, Veccia A.1, Pappagallo G.2, Galligioni E.1
1
Santa Chiara Hospital, Dept. of Medical Oncology, Trento, Italy, 2Epidemiology & Clinical Trials Office,
Oncology & Hematology Unit, Noale, Italy
Material & Methods: From March, 2002 to December, 2010, a consecutive series of 46 CRPC pts received at least one ReC after first-line DOC, for a total of 92 ReCs (median 2, range 1-7). ReCs consisted of
4-6 DOC cycles and were proposed until the appearance of a true resistance to DOC. For each ReC course,
we recorded the following parameters: treatment schedule, estramustine use, previous PSA response,
baseline parameters (hemoglobin, alkaline phosphatase, pain presence, ECOG), number of previous DOC
courses, PSA kinetic parameters during both previous DOC course and treatment holiday, duration of
treatment holiday before ReC. A binary logistic regression analysis was applied. Continuous variables were
categorized by quartiles and chosen for the initial model after a univariate chi-square analysis.
Results: In 66% of 92 ReCs we observed a PSA reduction > 50%. After a median follow-up of 25 mos,
the median survival is 32 mos and the projected 2-years overall survival is 77.5%. The observed major
toxicities were: grade 3 anemia (2%), grade 3 neutropenia (2%), and grade 3 sensitive neuropathy (2%); two
patients developed deep vein thrombosis (4%). Having an interval log-PSA equal to or more than 0.62, an
interval from the previous cycle equal to or more than 23 weeks, a response to the previous cycle, resulted
to be independently predictive of a response to ReC.
Conclusions: In our experience ReC appears to be a good option able to obtain further response. This
strategy may provide a long-term disease control with remarkable survival rate and a second line treatment
may be retarded until the appearance of a true DOC-resistance.Response to the previous cycle, interval
log-PSA ≥ 0.62 and the interval from the previous cycle of at least 23 weeks are factors able to identify the
pts having more probabilities to respond to ReC.
119
Unmoderated Posters
Introduction & Objectives: ReC with DOC has emerged as a therapeutic option for patients with CRPC
who respond to first-line docetaxel and then discontinue treatment without experiencing disease progression. The present study attempts to describe the feasibility and clinical outcomes of multiple ReCs and to
analyse the predictive factors.
P085
Epigenetic control of pi3k/akt activity in prostate cancer during hormone manipulation
Festuccia C.1, Gravina G.L.1, Piccolella M.2, Ruscica M.2, Muzi P.1, Marampon F.1, Tombolini V.1, Negri-Cesi
P.2, Motta M.2
University of L’Aquila, Dept. of Experimental Medicine, L’Aquila, Italy, 2University of Milan, Dept. of Endocrinology, Center of Endocrinological Oncology, Milan, Italy
1
Unmoderated Posters
Introduction & Objectives: Epigenetic modulation of different tumor suppressor and differentiation
genes is commonly alterated in carcinogenesis and seems to play a crucial role in prostate tumor progression to androgen independent disease. DNA methylation represents one type of epigenetic modification
influences tumor suppressor gene expression and seems also to be associated to increased resistance
versus apoptotic stimuli of advanced prostate cancers.
Material & Methods: Based on these considerations, we analyzed by western blotting analyses the
expressions of different isoforms of DNMT in androgen dependent and androgen independent LnCaP cell
derivatives and in androgen sensitive 22rv1 cell line cultured in androgen depleted condition or in the
presence of bicalutamide as well as by western blotting and immunohystochemical analyses in 22rv1
xenografts grown in castrated male nude and in intact mice receiving or not bicaltamide.
Results: We observed that (i) DNMT activity was increased in androgen independent clones and (ii)
bicalutamide as well as castration treatment increased significantly the levels of DNMT3a and DNMT3b,
representing two enzymes involved in DNA methylation at specific gene promoter sites, whereas the levels
of DNMT1, responsible for global DNA methylation, were only slowly influenced. We observed also that the
5-azacitidine, a pan DNMT inhibitor, slows-down the insurgence of the castration/anti-hormone resistant
phenotype in 22rv1 and LnCaP cells.
Conclusions: Taken together our results indicate that the gene specific DNMT activity are induced during
hormonal manipulation and suggest that the down-modulation of these activities can be used to restore
the expression of specific tumor suppressor genes and the reactivation of apoptotic pathways as wel as
to slow-down the insurgence of castration/anti-hormone as well as chemotherapy resistant phenotype.
Therefore the clinical use of DNMT inhibitors could be add in the practical therapeutic approach of locally
invasive and advanced prostate tumors.
120
P087
Statins reduce the risk of prostate cancer progression: Inhibition of geranylgeranyl
pyrophosphate metabolism
Clarke N.W.1, Hart C.A.2, Tawadros T.2, Brown M.D.2
1
Salford Royal NHS Foundation Trust, Dept. of Urology, Salford, United Kingdom, 2University of Manchester,
Genito Urinary Cancer Research Group, Manchester, United Kingdom
Material & Methods: BMS was isolated with ethical approval from consenting patients undergoing surgery for non-malignant disease. PC-3 binding, invasion and colony formation within BMS was assessed by
standardised in vitro co-culture assays in the presence of different statins and downstream metabolites.
Results: Statins at non toxic doses did not affect the ability of PC-3 cells to bind to BMS. Pre-treatment of
the BMS had no effect on it’s ability to attract PC-3 cells. Direct treatment of PC-3 cells with atorvastatin,
mevastatin, simvastatin (1μM) and rosuvastatin (5μM), but not pravastatin, significantly reduced invasion
towards BMS by an average of 66.68% (range 53.93-77.04%; p<0.05) and significantly reduced the number
(76.2±8.29 vs. 122.9±2.48; p=0.005) and size (0.2±0.0058mm2 vs 0.27±0.012mm2; p=0.0019) of colonies formed in BMS co-culture. Statin treated colonies displayed a more compact morphology containing
cells of a more epithelial phenotype, indicative of a reduction in the ability of PC-3 cells to migrate through
the BMS. Normal PC-3 phenotype and function was recovered by the addition of geranylgeranyl pyrophosphate.
Conclusions: Lipophilic statins reduce the migration and colony formation of PC-3 cells in human BMS by
inhibiting geranylgeranyl pyrophosphate production, reducing the formation and the spread of the metastatic prostate colonies.
121
Unmoderated Posters
Introduction & Objectives: Although statins do not effect the incidence of prostate cancer (CaP), usage
reduces the risk of clinical progression and mortality. Classically statins down-regulate the mevalonate pathway, inducing inhibition of cellular functions such as membrane integrity, cell signalling, protein synthesis
and cell cycle progression. However how statins reduce the clinical progression is currently unknown. Here
we present the mechanism of action of statin inhibition of prostate cancer progression using in vitro human
bone marrow stroma (BMS) co-culture models.
P088
Clinical outcomes and toxicity using stereotactic body radiotherapy (SBRT) for metastatic renal
cell carcinoma
Barney B.M., Call J.A., Stauder M.C., Laack N.N., Miller R.C., Olivier K.R.
Mayo Clinic, Dept. of Radiation Oncology, Rochester, United States of America
Unmoderated Posters
Introduction & Objectives: Radiotherapy is often omitted as treatment for renal cell carcinoma (RCC)
due to a perception that it is a radioresistant tumor. SBRT, in which large doses of highly conformal radiotherapy are delivered ≤5 fractions, may overcome this radioresistance resulting in improved tumor control.
At our institution, SBRT is used to treat patients with metastatic RCC who have symptomatic metastases
or inoperable, asymptomatic oligometastatic disease. We retrospectively reviewed clinical outcomes and
toxicity associated with SBRT for patients with metastatic RCC.
Material & Methods: From 1/2008 to 6/2011, 29 patients with 41 metastatic RCC lesions underwent
SBRT. Sites treated were spine (N=24), abdominal soft tissues (including spleen, liver, lymph nodes,
adrenal glands, and pancreas; N=9), lung (N=6), and non-spine bony site (N=2). SBRT was delivered in
1 (N=10), 3 (N=16), 4 (N=1), or 5 (N=14) consecutive daily fractions over one week. Patients with bony
lesions were treated to a median dose of 24 Gy (range, 16 to 30) in a median of 3 fractions (range, 1 to
5). Patients with non-bony lesions were treated to a median dose of 40 Gy (range, 30 to 60) in a median
of 5 fractions (range, 3 to 5). Treatment response was graded by RECIST v.1.1, and toxicities were scored
by CTCAE v.3.0. The SBRT dose for each site treated was converted to the single fraction equivalent dose
(SFED) to characterize the dose-control relationship. Data was analyzed using the Kaplan-Meier method to
determine rates of local failure (LF), freedom from any disease progression (FFP), and survival (OS).
Results: The median follow-up period for living patients was 11 months (range, 0 to 32 months). Only
two patients experienced progression within the SBRT field (crude patient LF rate, 7%), and 6-, 12-, and
24-month estimates of local control (LC) were 97%, 90%, and 90%, respectively. Both patients who
experienced LF did so within 12 months, and both were treated to vertebral body metastases; one patient
received 21 Gy in 3 fractions (SFED, 17.4 Gy), and one received 24 Gy in 3 fractions (SFED, 20.4 Gy). On
univariate analysis, SFED of <21 Gy was predictive for LF (P<0.05). Estimates for FFP at 6, 12, and 24
months were 56%, 18%, and 0%. OS estimates for the cohort at 6, 12, and 24 months were 78%, 61%,
and 44%. The most common early treatment-related toxicities were Grade 2 nausea and vomiting and musculoskeletal pain. Two patients experienced pain that lingered for >3 months after completing treatment.
No early toxicity Grade 3 or greater was observed, and only one patient, treated to a vertebral body metastasis, experienced significant late toxicity (soft tissue fibrosis, Grade 3).
Conclusions: SBRT shows promise as a safe and effective local therapy for patients with Stage IV RCC.
SFED ≥21 Gy is associated with improved LC. Further follow-up is needed to better quantify the risk of late
complications associated with SBRT.
122
P089
Comparison of surgical and functional outcomes of robot-assisted versus pure laparoscopic
partial nephrectomy: A single surgeon experience
Seo S.I.1, Jung B.C.1, Jeon S.S.1, Hong J.H.2, Kwak C.3, Lee H.M.1, Choi H.Y.1
1
Sungkyunkean Univ. Samsung Medical Center, Dept. of Urology, Seoul, South Korea, 2Univ of Ulsan College of Medicine. Asan Medical Center, Dept. of Urology, Seoul, South Korea, 3Seoul National University
Hospital, Dept. of Urology, Seoul, South Korea
Material & Methods: Data from 100 consecutive patients who underwent LPN (n = 52) or RAPN (n =
48) performed by a single experienced laparoscopic surgeon between October 2007 and June 2010 were
analyzed retrospectively. Perioperative data, including clinical, pathological, and functional outcomes, were
compared between the LPN and RAPN groups.
Results: No significant differences were found between groups with regard to mean EBL, main operation
time, warm ischemic time (WIT), intraoperative complications, postoperative complications, hospital stay,
or % reduction of hemoglobin. The mean duration of follow-up was 16.2 for LPN patients vs. 8.9 months
for RAPN patients (p < 0.001). With respect to the clamping method, more artery-only clamping occurred
during RAPN than LPN (38.5 vs. 75%, respectively, p = 0.001). The mean pathologic tumor volume for LPN
was 4.0 cm3 vs. 8.2 cm3 for RAPN (p = 0.006). The mean resected healthy tissue volume was 25.1 cm3 for
LPN vs. 16.1 cm3 for RAPN (p = 0.044). There were no significant differences in positive margin or change
in renal function between the two cohorts.
Conclusions: RAPN is a comparable and alternative option to LPN, providing equivalent oncological and
functional outcomes, as well as comparable morbidity to LPN. Although RAPN could offer the advantages
of saving more healthy marginal tissue, longer term functional study is necessary.
123
Unmoderated Posters
Introduction & Objectives: To compare the results of laparoscopic partial nephrectomy (LPN) and Robotassisted partial nephrectomy (RAPN) performed by a single surgeon experienced in laparoscopic urologic
surgery.
P090
Laparoscopic partial nephrectomy with radiofrequency ablation without ischemia
Golovashchenko M.1, Alekseev B.Ya.2, Kalpinskiy A.S.2, Nyushko K.M.2, Vorobyev N.V.2, Polyakov V.A.2,
Chissov V.I.2
Moscow Research Oncology Institute, Dept. of Research, Moscow, Russia, 2Moscow Hertzen Oncology
1
Unmoderated Posters
Introduction & Objectives: Laparoscopic partial nephrectomy (LPN) is standard procedure for localized
kidney cancer with tumor size ≤ 3-4 cm. Main problems of LPN are: difficulties in assessing adequate
haemostasis and need of performing renal ischemia. We present our experience of usage new technique of
LPN with radiofrequency ablation (RFA) without ischemia.
Material & Methods: Between 2003 and 2011, 100 LPNs were performed at our institution. from them
37 (37%) patients were performed standard LPN and 63 (63%) patients - LPN with application of RFA. All
procedures were performed by a single, experienced laparoscopic surgeon. Groups were comparable
on a median of age and mean size of a tumour according to CT and histologic examination (р> 0.05). The
mean size of a tumour in group of standard LPN was 28.1 ± 11.8 mm (range: 13-70 mm) and 24.5 ± 13.2
mm (range: 5-85мм) in group LRP with RFA. All operative interventions were transperitoneal. The monopolar Cool-tip® RF system (Tyco Valleylab, USA) was used with an one-needle probe (17Gauge, length 20
cm, working surface 20 mm) and a set of passive electrodes. Probe introduction was made under the
ultrasound control on a assume line of a resection with setback 5-7 mm from tumour edge. The time of
each RFA point was about 2 minutes and depend on tissue resistance. No warm or cold renal ischemia was
done.
Results: Groups of patients were comparable on mean operating time, median of duration of hospitalization and rate of complications. The significant difference was observed only in median of blood loss.
Mean operating time was 136.4 ± 71.1 min (range: 60 - 360) for group of standard LPN and 116.9 ± 29.8
min (range: 75 - 200) for LPN with RFA (p > 0.05). The median blood loss for group of standard LPN was
300 ml (200 - 600) and 100 ml (50 - 200) for LPN with RFA (р <0.001). Positive surgical margins were
not observed. The median of duration of hospitalization was 8 days (7-9,5) in group of standard LPN and
8 days (7-9) for group of patients whom undergone LPN with RFA (p > 0.05). The frequency of intra - and
postoperative complications in both groups were comparable (13.5% and 19.0%). We met complications
mainly at a stage of development of the technique. The follow up time was differ in groups that has been
connected with later time of development of technique LPN with RFA (р <0.001). The median of follow up
time in group of standard LPN was 72 months (27 - 87), and 22 months (12 - 36) in group of LPN with RFA.
Local recurrence and disease progression were not observed during follow up period. All patients are still
live with preserved renal function.
Conclusions: This new radiofrequency-based technique of LPN allows efficient and rapid LPN without the
need for kidney ischemia and allows reduce the blood loss. Tissue structure is nicely preserved allowing
interpretation of resection margins and there is only minimal collateral tissue damage.
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P091
Radiofrequency ablation of small renal cell carcinoma
Golovashchenko M.1, Alekseev B.Ya.2, Kalpinskiy A.S.2, Nyushko K.M.2, Schelesko A.A.2, Stepanov S.O.2,
Chissov V.I.2
Moscow Research Oncology Institute, Dept. of Research, Moscow, Russia, 2Moscow Hertzen Oncology
1
Material & Methods: From April 2006 to March 2011, 44 RFA procedures in 40 selected patients with
kidney tumour have been performed. The mean age of 66.1 ± 9.5 years (range, 46-84 years). Most of the
diagnosed kidney tumour candidates had contraindications to surgery; 10 patients had solitary kidney.
36 patients underwent 1 RFA session and 4 patients underwent 2 RFA session. The monopolar Cool-tip®
RF system (Tyco Valleylab, USA) was used and guided by ultrasound. Mean RFA time was 12.6 ± 3.0
minutes (range, 6-20), depending on the size of the tumour. Treatment efficacy was assessed by 6-monthly
contrast-enhanced CT and by Doppler ultrasound every 3 months following RFA. The absence of contrast
enhancement on CT was considered to be a successful treatment.
Results: The average tumour size was 28.5 ± 8.4 mm (range, 12-60 mm). 28 patients underwent a tumor
biopsy prior to the ablation. 26 biopsies confirmed RCC aetiology, 2 were undetermined. A 1 treatment cycle was used for each tumor less 30 mm, and for each tumor more 30 mm 2 cycles was used. 4 patients
with a tumour size more 40 mm underwent a selective embolization before RFA. Median follow-up was 18
months (range, 1-49). Complications included 1 limited subcapsular haematoma. 4 patients with unsuccessfully ablated tumors underwent repeat RFA session, 1 patient was underwent nephrectomy. One patient
developed a distant metastasis and was treated conservatively with target agents. Overall local cancer
control was 85%. 1 cancer related death occurred, 1 (2.5%) patient died of non-cancer related causes.
Conclusions: Percutaneous RFA for small RCC is feasible in older and unfit. Complication rates are acceptable. Overall local cancer control was 85%. We recommend a selective embolization before RFA to
patients with a tumour size more 40 mm.
125
Unmoderated Posters
Introduction & Objectives: Percutaneous Radiofrequency Ablation (RFA) is used for the treatment of
small renal cell carcinomas (RCC), especially in elderly patients and patients who are unfit for surgery. The
aim of the study is to present our experience with percutaneous RFA of RCC.
P092
Results from a phase 1 trial of tivozanib (AV-951) combined with temsirolimus therapy in
patients with renal cell carcinoma
Kabbinavar F.F.1, Srinivas S.2, Hauke R.J.3, Amato R.J.4, Esteves B.5, Cotreau M.M.5, Strahs A.L.5,
Fishman M.N.6
University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, United States of America, 2Stanford Medical Center, Stanford, United States of America, 3Nebraska Cancer Specialists, Omaha,
United States of America, 4University of Texas Health Science Center, Houston, United States of America,
5
AVEO Pharmaceuticals, Inc., Cambridge, United States of America, 6H. Lee Moffitt Cancer Center, Dept. of
Oncology, Tampa, United States of America
Unmoderated Posters
1
Introduction & Objectives: Tivozanib, a potent and selective oral small molecule tyrosine kinase inhibitor
(TKI) of vascular endothelial growth factor receptor (VEGFR)-1, -2, and -3, has demonstrated antitumor
activity in a phase 2 study in renal cell carcinoma (RCC). Temsirolimus, a mammalian target of rapamycin
(mTOR) inhibitor, is approved for treatment of advanced RCC. This phase 1b open-label study examined
combination tivozanib and temsirolimus therapy in patients with advanced RCC to determine the safety and
tolerability, maximum tolerated dose (MTD), and clinical activity.
Material & Methods: Patients with advanced RCC (with clear cell component) who had failed up to 1 prior
VEGF-targeted therapy received daily oral tivozanib (3 weeks on, 1 week off = 1 cycle) and intravenous
temsirolimus (once weekly). A standard 3+3 dose escalation design was used at 4 levels: 0.5 mg/day and
15 mg/week; 1.0 mg/day and 15 mg/week; 1.5 mg/day and 15 mg/week; and 1.5 mg/day and 25 mg/
week of tivozanib and temsirolimus, respectively.
Results: As of 24 January, 2011, 27 patients had been treated and accrual was closed. Demographic
features were: 25 male/2 female; 89% Caucasian; median age of 61 years (range, 43-71 years); Karnofsky
Performance Status of 100/90/80 for 18, 5, and 4 patients, respectively. Twenty-one of 27 patients (78%)
had received prior VEGF-targeted therapy. Median duration of treatment was 21.9 weeks (range, 6.9-97.9
weeks). Treatment-emergent adverse events seen in ≥10% of patients were (number of patients with all
grades/grade 3 or 4 toxicity): fatigue (20/4), stomatitis (16/2), diarrhea (15/2), decreased appetite (14/0),
nausea (13/1), constipation (11/1), and dyspnea (10/1). The MTD for the combination of tivozanib and
temsirolimus was 1.5 mg/day and 25 mg/week, respectively. No dose-limiting toxicities were observed.
Clinical activity in the 22 evaluable patients included: 23% with partial response and 68% with stable
disease in patients who had failed VEGF-targeted therapies.
Conclusions: Tivozanib is the first VEGFR TKI that can be combined with temsirolimus at full dose and
schedule of both agents. The combination of tivozanib with temsirolimus was well tolerated and showed
encouraging clinical activity in patients with advanced RCC.
126
P093
Long-term oncologic outcome of laparoscopic radical nephrectomy for renal cell carcinoma
Hongo F. , Kawauchi A., Naitoh Y., Nakamura T., Soh J., Kamoi K., Mikami K., Miki T.
Kyoto Prefectural University of Medicine, Dept. of Urology, Kyoto, Japan
Introduction & Objectives: For renal cell carcinoma, laparoscopic radical nephrectomy (LAP-Nx) is one
of the first-choice treatments at many hospitals worldwide. We have performed LAP-Nx since 1999. To
evaluate and compare the oncologic outcome of LAP-Nx with the open radical nephrectomy (OPEN-Nx).
Results: The median follow-up period was 65 months (6-119) for LAP-Nx group and 84 months (7-146)
for open group. The 5-year disease free survival rate for the LAP-Nx and OPEN-Nx group was 93.3% and
93.4%, respectively. The 5-year cancer-specific survival was 95.5% and 94.3%, respectively. No significant
differences were found in the disease-free and cancer-specific survival rate between two groups.
Conclusions: The oncologic outcome of LAP-Nx did not differ much from that of the open approach.
127
Unmoderated Posters
Materials & Methods: The clinical and follow-up data of 183 patients with T1-2N0M0 renal cell carcinoma
who underwent LAP-Nx were retrospectively compared with those of 61 patients who underwent OPEN-Nx.
P094
Complete remissions and long-term response on treatment with sunitinib malate in patients
with metastatic renal cell carcinoma
Mermershtain W.1, Nativ O.2, Dinerman M.3, Dudnik J.1, Ariad S.1
1
Soroka University Medical Center, Dept. of Oncology, Beer Sheva, Israel, 2Bnai-Zion Medical Center, Dept.
of Urology, Haifa, Israel, 3Kaplan Medical Center, Dept. of Oncology, Rehovot, Israel
Unmoderated Posters
Introduction & Objectives: Management of renal cell carcinoma (RCC) has made considerable progress
in recent years. Sunitinib is a reference standard of first line care for the treatment of metastatic renal cell
carcinoma (mRCC). Sunitinib has doubled progression-free survival and quadrupled the response rate compared to Interferon alpha. We analyzed the long-term response of pts with metastatic RCC on treatment
with sunitinib.
Material & Methods: 12pts (Male/Female ratio 8/4) who were treated by Sunitinib were defined as longterm responders. A “long-term” was defined by us as minimal response of 12 months. The mean age at
diagnosis was 53,8 years (range 37-69). 10pts underwent open radical nephrectomy and 2pts underwent
partial nephrectomy. The mean age at presentation of metastases was 59,3 years (range 42-78). The mean
time from primary diagnosis and treatment to presentation of metastases was 65 months (range 0-336).
Most of the pts had lung mts with local recurrence, or bone mts, or retroperitoneal LN mts, liver and brain
mts.
Results: Mean duration of response 29 months (range 12-67). Most of pts followed the treatment. Complete response: 5pts, mean duration of response 37months (range (23-67); partial response: 3pts, mean
duration of response 15 months (range 12-18); and stable disease: 4pts, mean duration of response 30
months (range 20-42).
Conclusions: Our data highlights the efficacy and safety of Sunitinib for the treatment of mRCC.
128
P095
Routine sparing of adrenal gland during radical nephrectomy: Ten years
Abdelbaky A.M., Koo Ng J., Johnson P.
Sunderland Royal Hospital, Dept. of Urology, Sunderland, United Kingdom
Material & Methods: Between 2001-2005, 60 patients had radical nephrectomy for upper tract tumors.
Patients who had RCC were identified. The adrenal gland was spared in all radical nephrectomies unless
there is a radiological or intraoperative sign of the gland involvement. The medical records, pathological
specimen reports, and postoperative follow up scans for those patients were reviewed. Patients who had
adrenal gland in the specimens were identified.
Results: Mean age was 65 yrs (39-91). 50 patients had RCC, 8 TCC, one RCC & TCC and one had oncocytoma. 8 had adrenalectomy for the previously described criteria. The absence of adrenal gland was
confirmed pathologically for 42 patients. 29 had pathological stage T1-2, 12 were T3 and one T4. 4 died
during the postoperative period secondary to non-cancerous reasons and were excluded. Mean follow up
was 65m (13-111). Despite the loss of some patients for follow up, we were able to confirm their mortality
using our electronic medical records by checking their recent other speciality clinic visits. 10 patients died
during the first 5 years. 6 died of metastatic RCC; all were T3; while 4 died of different causes. 2 had local
recurrence, one had contralateral recurrence. None of T1-2 patients died during that period. Five years
survival rate was 100% for stage T1-2 and 46% for T3-T4.
Conclusions: This series shows survival rates that are very similar to most published series (70-90% for
stage T1-2; 40-60% for stageT3-4) where adrenal sparing was not routinely adopted. Our results support
other studies which recommended abandoning routine ipsilateral adrenalectomy for the treatment of RCC.
129
Unmoderated Posters
Introduction & Objectives: Until recently radical nephrectomy was considered the gold standard
treatment for renal cell carcinoma (RCC). Historically, ipsilateral adrenalectomy has been described as part
of this procedure. Few series have shown the low incidence of adrenal involvement (3-5 %), furthermore
others have proven that routine incorporation of ipsilateral adrenalectomy has no benefit even with the
presence of adrenal metastases. As a result, routine adrenalectomy is no longer recommended by the
EAU if preoperative CT was normal. At our unit, one surgeon opted to routinely spare the adrenal gland
since 2001-unless contraindicated- during radical surgery for RCC. The aim of this series is to present the
outcome of this technique in terms of patient survival and rate of recurrence.
P096
NDRG2 is involved in the oncogenic properties of renal cell carcinoma and its loss is a novel
independent poor prognostic factor
Lee H.J.1, Liang Z.L.2, Kang K.3, Yoon S.3, Huang S.M.2, Kim J.M.2, Lim J.S.3
1
Chungnam National University Hospital, Dept. of Internal Medicine, Daejeon, South Korea, 2Chungnam
National University Hospital, Dept. of Pathology, Daejeon, South Korea, 3Sookmyung Women’s University,
Dept. of Biological Science, Seoul, South Korea
Unmoderated Posters
Introduction & Objectives: Although N-myc downstream-regulated gene 2 (NDRG2) is a candidate tumor
suppressor, its exact role in renal cell carcinoma (RCC) is not fully understood. We investigated the functional role of NDRG2 and its clinical relevance in RCC tumorigenesis.
Material & Methods: NDRG2 expression and its clinical implications in clear cell RCC were evaluated. Biological function was assessed by a proliferation assay, anchorage-independent growth assay, and wound
healing and transwell migration assays in RCC cell lines overexpressing NDRG2 coupled with an investigation of the effects of NDRG2 expression on the epithelial-mesenchymal transition (EMT).
Results: NDRG2 was differentially expressed in patients with RCC. A loss of NDRG2 was significantly
associated with a higher proportion of tumors >10 cm (P = 0.012) and a high nuclear grade (P = 0.003).
Furthermore, multivariate analyses indicated that a loss of NDRG2 was an independent poor prognostic
factor for patient survival (recurrence-free survival, HR, 7.901; disease-specific survival, HR, 15.395; overall survival, HR, 11.339; P < 0.001 for all parameters). NDRG2 expression inhibited the anchorage-independent growth and migration of RCC cells. NDRG2 expression also modulated the expression of EMT-related
genes such as Snail, Slug, and SIP1, and it decreased EMT signaling in RCC cells. Finally, NDRG2 recovered
E-cadherin expression in E-cadherin-negative RCC cells.
Conclusions: These results indicate that a lack of NDRG2 is associated with oncogenic properties through
the loss of its role as a tumor suppressor, and that NDRG2 is an independent poor prognostic factor predicting survival in clear cell RCC, suggesting that it can serve as a novel prognostic biomarker.
130
P097
Accuracy of multidetector CT scans in staging of renal carcinoma
Ather M.H.1, Syed S.M.1, Hafeez K.H.1, Salam B.S.2
Aga Khan University, Dept. of Surgery, Karachi, Pakistan, 2Aga Khan University, Dept. of Radiology,
Karachi, Pakistan
1
Material & Methods: In a retrospective study, a total of 98 consecutive patients with renal cell carcinoma
were preoperatively assessed for tumor staging using multidetector-row CT. Triphasic CT imaging (i.e.,
noncontrast, arterial, and parenchymal phase) was performed using multidetector-row CT with the slice
thickness of 5 mm and using multi planar reconstructions to define the tumor characteristics. A single blinded reader evaluated the CT scans independently who reviewed the scan on multi planar reconstructions.
The results were then correlated with the histopathological results.
Results: A total of 98 renal cell carcinomas were proven on histopathology. There was a significant (p
0.05) difference in the mean maximum radiological and maximum pathological diameter of the tumor with
radiological diameter being greater. Twenty-seven tumors were down staged and only 1 was up staged.
The specificity of CT for capsular invasion, nodal disease and adrenal involvement was 85, 82 and 98%
respectively. The specificity was over 97% for tumor thrombus in renal vein and IVC.
Conclusions: The multi planar reconstruction capability of multidetector-row CT allowed good specificity
in predicting renal vein, IVC involvement, capsular invasion and nodal disease.
131
Unmoderated Posters
Introduction & Objectives: Accurate staging in the management of renal cell carcinoma has become
particularly important in the era of nephron sparing surgery. Recent advances in CT technology have made
it first line imaging for preoperative management. The aim of this study is to determine the diagnostic
accuracy of multidetector-row computed tomography (MDCT) compared to histopathological findings in
tumor staging of renal cell carcinoma, with the focus on tumor size and stage, renal vein involvement, and
peri-renal infiltration.
P098
Predictive factors for late recurrence of renal cell carcinoma
Kwak C.1, Seo S.I.2, Hong J.H.3, Lee J.Y.4
Seoul National University Hospital, Dept. of Urology, Seoul, South Korea, 2Sungkyunkean Univ. Samsung
Medical Center, Dept. of Urology, Seoul, South Korea, 3University of Ulsan College of Medicine, Asan
Medical Center, Dept. of Urology, Seoul, South Korea, 4College of Medicine, The Catholic University, Dept.
of Urology, Seoul, South Korea
1
Unmoderated Posters
Introduction & Objectives: We aimed to evaluate the clinical and pathologic features and predictive
factors for late recurrence of RCC.
Material & Methods: A total of 747 patients who had undergone curative surgery for RCC with follow up
duration over 5 years or recurrence within 5 years were included in this study. Based on the recurrence duration, the patients were stratified into 4 groups; group 1 (no recurrence more than 5 years after surgery,
n=425), group 2 (synchronous metastasis, n=138), group 3 (recurrence within 5 years, n=143), and group
4 (recurrence after 5 years, n=41). Multivariate analysis with multiple logistic regression analysis and Cox
proportional hazards regression model was used to identify the pathologic and clinical factors affecting the
late recurrence more than 5 years after surgery and its clinical outcome.
Results: The subgroups based on the recurrence duration were significantly different with respect to
clinicopathologic parameters including age at initial diagnosis, preoperative hemoglobin, platelet, hs-CRP
levels, pT stage, and nuclear grade. In multiple logistic regression analysis, age at diagnosis (OR 1.085,
95% CI 1.012–1.163, p=0.022), and preoperative hs-CRP level (OR 6.211, 95% CI 1.590–24.270, p=0.009)
were independent prognostic factors for late recurrence more than 5 years after surgery. In group 2, 3,
and 4, 5-year cancer-specific survival after recurrence were 27.0%, 41.1%, 73.7%, respectively (p=0.001).
Multivariate analysis by Cox proportional hazard model indicated that late recurrence (HR 0.487, 95% CI
0.274–0.864, p=0.014), as well as age at diagnosis, initial presenting symptom, pT stage, histologic
subtype, sarcomatoid differentiation, and lymphovascular invasion, were independent predicting factors
for cancer-related death.
Conclusions: Late recurrence of RCC is not a rare event, and age and serum hs-CRP at initial diagnosis
may be independent predicting factors for late recurrence of RCC.
132
P099
Targeting fibroblast growth factor (FGF) receptor 1 (FGFR1) blocks FGF/FGFR1 pathway and
impacts on renal cell carcinoma growth
Tsimafeyeu I.V.1, Smirnov A.N.1, Kalachev A.A.1, Popov D.S.2
Kidney Cancer Research Bureau, Russian Office, Moscow, Russia, 2Maxwell Biotech Group, Research
Department, Moscow, Russia
1
Material & Methods: To assess the effect of anti-FGFR1 antibody on FGF-mediated signaling, the human
renal carcinoma Caki-1 FGFR1-expressing cells were incubated (0.5% FBS) and were dosed with OM-RCA-01
at 100, 50, 10, and 1 mcg/ml. Control wells were left untreated. Three hours after dosing, basic FGF
was added at a concentration of 50 ng/ml. Additional control wells were treated with OM-RCA-01 without
FGF-stimulation. Cell growth inhibition was determined using Promega’s Cell Titer-Glo® assay.Charles River
female NCr nu/nu mice (6-12 weeks of age) were set up with 1 mm3 Caki-1 tumor fragments sc in flank.
Tumor sizes were measured in a blind fashion twice a week with a vernier caliper. Mice with established
tumors (an average size of 80 - 120 mg) were randomly divided into vehicle and treatment groups per 10
animals in group. Animals were treated with antibody using different doses (1 or 10 mg/kg). Endpoint was
significant differences in tumor growth delay. Monoclonal antibody OM-RCA-01 was provided by OncoMax
Ltd. (Moscow, Russia).
Results: In vitro study showed that basic FGF significantly increased proliferation of the human FGFR1expressing renal carcinoma cells (P=0.011). No effect of basic FGF on cell line proliferation was observed
when the cells were incubated with OM-RCA-01 antibody at any concentrations up to 100 mcg/kg in comparison with FGF-untreated control (P=0.855). In vivo, the tumors in untreated mice continued their aggressive growth to reach the size of 2000 cm3, at which point the mice were killed. In contrast, treatment with
OM-RCA-01 not only significant arrested further growth of the tumors (P=0.006) but also demonstrated
differences in tumor volume compared with vehicle already on Day 13. A similar anti-tumor activity of OMRCA-01 was observed when the antibody was given in low (1 mg/kg) or high (10 mg/kg) doses (P=0.917).
Conclusions: Targeting FGFR1 blocks FGF/FGFR1 pathway in renal cell carcinoma. Monoclonal antibody
OM-RCA-01 has significant early anti-tumor efficacy in Caki-1 xenograft model.
133
Unmoderated Posters
Introduction & Objectives: The association between FGFR1 overexpression and renal cell carcinoma
(RCC) has been found in several studies; elevated levels of basic FGF have been linked to disease progression on sunitinib in RCC patients (Tsimafeyeu et al, ASCO meeting 2010). We investigated the effects of
FGFR1 inhibition using OM-RCA-01, a humanized neutralizing monoclonal antibody against FGFR1, in RCC
experimental models.
P101
What proportion of patients have sufficient renal function to undertake adjuvant chemotherapy
following nephro-ureterectomy for muscle invasive transitional cell tumour of the upper urinary
tracts? Is a randomised chemotherapy trial feasible?
Chapman A., Johnson I.
Unmoderated Posters
Freeman Hospital, Dept. of Urology, Newcastle Upon Tyne, United Kingdom
Introduction & Objectives: Urothelial cancers (UC) of the upper urinary tract are uncommon. They are
clinically aggressive with higher stages of disease having a very poor prognosis. Lack of adequate preoperative staging is an obstacle to neoadjuavnt chemotherapy. Currently there is no consensus as to the best
treatment for patients with upper tract muscle invasive UC following surgery. There is a growing need to
examine the potential benefits of platinum based chemotherapy in patients who have had a nephroureterectomy for muscle invasive UC of the upper tract. Given the low numbers of cases nationally this would
need to be a multicentre randomised controlled phase III trial. Although data is available with regards to
estimated renal function post nephrectomy, there is concern that this specific group of patients will have
insufficient renal function to tolerate platinum based agents post nephrectomy in light of their associated co-morbidities. Before embarking on a large and expensive study we investigated the residual renal
function in patients who would be eligible for entry into such a trial. The study aim was to calculate the
estimated glomerular filtration rate (eGFR) in patients who have undergone nephro-ureterectomy for upper
tract muscle invasive UC and assess their suitability for adjuvant chemotherapy.
Material & Methods: A retrospective analysis was made of all patients who underwent nephro-ureterectomy between January 2006 and August 2010 in the Freeman Hospital, Newcastle upon Tyne, UK. Those
patients for which a histological diagnosis of muscle invasive UC was made were identified. The eGFR for
this group was calculated using the abbreviated MDRD formula and post operative biochemistry.
Results: A total of 150 patients underwent nephro-ureterectomy between January 2006 and June 2010
(54 months). Of these 21 did not have UC (16 cases of Renal Cell Carcinoma, 4 for chronic infection and 1
for retroperitoneal fibrosis). 57 of the 129 remaining patient had muscle invasive UC and their mean eGFR
was 49.6 (range 5.6 – 103). The eGFR results for this group are shown in Table 1. Table 1:
eGFR(mL/min/1.73 m2)
Number (%)
<25
7 (12)
25-50
27 (47)
>50
23 (40)
Conclusions: Our results show 87% of patients undergoing nephro-ureterectomy for muscle invasive UC
would have an eGFR sufficient for them to receive adjuvant chemotherapy, though only 40% of patients
would have been eligible for cisplatin, with 47% eligible for carboplatin. Our findings suggest that a
randomised trial of adjuvant chemotherapy in upper tract UC is possible but it will need to recruit from a
relatively large number of high volume centres to succeed.
134
P103
Single centre experience of neoadjuvant chemotherapy for muscle invasive transitional cell
carcinoma of the urinary bladder
Faure Walker N.A.1, Hilman S.2, Beresford M.3, Wilson P.2, Bahl A.3
University Hospitals Bristol NHS Foundation Trust, Dept. of Academic Medicine, Bristol, United Kingdom,
University Hospitals Bristol NHS Foundation Trust, Dept. of Clinical Oncology, Bristol, United Kingdom,
3
University of Bristol, Dept. of Clinical Sciences, Bristol, United Kingdom
1
2
Material & Methods: Retrospective case review was performed. Inclusion criteria were patients diagnosed with T2-4N0M0 bladder TCC treated with NC in one centre who underwent subsequent RC or RR.
Outcomes were overall survival, chemotherapy regime, toxicities and tumour pathology at diagnosis and
after RC.
Results: 31 patients were included (28 male [90.3%] and 3 female [9.7%]). Median age was 68. Stage
distribution was as follows: T2- 21(75%), T3-5(17.9%) and T4-2(7.1%). Patients received median 3(range 2-6)
cycles of Gemcitabine/Cisplatin. Documented toxicities included fatigue (12[38.7%]), DVT/PE (5[16.1%]),
GI disturbances (4[12.9%]), and dizziness (3[9.7%]). There were no NC related mortalities. There were 2
episodes of neutropaenic sepsis out of a total of 99 cycles of NC. Of the 28 patients who were offered RC,
10(35.7%) declined surgery as they felt ileal conduit was unacceptable. Following NC, histopathology showed 7(28%) achieved a complete response, 4(16%) had reduction in T stage, 10(40%) had stable disease
and 4(16%) progressed in comparison to their pre-NC staging.Overall survival:
Year 1 % (95% CI)
Year 2 % (95% CI)
Year 3 % (95% CI)
Cystectomy
100
82.1 (59.1-100)
82.1 (59.1-100)
Radical radiotherapy
100
88.9 (68.0-100)
71.1 (36.0-100)
Conclusions: NC achieved a Clinical benefit rate (complete + partial response rate) of 44%. Progressive
disease was noted in 16% of those who underwent NC. There were no NC related mortalities. Neutropaenic sepsis occurred in only 2 out of the total 99 cycles of NC in 31 cases. Most common toxicities were
fatigue, DVT/PE and dizziness. 35.7% of the patients refused cystectomy and underwent radiotherapy as
their preferred treatment. There was no statistical difference in overall survival between radiotherapy and
cystectomy although the number of patients included was relatively small.
135
Unmoderated Posters
Introduction & Objectives: Neoadjuvant chemotherapy (NC) before radical treatment has been shown to
improve 5 year survival by 5% in patients with T2-4 N0M0 transitional cell carcinoma (TCC) of the bladder,
compared to radical treatment alone[1]. There is no robust data that demonstrates an advantage of radical
cystectomy (RC) over radical radiotherapy (RR) following NC. This is a retrospective study to evaluate the
mortality and morbidity of neoadjuvant chemotherapy administered in one centre to patients with stage
T2-4 N0M0 TCC of the urinary bladder. 1 McLaren DB et al. Clinical Oncol 2005; 17: 503-507
P104
Use of mycobacterial cell wall DNA complex immediately after endovesical surgery in the
treatment of patients with non-muscle invasive bladder cancer
Morales A.1, Lihou C.2, Lang Z.2, Cohen Z.3
Unmoderated Posters
1
Queen’s University, Centre For Urological Research, Kingston, Canada, 2Endo Pharmaceuticals Inc., Dept.
of Clinical Development - Oncology, Chadds Ford, United States of America, 3Bioniche Life Sciences Inc.,
Dept. of Clinical Research, Belleville, Canada
Introduction & Objectives: Administration of intravesical BCG (Bacillus Calmette-Guérin) in the treatment
of non-muscle invasive bladder cancer (NMIBC) is contraindicated in the presence of a disrupted urothelium, i.e. immediately following a transurethral resection of bladder tumor (TURBT) or biopsy. A minimum
period of 1 week must elapse prior to BCG treatment to allow healing of the urothelium and to decrease
the risk of potential serious complications such as sepsis. Mycobacterial cell wall DNA complex (MCC), a
sterile suspension derived from the non-pathogenic Mycobacterium phlei, has recently been shown to exert
anticancer activity by reducing recurrences in patients who have previously failed BCG. MCC exhibits a dual
mechanism of action: a direct effect on cancer cells and an indirect anticancer effect via stimulation of the
immune system by activation of monocytic cells. The aim of this analysis was to review and summarize
cases from our clinical trial database and determine whether MCC can be safely instilled into the bladder
immediately following a TURBT or biopsy.
Material & Methods: A retrospective analysis was performed to identify patients who received an MCC
instillation immediately after undergoing a bladder cancer-related surgery, i.e. tumor resection or biopsy,
in our database of a recently completed clinical trial that enrolled patients with high grade urothelial
carcinoma who failed to respond to one or more courses of BCG. Analysis included the description of any
adverse events (AE), their severity and relationship to MCC.
Results: 16 out of 129 patients (12.4%) received an instillation on the same day of surgery (either a tumor
resection or biopsy) for a total of 28 instillations. AEs were experienced by 5 patients out of 16 (31.3%) following 5 out of 28 (17.9%) instillations (all in different patients). In 4 of these 5 instillations, AEs consisted
of local bladder/urological symptoms such as hematuria, urinary frequency, dysuria, and suprapubic
cramps. They were mild to moderate in severity and not considered related to MCC. In the other instillation,
the patient experienced systemically-related AEs such as rigor, nausea and headache with moderate severity which were possibly related to MCC. None of these AEs resulted in treatment discontinuation. 3 of the 5
patients received an instillation on the same day of surgery at another time without experiencing any AEs.
Conclusions: In a limited number of patients, MCC was well tolerated when instilled intravesically immediately after tumor resection or biopsy. Further investigation is needed to determine if intravesical MCC, like
cytotoxic agents, can be administered in the perioperative setting to prevent re-implantation of circulating
tumor cells, and potentially impact the rate of recurrence.
136
P105
The influence of neoadjuvant chemotherapy on urodynamics and kidney function in patients
with invasive bladder cancer (BC)
Stakhovskyi E.A., Voylenko O.A., Stakhovskyi A.E., Kotov V.A., Vitruk Y.V.
National Cancer Institute, Dept. of Plastic and Reconstructive Oncological Urology, Kiev, Ukraine
Material & Methods: The data on complex investigations and treatment of 28 patients with invasive BC
on stage T2a-T4a disease between 2008 and 2010 were analyzed. For all patients was performed neoadyuvant chemotherapy (Hemzar-cisplatin) followed by assessing its efficiency criteria RECIST. Patients age
from 36 to 74 (61.1 + 11.1) years old [males – 23 (82.1%), females- 5 (17.9%)].
Results: Stabilization of the tumor by RECIST criteria was observed in 9 (32.1%) cases, progression - 3
(10.7%), partial regression - 14 (50%) and complete response - in 2 (7.1%) cases. In 11 (39.3%) patients (13
ureters) BC was the cause of megaureter. At the control examination after chemotherapy, megaureter was
founded in 6 (21.4%) patients (7 ureters), with in 5 cases the level ureterectasia remained unchanged and
in 2 - decreased stage. In 5 (17.9%) patients (6 ureters) megaureter was not found. Thus, a neoadjuvant
chemotherapy allowed in 6 (46.1%) of 13 cases to restore the upper urinary tract urodynamics and improve
it - in 2 (15,4%) (c 2 = 2.19 (p = 0.13) due to a small number of patients). At initial examination of 23 male
patients, in 20 (86.9%) cases was revealed of lower urinary tract symptoms. Chemotherapy was led to
improvement of the act of urination, namely: reduction of prostate volume by 11.6 cm³, improving of the
average and the maximum flow rate by 3.4 and 7.6 ml / s, reducing the volume of residual urine in 32.5ml,
flow time by 14.1s, IPSS by 6.5 points and improve QoL from 2.9 to 1.8 points.
Conclusions: Conducting of the neoadjuvant chemotherapy in patients with invasive BC, in 46.1% cases
megaureter allowed restore urodynamics of upper urinary tract and improve it in 15.4%. In addition, chemotherapy improves of lower urinary tract symptoms and quality of life of patients.
137
Unmoderated Posters
Introduction & Objectives: Violation of urodynamics of upper and lower urinary tract in not invasive BC
is extremely rare: from 1.6% to 2.6%, but the invasive forms becomes worse of the clinical picture, which
is primarily due to obstructive symptoms. The aim of our work was to improve the efficiency of complex
treatment and quality of life of patients with invasive BC by studying the efficacy of neoadjuvant chemotherapy and its impact on functional status of the urinary tract.
P106
Whole pelvis or bladder only chemoradiation for lymph node negative (LN-) ivasive bladder
cancer: Single institutional experience
Tunio M.A., Altaf Hashmi
Sindh Institute of Urology & Transplantation (SIUT), Dept. of Radiation Oncology, Karachi, Pakistan
Unmoderated Posters
Introduction & Objectives: Whole pelvis (WP) concurrent chemoradiation (CCRT) is the standard bladder
preserving option for patients with invasive bladder cancer. Standard practice is to treat elective pelvic
lymph nodes, so our aim was to evaluate whether bladder only (BO) CCRT leads to similar results compared
to standard WP-CCRT.
Material & Methods: Eligibility included histopathological proven muscle invasive bladder cancer, radiological lymph node negative (T2-T4, N-) and maximal transurethral resection of bladder tumor (TURBT) with
normal hematological, renal and liver functions. Between March 2005 and May 2006, 230 patients were
accrued. Patients were randomly assigned to whole pelvis (WP-CCRT; 120 patients) and bladder only (BO–
CCRT; 110 patients). Data regarding the toxicity profile, compliance, initial complete response (CR) rates at
3 months, occurrence of locoregional or distant failure was recorded.
Results: With a median follow-up of 5 (3-6) years, WP-CCRT was associated with a 5-year DFS of 47.1%
compared with 46.9% in patients treated with BO-CCRT (p value 0.5). The bladder preservation rates were
58.9% and 57.1% in WP-CCRT and BO-CCRT respectively (p value 0.8) and 5-year over all survival (OS) rates
were; WP-CCRT 52.9%, BO-CCRT 51% (p value 0.8).
Conclusions: BO-CCRT showed similar bladder preservation, DFS and OS rates compared with WP-CCRT.
Smaller field sizes including bladder with 2 cm margins can be used as bladder preservation protocol for
muscle invasive LN- bladder cancer patients to minimize the side effects of CCRT.
138
P107
Comparison of clinical and urodynamic outcome in detubularised and nontubularised
ileocaecal orthotopic neobladder
Aly A.A.
Na Institutetional Cancer, Dept. of Surgery, Cairo, Egypt
Material & Methods: This study included twenty patients with invasive carcinoma of the urinary bladder
who have been managed in the period from January 2007 to December 2009 in the surgical department,
National Cancer Institute and urology department, Cairo University Hospitals. These patients were randomized into two groups; conventional ileocaecal neobladder (groupA) and detubularised one (group B). All
our patients were evaluated postoperatively every 3 months .The follow-up time lasted for 3 year, and the
median follow-up was 12 to 36 months (mean 22.9 ± 9.26 SD). Most patients were urodynamically assessed 1 year postoperatively.
Results: There was no perioperative mortality. No statistically significant difference was found in the complications between both groups. Of the 20 operated patients, 8 achieved excellent day-time continence
(1 in group A, 7 in group B), 5 achieved good day-time continence (2 in group A, 3 in group B), 4 achieved
fair day-time continence (group A), while the remaining 3 patients (group A) had unsatisfactory continence.
With regards to night continence, 4 (all from group B) were completely dry at night, while 6 (1 in group A,
5 in group B) have good control, helped with timed voiding and fluid restriction. Nocturnal continence was
fair in 4 patients (3 in group A, and 1 in group B), while six patients in group A had unsatisfactory nocturnal
continence. The mean maximal pouchal capacity and voided volume are significantly higher in group B.
Although significant uninhibited contractions (> 40 cmH2O) did not occur in any of the patients in group B,
they occurred in 8 patients in group A, which is highly significant.
139
Unmoderated Posters
Introduction & Objectives: We analyzed the results of our patients receiving detubularised ileocaecal
orthotopic neobladder after radical cystoprostatectomy compared with another group who received
nontubularised one.
P108
Organ preservation in bilharzial bladder cancer in egypt: Single institutional experience
Abbas H.M.1, Aboziada A.1, Elwanis E.1, El-Gamal A.2, Mokhtar A.3, Mourad F.4
South Egypt Cancer Institute, Assiut University, Dept. of Radiotherapy, Assiut, Egypt, 2Faculty of Medicine,
Dept. of Urology, Assiut, Egypt, 3South Egypt Cancer Institute, Assiut University, Dept. of Urology, Assiut,
Egypt, 4South Egypt Cancer Institute, Assiut University, Dept. of Radiology, Assiut, Egypt
1
Unmoderated Posters
Introduction & Objectives: Phase II study was conducted to evaluate bladder preservation protocol in
Bilharzial and non Bilharzial invasive transitional cell carcinoma (TCC) bladder cancer using gemcitabine
and conformal radiotherapy (RT).
Material & Methods: 30 patients TCC with good performance status and renal function subjected to
maximum trans-urethral resection of bladder tumor (TURBT). Patients received 66 Gy/33 fractions/6.5
weeks with weekly gemcitabine 125mg/m2. Evaluation was done after one month with cystoscopy and CT/
MRI pelvis. Patients who had complete remission (CR) subjected for follow up and patients who had invasive
bladder tumor subjected to radical cystectomy.
Results: 24 patients had CR after one month evaluation. Stage 2 tumor, low grade, non Bilharzial and
maximum TUR were the only prognostic factors. The treatment schedule was tolerable and was associated
with infrequent incidence of moderate toxicity that was easily controlled without interruption of RT. Cystectomy free survival was 88% at a median follow up 2 years.
Conclusions: Gemcitabine and conformal RT after TURBT treatment could be an effective way to achieve
a high response rate in the treatment of invasive TCC of the bladder with good tolerance. Organ preservation in Bilharzial bladder is still possible.
140
P110
A new type of orhtotopic ileal neobladder after radical cystectomy - A preliminary Rport
Shimpi R.K.S.
Uro-Andrology Clinic, Dept. of Uro-Oncology, Pune, India
Introduction & Objectives: Orthotopic neobladder described first by Camey has advantages of near
normal voiding function, continence and superior body image. We report our initial experience and results
of patients undergoing radical cystectomy and a new type of orthotopic neobladder.
Results: Mean Age was 60 yrs. At 6 months, 96.42% had daytime and 89.28% had nighttime continence.
Mean maximum capacity was 530 ml. Mean pressure at maximum capacity was 17.8 & residual volume
of urine was 40 ml. The ureteric access was easier during replacement of stents and none of the patients
had ureteric strictures.4 patients needed CISC, 2 had wound infection, one perioperative death due to pulmonary complication. 2 had pyelonephritis. According to QOL questionnaire, all patients have satisfactory
quality of life.
Conclusions: This novel type of ileal neobladder is technically sound, has advantages of easy access to
ureters and reduced stricture rates. It provides superior quality of life as compared to ileal conduit and
also the complication rates are acceptable.
141
Unmoderated Posters
Material & Methods: 28 patients (25 males, 3 females) treated between 2007 – 2010 with radical cystectomy and ileal neobladder, were included in this study. Ileal neobladder was configured from detubularised 60 cm of ileum. The ureters were anastomosed to two separate horns of ileal neobladder over feeding
tubes. These were replaced by D-J stents at 3 weeks. Patients were followed up 3monthly. Voiding pattern,
daytime and nighttime continence, ureteric obstruction and need for CISC were assessed.
P111
Does the type of diversion affect 30 day outcome in patients undergoing radical cystectomy?
Ather M.H., Raza S.J., Alam Z.A.
Aga Khan University, Dept. of Surgery, Karachi, Pakistan
Unmoderated Posters
Introduction & Objectives: In the current work, we have analyzed patients undergoing radical cystectomy with Ileal conduits or orthotopic neo bladder substitute, and determined if the type of diversion
influenced the 30 day complication rates using Clavien system.
Material & Methods: We retrospectively reviewed our prospectively maintained data base of patients
who had under gone RC and urinary diversion. Patients were divided into two groups based on the type of
diversion they received, i.e. Ileal conduit and orthotopic Neo bladder substitute. Both groups were compared in terms of their basic demographic and operative characteristics. The complications were noted with
either type of diversion, occurring with in 30 days of the procedure. Univariate and multivariate analysis
were performed to check assess the factors responsible for the complication. Odds ratio was calculated
for various factors and type of diversion leading to complications. Data was analyzed on Statistical Package for Social Sciences (SPSS) version 16 and p value <0.05 was considered to be significant.
Results: A total of 124 patients underwent radical cystectomy with 35 receiving orthotopic neo bladder
substitute (NB) and 89 receiving ileal conduit (IC). Most of the patients were male (105 Male and 19 females), with mean age of 59.3 +/- 11.7 years (range 28-88 years). Both groups were comparable in terms
of their basic demographic and operative characteristics, except for ASA score. The overall complication
rate was 44%, with 42% and 48% complications seen in IC and NB groups respectively. Most common
complication was wound infection, followed by uretero-Ileal anastomotic leak in the IC group, while wound
infections were followed by urinary tract infections in patients receiving NB. There were 4 mortalities seen
in the IC group, while the NB group had a single mortality. On a univariate analysis, none of the factors had
statistical significant influence on the post operative complications, including the type of diversion. On a
multivariate analysis similar results were seen and no specific factor was indentified to be influencing the
complications. The odds ratio of developing complication following IC was 0.87; however this difference
was again statistically not significant.
Conclusions: Type of urinary diversion does not affect the complication rate.
142
P112
Photodynamic diagnosis of non-muscle invasive bladder cancer using Hexaminolevulinic Acid
Enache M.A.1, Dragoescu P.O.1, Tomescu P.I.1, Maria C.1, Panus A.1, Dragoescu N.A.2, Plesea I.E.3
Craiova Emergency Hospital, Dept. of Urology, Craiova, Romania, 2Craiova Emergency Hospital, Dept. of
Anesthesiology, Craiova, Romania, 3Craiova Emergency Hospital, Dept. of Pathology, Craiova, Romania
1
Material & Methods: The prospective randomised study was conducted over a 12 months period and
included 87 patients with primitive NMIBC, diagnosed and treated in our department in 2009 and 2010.
All patients initially underwent a cystoscopy examination followed by the resection (TUR) of the identified
tumors. 42 patients were included in the study group (PDD) while 45 patients were diagnosed and treated
by conventional methods (WLC group). Patients in the PDD group underwent an additional PDD cystoscopy
axamination as well as photodynamic assisted tumor resection (TUR-PDD) at 1-2 hours after receiving a 85
mg hexaminolevulinic acid bladder instilation. Adjuvant intravesical therapy was performed depending on
tumor risk follow-up white light cystoscopy and urine cytology was performed at 3, 6, 9, 12 months.
Results: There were no statistically significant differences between the two groups regarding age, sex,
place of origin, smoking history, clinical symptoms or presence of urological history as well as tumor size,
location and number. A total of 143 tumors were identified for both groups by WLC with an extra 24 more
tumors being identified by PDD cystoscopy in 18 patients from the PDD group. Tumor detection analysis
was performed as a within patient comparison in the flourescence group. Fluorescence cystoscopy proved
a 97% diagnostic sensitivity compared to 79.7% for WLC and identified 25.5% more tumors than the conventional examination (p<0.001) in the PDD group. We also demonstrated a significant reduction of tumor
recurrence rates by 8.57%, 10.48%, 14.76% and 19.05% at 3, 6, 9 and 12 months respectively by using
PDD (HR=0.3933.95% CI=0.1625 - 0.9517; p=0.0385) that became an independent positive prognosis
factor.
Conclusions: Use of PDD cystoscopy in patients with NMIBC leads to significant improvement of their
initial diagnosis efficiency (by over 25%). Better patients prognosis and quality of life following conservative
PDD assisted TUR treatment of thes tumors can be obtained by significantly reducing the tumor recurrence
rate (by 8.5 - 19%) in the first year of follow-up.
143
Unmoderated Posters
Introduction & Objectives: Bladder cancer (BC) is the most common tumor of the urinary tract. White
light cystoscopy (WLC) is currently considered the standard investigation for the diagnosis of bladder
tumors. Recent studies suggest that using exogenous fluorescence (photodynamic diagnosis, PDD) can
improve the diagnostic sensitivity and specificity of cystoscopy as well as the radicality of transurethral
tumor resection (TUR) of non-muscle invasive bladder cancer (NMIBC). Our study aims to anlyze the value
of using PDD in the diagnosis and treatment of NMIBC in our initial experience.
P113
Hydronephrosis is an independent predictor of lymph node involvement in muscle-invasive
bladder transitional cell carcinoma
Abbasi Eslaloo M.A.1, Kamali K.2, Abbasi Eslaloo A.3
Unmoderated Posters
1
Shahid Beheshti University of Medical Sience, Dept. of Internal Medicine, Tehran, Iran, 2Tehran University
of Medical Science (TUMS), Dept. of Urology, Tehran, Iran, 3Tehran University of Medical Science (TUMS),
Dept. of Pathology, Tehran, Iran
Introduction & Objectives: Up to 30% of patients with Transitional Cell Carcinoma (TCC)of bladder develop muscle-invasive disease.Hydronephrosis is an easily demonstrable finding in the initial evaluation of patients with bladder carcinoma that ranges from 7.2% to 54.1%. Hydronephrosis is regarded as an important
factor in staging.Some studies have suggested the prognostic significance of preoperative hydronephrosis
with higher stage disease, pelvic lymph node metastasis and worse survival in patients underwent radical
cystectomy. The aim of this study was to investigate the prognostic effect of hydronephrosis prior to
radical cystectomy in muscle-invasive Transitional Cell Carcinoma (TCC) of the bladder.
Material & Methods: During 6-years, a consecutive of 164 patients (138 male and 26 female) with TCC
of the bladder, who underwent radical cystectomy, were included in this retrospective study. None of the
patients had distant metastatic disease at the time of cystectomy. Hydronephrosis was confirmed by
radiographic imaging. Tumor staging and grading were conducted in accordance with TNM and WHO classifications (grade I to III), respectively.
Results: Hydronephrosis was detected in 86 of 164 patients (52%).The mean age was 63.9+-11.1 years
(range 63 to 85). Patients with hydronephrosis were more likely to have extravesical disease at the time
of radical cystectomy compared with patients without hydronephrosis (36% vs 15.4%, OR: 1.17, CI95%:
1.03-1.8, P=0.03).Herein we determined that preoperative hydronephrosis was significantly associated with
higher T stage (P = 0.01) as well positive lymph nodes (P < 0.001). Fifty patients (30.5%) had a tumor at the
ureteral orifice. Our data suggest that hydronephrosis due to TCC of bladder without tumour at the orifice
was more prone to develope non organ-confined disease (32% vs 18%, OR:1.2; CI95%:1.2-1.7, p=0.03) and
lymph node metastases (80% vs 30% , OR: 1.57; CI95%:1.3-2.4, p<0.001).In the present study the local
recurrence was detected in 15/164 (9.1%) of patients, frequently more experienced in hydronephrosis
compared with non-hydronephrotics. Up on multivariate analysis hydronephrosis was correlated with higher
tumor stage, orifice and lymph node involvement. Preoperative hydronephrosis was significantly associated with higher T stage (P = 0.01) and Lymph node involvement (p<0.001).
Conclusions: In conclusion, the presence and high grade of preoperative hydronephrosis are related
to the higher pT stage and are significant prognostic factors for cancer-specific survival in patients who
underwent radical cystectomy for bladder cancer. Lymph node assessment is an important component of
bladder cancer staging because nodal status is strongly correlated with prognosis. This could be helpful in
deciding the therapeutic plans and assessing the prognosis of patients before the operation.
144
P114
Elevation of urine interleukin (IL)8 and IL5 concentration as a predictive and prognostic factor
in patients with bladder carcinoma
Milosevic R.1, Vojvodic D.2, Cerovic S.3, Milovic N.1, Aleksic P.1, Campara Z.1, Bancevic V.1, Kosevic B.1,
Jovanovic M.1, Maric P.1, Nikolic I.1, Mocovic D.1, Teodorovic G.1, Spasic A.1, Simic D.1, Stanojevic I.2, Magic
Z.2, Majstorovic I.2
Introduction & Objectives: The precise staging of bladder tumors represents the clinical base in treatment planning and prognosis of the illnes. Local tumor growth as well as metastatic potential is critically
dependent of microenvironmental growth factor production. The mixture of cytokines that is produced
in the tumour microenvironment has an important role in cancer pathogenesis. Local specific antitumor
immune response represents most important factor that influence tumor growth and spreading and finally
disease outcome. The aims of our investigations were to: investigate urine cytokine levels in patients with
TCC correlating them to clinical and pathological signs of tumor advances and to find out is it possible for
urine cytokine levels to determine prognosis and final outcome of the illnes.
Material & Methods: Naturally, micturated urine samples were obtained from 101 patients (pts). 74 pts
have newly diagnosed TCC, and 27 pts did not have any clinical signes of TCC. Patients with TCC were
divided according to cytological, radiological and patohistological findings in two groups: group with superfitial (G2, pT1) -27 pts, or infiltrative TCC (G3-G4, pT2-pT3) -47pts. Concentration of cytokines (IL1b, TNFa,
IFNg, IL2, IL4, IL5, IL6, IL8, IL10 and IL12) was estimate with commercial flowcytometric test kit. Statistic
analysis of the results was performed using the Kolmogorov-Smirnov test.
Results: In group of pts without TCC we did not register elevation of examined cytokines vs. group of
pts with TCC where we register elevation in all cases, which was statistically very significant difference
(p<0,001). We also register statistically very significant difference (p<0,001) in concentration of IL8 and
IL5 between group of pts with infiltrative TCC and group of pts with superfitial TCC. There was also statistically very significant difference (p<0,001) in concentration of IL8 and IL5 between patients with T1 stadium
who was G3, pT1 stadium vs G2, pT1. The highest levels of these IL was recorded in patients with recidive
and progresion in T2 stadium (8 pts) that was also statistically very significant difference (p<0,001). In
group of pts with infiltrative TCC 13 pts have rapid illnes progresion and 9 of them have died during next six
months inspite of all standard therapeutic procedures. All of these patients have IL 8 above 3000 and only
one of them did not have IL 5 above 1000, differing statistically very significant (p<0,001) in comparison
with other pts with infiltrative TCC.
Conclusions: Our study results indicate that there is statistically very significant value of IL8 and IL 5
urine concentration in prediction and prognosis of risk of ilness progresion and final ilness outcome. Urine
concetration of IL8 above 3000 and IL5 above 1000 seems to be very bad prognostic factors and are
predictors for rapid illnes progresion.
145
Unmoderated Posters
1
Military Medical Academy, Dept. of Urology, Belgrade, Serbia, 2Military Medical Academy, Institute For
Medical Research, Belgrade, Serbia, 3Military Medical Academy, Institute For Pathology, Belgrade, Serbia,
P115
Human Papilloma Virus (HPV) infection a1nd abnormal P53 expression as prognostic indicators
in transitional cell carcinoma (TCC) of the urinary bladder
Mete U.1, Balyan J.1, Chakraborti A.1, Shenvi S.1, Singh M.P.2, Ratho R.2, Kakkar N.3
1
PGIMER, Chandigarh, Dept. of Urology, Chandigarh, India, 2PGIMER, Chandigarh, Dept. of Virology, Chandigarh, India, 3PGIMER, Chandigarh, Dept. of Pathology, Chandigarh, India
Unmoderated Posters
Introduction & Objectives: Data on the role of HPV in bladder carcinogenesis are controversial. Dysregulation of p53 is critical in the development of TCC of urinary bladder. Few studies have documented
concurrent HPV positivity and abnormal p53 accumulation in bladder TCC. Aims of our study were to assess frequency of P53 gene mutations, prevalence of HPV infection in patients with TCC of urinary bladder
and to find out its correlation with standard clinical and histological parameters for tumor recurrence and
progression.
Material & Methods: Tumor tissue samples of 50 patients with transitional cell carcinoma (TCC) of urinary bladder obtained by TURBT or radical cystectomy were examined histopathologically. P53 mutations
were assessed by DNA isolation and PCR-SSCP (polymerase chain reaction- single strand conformation polymorphism) analysis. PCR (Polymerase Chain Reaction) was used to detect HPV DNA (type 16 & 18) Data
were analysed by Fisher’s two tailed t-test & Pearson’s chi-square test using SPSS 15 statistical software.
Results: 20 (40%) patients had presented with primary superficial tumors,12(24%) with recurrent superficial and 18 (36%) had invasive TCC. 10% had Ta, 54% had T1 and 36% had T2 lesion. Out of 50 patients
7 (14%) had p53 mutations detected in exons 5 and 6. P53 mutations were more in invasive tumor (n=4,
57.1%) as compared to superficial tumor(n=3,42.9%). None of the 50 bladder cancer specimens were
positive for HPV DNA.
Conclusions: HPV 16 & 18 prevalence is very low amongst Indian patients with bladder cancer and
therefore unlikely to be the causative factor for bladder TCC. P53 mutations are associated with aggressive behavior. Therefore patients having tumor with P53 mutations should be followed up closely. This
molecular prognosticator may play a role in the clinical routine management of patients with bladder tumor.
Further studies should explore their potential clinical significance taking into their cost-effectiveness.
146
P116
Is real the association between bladder cancer and human papillomavirus infection?
A meta-analysis that studies the relationship between them
Jimenez-Pacheco A.1, Arrabal-Polo M.A.2, Lahoz-Garcia C.2, Valle-Diaz De La Guardia F.3, Jimenez-Pacheco
A.4, Sorlozano-Puerto A.5, Luna-Del Castillo J.6, Gutierrrez-Fernandez J.5
”Santa Ana” Hospital, Dept. of Urology, Granada, Spain, 2”San Cecilio” University Hospital, Dept. of Urology, Granada, Spain, 3”San Juan De La Cruz” Hospital, Dept. of Urology, Jaen, Spain, 4”Alto Guadalquivir”
Hospital, Dept. of Emergency, Jaen, Spain, 5University of Granada, Dept. of Microbiology, Granada, Spain,
6
University of Granada, Dept. of Statistical, Granada, Spain
1
Material & Methods: MEDLINE database was researched using the key words bladder cancer and virus.
Subsequent selection was made of 28 articles published in English, Spanish or French of the relationship
between HPV and bladder cancer using a described methodology. Clinical cases were excluded. A search
of the references of the chosen articles confirmed that no studies had been missed. Because of the wide
diversity of the studies, they were stratified according to the laboratory test used. Main standard in metaanalysis was odds ratio of virus infection corresponding to bladder cancer illness. Ratio estimator for both
models was obtained by DerSimonian y Laird method, using previously a heterogeneity test and Higgins I2
statistic. To assess verification bias Begg`s and Egger`s tests were used. Stata 11.1 was used for analysis.
Results: First, we pooled all of studies and we obtained significative heterogeneity, P<0.001. Variability
depending on heterogeneity among studies was 60.4%: the pooled odds ratio was 2.53 (95% CI, 1.40 to
4.57). We studied variability causes and we split up into articles which are DNA based and no-DNA based,
and first ones into PCR based and no-PCR based. We obtained following results:
Study Type
Pooled OR
95% CI
Study Type
Pooled OR
95% CI
DNA Based(n=22)
2.30
1.04 to 5.10
PCR Based (n=17)
2.63
1.03 to 6.73
No-PCR Based (n=5)
1.49
0.37 to 6.02
No-DNA Based (n=6)
3.26
1.54 to 6.93
No verification bias test was significant, but the funnel plot was slightly indicative of that problem.
Conclusions: We have found enough evidence about association between HPV infection and bladder
cancer. Made the division between the articles, we found significant association for both samples based or
not based on DNA, although in the first (based DNA) the pooled odds ratio without PCR is significantly lower
than with PCR method.
147
Unmoderated Posters
Introduction & Objectives: Studies have suggested the possibility that human papillomavirus (HPV)
infection is a risk factor which contribute to bladder cancer but there are not definitive conclusions drawn
yet. We performed a meta-analysis of observational studies published until August, 2010 to establish the
degree of association between bladder cancer and HPV.
P118
Expression analysis and clinical significance of CXCL16/CXCR6 in patients with bladder cancer
Nam H.J., Ha H.K., Lee S.D., Lee J.Z.
Pusan National University Hospital, Dept. of Urology, Busan, South Korea
Unmoderated Posters
Introduction & Objectives: Interaction of chemokine and its receptor is closely involved in progression
and metastases of cancer. We hypothesized that CXCL16-CXCR6 ligand-receptor system plays an important role in bladder cancer progression.
Material & Methods: To evaluate this hypothesis, expression level of CXCL16 and CXCR6 was evaluated 160 patients including 155 patients with bladder cancer and 5 benign bladder disease. The tissues
obtained from partial cystectomy or cystoscopic biopsy for benign diseases and transurethral bladder
tumor resection or radical cystoprostatectomy for bladder cancers were analyzed by immunohistochemical staining and real time RT-PCR. We compared the expression of CXCL16/CXCR6 in bladder cancer and
benign bladder disease. We also evaluated the correlation between the expression of CXCL16/CXCR6 and
clinic-pathologic parameters in bladder cancer.
Results: The expression of CXCR6 was increased in patients with bladder cancer than benign bladder
disease in RT-PCR. The mRNA expressions of CXCL16 and CXCR6 were 1.75x10-2 and 1.99x10-2 in benign
bladder tissue and 1.39x10-2 and 2.32x10-2 in bladder cancer tissue, respectively. In immunohistochemical
staining, the expression of CXCL16/CXCR6 in bladder cancer tissues was higher than in benign bladder tissues. On multivariate analysis, the IHC staining of CXCL16 was related with 2004 WHO grade and
lymphovascular invasion ((p=0.021 and p=0.011, respectively), The CXCR was related with 1973 WHO
grade (p=0.001), 2004 WHO grade (p<0.001), pathologic T stage (p=0.002), perineural invasion (p=0.031).
However, Cox regression analysis revealed the expressions of CXCL16 and CXCR6 were not related with
cancer recurrence and cancer specific survival (p=0.142 and p=0.324, respectively).
Conclusions: The expression of CXCL16/CXCR6 was higher in bladder cancer than benign disease and
related to aggressive cancer behavior. Based on our results, the CXCL16/CXCR6 axis appears to be important molecules in the progression of bladder cancer and is a potential therapeutic target.
148
P119
Long-non-coding RNA expression profile in urothelial cell carcinoma
Peter S., Catto J.
University of Sheffield Medical School, Academic Urology Unit and Institute For Cancer Studies, Sheffield,
United Kingdom
Material & Methods: To test this hypothesis, RNA was extracted (following the protocol from the mirVanaTM kit, Ambion) from 66 normal and malignant urothelial samples (23 low grade tumours, 14 high grade
tumours, 20 invasive tumours and 9 healthy tissues) and a new microarray system, NCodeTM, was used
to determine the coordinated expression of lncRNA with associated protein-coding genes. GeneSpringTM
analysing software was applied to find statistically significant regulated transcripts and associate them
with possible biological networks.
Results: In comparison with normal tissue, 190 transcripts were found to be regulated in the bladder
tumours (Oneway-ANOVA test with multiple testing correction (Bonferroni FWER), p-value cut-off of p = 0.01
and fold change in expression > 2). Of these transcripts, 140 are mRNAs, only 50 are lncRNAs. To evaluate
the new microarray system, the 140 regulated mRNAs were compared to a database (Gene Expression
Atlas) showing that 76% of them were confirmed in earlier studies, including genes such as PAGE4, WFDC1,
TTK, LYVE1 and RHOJ, all involved in tumourigenesis. We found that in UCC, lncRNA alteration seems to be
tumour phenotype-specific, with only 7% being regulated in all 3 phenotypes. The majority of the lncRNA
have not been described before, however, about 10% can be associated with known protein coding genes
(e.g. POU3F3, RUNX1 and FGFR3) via chromosomal location, indicating a potential functional role.
Conclusions: Thus, the detection of significantly altered lncRNA expression in UCC will aid the identification of new, functional lncRNA candidates for further studies about their interaction targets and mechanisms.
149
Unmoderated Posters
Introduction & Objectives: The treatment of patients with urothelial cell carcinoma (UCC) of bladder
could be improved if robust biomarkers would be available to better identify tumour progression and
behaviour. Understanding the development and regulatory networks of cancer cells is essential for finding
these biomarkers. It has been shown that non-coding RNAs play a major role in gene regulation and more
recently, that long non-coding RNA (lncRNA) also has a regulatory function. We hypothesized that the
expression of functional lncRNA will be different in UCC compared to healthy tissue.
P120
New method of combined adjuvant treatment in patients with non-muscle invasive bladder
cancer
Alekseev B.Ya.1, Golovashchenko M.P.1, Teplov A.A.1, Filonenko E.V.1, Andreeva Yu.Yu.1, Pirogov A.V.2,
Pashkova E.V.2
Moscow Hertzen Oncology Institute, Dept. of Oncourology, Moscow, Russia, 2The Analytical Centre of
Chemical Faculty of MSU, Dept. of Analytical Chemistry, Moscow, Russia
1
Unmoderated Posters
Introduction & Objectives: Non-muscle invasive bladder cancer (NMIBC) is associated with high risk of
disease recurrence and progression. Therefore development of techniques for prevention of recurrence
is actual. The aim of our study was to assess results of adjuvant intavesical chemotherapy (IVC) with
Mitomycin C (MMC) in combination with photodynamic therapy (PDT) or low level laser therapy (LLLT) after
transurethral resection (TUR).
Material & Methods: Since 2006 till 2010 years 131 patients with intermediate risk NMIBC were included
in the study. All patients received TUR of the bladder and adjuvant IVC. 27 patients (21%) were included
in the experimental part of the study. In this patients concentration of MMC was assessed in normal and
tumor tissue after standard IVC and in combination of chemotherapy with PDT/LLLT using high effective
liquid chromatography (HELC). Standard treatment (TUR + 6 intravesical instillation of MMC) was performed for all 27 patient of experimental part. 104 patients (79%) were included in clinical part of the study.
Patient’s age was 60.5 ± 8.5 years (26-80 years). Males – 72, females – 32. In control arm 54 patients
(52%) received TUR + 6 courses IVC of MMC. In experimental arm A 25 patients received 6 courses IVC
in combination with PDT as adjuvant treatment. In experimental arm B 25 patients received 6 courses IVC
in combination with LLLT as adjuvant treatment. 5-aminilevulinic acid (alasens), as photosensitizer, laser
radiation with wave length of 630 nm and light energy of 25 Dj/cm2 were used in PDT. Light energy of 1.6
Dj/cm2 were used in LLLT. Patients in all groups were comparable by prognostic risk factors using EORTC
criteria.
Results: Experimental part of the study demonstrated that median MMC concentration in normal tissue
was 197 mkg/g after standard chemotherapy, 33.5 mkg/g after IVC+PDT and 67 mkg/g after IVC+LLLT.
In tumor tissue median MMC concentration was 101 mkg/g after standard chemotherapy, 42 mkg/g after
IVC+PDT and 128 mkg/g – IVC+LLLT (p=0.0002). During median follow-up 18 months in experimental arm
A and 20 months in experimental arm B no recurrences were diagnosed. In control arm median follow-up
was 31 months. During this period median progression free survival was 24.5 months. Complication rate
was similar in control and two experimental groups of patients (p=0.46).
Conclusions: IVC in combination with PDT and LLLT are perspective methods of treatment of patients with
intermediate risk NMIBC. Combination therapy increases concentration of MMC in tumor tissue and extended time for recurrence. These methods are not associated with increasing risk of complications.
150
P121
The combination of psoralen and ultra violet a irradiation as a candidate for adjuvant therapy
against non-muscle-invasive bladder cancer
Pooya M.1, Behzadi M.2, Heshmati F.3, Fischer B.1, Sais G.1, Banzola I.1, Sulser T.1, Provenzano M.1
1
University Hospital Zurich, Dept. of Urology, Zurich, Switzerland, 2ETH, Dept. of Theoretical Biology,
Zurich, Switzerland, 3Cochin Hospital, Dept. of Internal Medicine, Paris, France
Material & Methods: Human bladder cancer cell lines (T24, HTB-2) were cultured in vitro, treated with
8-methoxypsoralen (8-MOP, an FDA approved psoralen derivative) and irradiated with UVA (365 nm) at different doses. After PUVA treatment, cells were counted to measure cell growth. MTT assay was performed in order to analyze the cytotoxic and BrdU incorporation assay to evaluate the anti-proliferative and
anti-DNA replication effects of PUVA treatment. Enzymatic Caspases assays were performed to detect
the predominant involved apoptotic pathways and cells were observed under the fluorescence microscope
after staining with Annexin V-FITC to measure the amount of apoptotic cells.
Results: The significant reduction in cell number appeared 24 hours after treatment with 0.5 J/cm2 UVA
and higher doses. In MTT assay, 48 hours after treatments with 1 J/cm2 UVA and 72 hours after treatment
with 0.5 J/cm2 UVA, the cytotoxic effect on the cell lines was revealed significantly. BrdU incorporation assay showed a significant reduction of cell proliferation 24 hours after PUVA treatment with 1 J/cm2 UVA and
more. In enzymatic Caspases assays, the enzymatic activity of Caspase 3 increased significantly 24 hours
after treatment with 1 J/cm2 UVA and more and 48 hours after treatment with even 0.5 J/cm2 UVA. Both
Caspases 8 and 9 showed an increased enzymatic activity 24 hours after treatment with 2 J/cm2 UVA and
higher doses. In fluorescence microscopic observation, 48 hours after treatment with 0.5 J/cm2 UVA and
higher doses the number of apoptotic cells significantly increased compared to no-PUVA-treated cells. In all
of the experiments, UVA alone or 8-MOP without any following UVA irradiation had no meaningful effects on
the cell lines at all. Interestingly, the effects of half dose (250 ng/ml) and the standard dose (500 ng/ml) of
8-MOP were almost the same.
Conclusions: PUVA treatment has a significant anti-growth effect on human bladder cancer cell lines by
inducing cytotoxicity, blocking proliferation and triggering apoptosis in tumor cells. These results suggest
a possible relevant use of PUVA therapy for the treatment of NMIBC, probably with the lower doses of UVA
and 8-MOP.
151
Unmoderated Posters
Introduction & Objectives: The combination of psoralen metabolites and Ultra Violet A (UVA) irradiation
(PUVA therapy) is an approved treatment protocol for several diseases. It causes apoptosis and local
immune reaction mainly by generating reactive oxygen species (oxygen-dependent pathway). Additionally,
UVA forms strong interstrand cross-links between psoralen and DNA strands, which blocks DNA replication, thereby inhibiting cell proliferation (oxygen-independent pathway). We evaluated the anti-tumor growth
effects of PUVA treatment on bladder cancer cell lines as the first step of further investigations, in order to
consider it as a new treatment candidate for non-muscle-invasive bladder cancer (NMIBC).
P122
Electroporation of Mitomycin C into T24 bladder cancer cell lines
Vasquez J.L.1, Hermann G.1, Gehl J.2
Frederiksberg Hospital, Dept. of Urology, Copenhagen, Denmark, 2Herlev Hospital, Dept. of Oncology,
Copenhagen, Denmark
Unmoderated Posters
1
Introduction & Objectives: Electroporation (EP) is a physical method used to alter the permeability of
the cell membrane. This procedure applies short and intense electric pulses in order to introduce drugs or
genes into the cell. EP is the basis of electrochemotherapy (ECT), where uptake of chemotherapeutics is
enhanced by EP. Mitomycin C (MMC) is widely used for the treatment of non-muscle invasive bladder cancer
(NMIBC). However, the treatment of this disease is not optimal; recurrence and progression of tumours are
frequent. These facts lead us to find ways to improve current therapies. A relatively new technique called
Electromotive Drug Administration (EMDA) has shown promising results in the treatment of NMIBC. This
technique combines bladder instillation of MMC and the application of an electric field over the urinary bladder. Nevertheless EMDA’s mechanisms of action are still uncertain. The aim of this study is to determine if
EP improves the cytotoxicity of MMC on bladder cancer cell lines.
Material & Methods: The cell line used was T24, an aggressive bladder cancer cell line. Cells were
harvested and counted, then diluted to a concentration of 6,1 x 106 cells/ml. 270µL of cell suspension was
put in each of two 4 mm wide EP cuvettes. Then 30 µl of drug, or in case of controls PBS, was added to
reach the final drug concentration. One cuvette was left unpulsed and the other was exposed to 6 electric
pulses at an electric field intensity of 1 KV/cm, with pulse duration of 99 µs. After the procedure cells were
incubated at 37° C for 22 hours. MMT assay was performed to determine cell viability.
Results: Cell death due to the EP procedure was approximately 25% when compared to controls. The
effect of EP and MMC was of a factor 2 on the IC50 (inhibitory concentration 50%). The IC50 for EP + MMC
was 500 µM and 1000µM for MMC alone.
Conclusions: EP itself caused a cell death of approximately 25%. This mortality is high for the rather low
electric field used in this study (1 KV/cm, 6 pulses). A study reported cell death of less than 4% with the
application of 8 pulses of 1.2 KV/cm on DC3-F cell line. Considering that these 2 cell lines are morphologically similar and have a similar behaviour on cell cultures; this might suggest that bladder cancer cells are
more sensitive to electricity than other cells. Previous studies have tested different drugs for its use with
ECT. Bleomycin, a hydrophilic drug, has been found to be optimal for this therapy because its cytotoxic
effect can be enhanced by a factor 300 when associated with EP. This is the first time such an assessment
is performed for MMC. In this case, MMC might have anphiphilic properties, meaning that it is able to penetrate the cell membrane. This explains why EP improves MMC’s citotoxicity only by a factor 2. However,
this modest enhancement might have significant consequences in vivo or in a clinical setup. Therefore in
vivo studies are necessary in order to evaluate this phenomenon.
152
P123
Small cell carcinoma of the urinary bladder: Single istitute eperience
El-Gehani F.1, Kamal M.2, Pertschy D.3, Joseph K.1, Pervez N.1
University of Alberta, Dept. of Medical Oncology, Edmonton, Canada, 2University College Dublin, Medical
Student, Dublin, Ireland, 3University of Alberta, Medical Student, Edmonton, Canada
1
Introduction & Objectives: Small cell carcinoma (SCC) of the bladder is a rare disease accounting for <
1% of all bladder tumors and there is no established treatment strategy for managing these patients. The
goal of this project is to report the clinical experience and management of patients with SCC of the bladder, treated in the Cross Cancer Institute from 1999 to 2009.
Results: Twenty seven patients were identified with primary bladder SCC (male: female ratio 2.4:1; mean
age 70 years; mean follow-up 20 months). The majority of patients presented with hematuria (78%). Ten patients (37%) had extensive-stage disease at diagnosis and five of them (50%) received best supportive care.
Fifteen patients (56%) presented as having limited stage disease; eight (53%) of them were treated with
concurrent chemotherapy and radiation while four (27%) of them were treated with a radical cystectomy
with or without adjuvant chemotherapy. In all, 17 patients were treated with chemotherapy; sixteen of them
(94%) received platinum and etoposide and only one received cyclophosphamide, doxorubicin and vincristine regimen. No patient received prophylactic cranial irradiation (PCI). At the time of analysis, only 5 (18%)
patients were still alive, with one (5%) developing brain metastasis. The median survival was 22 months.
Conclusions: SCC of the bladder represents a significant health problem in the older population, more
commonly in men. It is an aggressive tumor with a propensity for early metastasis. The response rate to
chemotherapy is high but the overall prognosis is poor. Brain secondaries are less common than for SCC
of the lung and currently the role of PCI is unclear. As there is no standard of care for these patients, they
are treated according to local protocols. Further efforts should be made to develop more effective treatments and the role of PCI should be investigated in the setting of a clinical trial, in conjunction with other
extrapulmonary SCCs.
153
Unmoderated Posters
Materials & Methods: We analyzed retrospectively data from all patients diagnosed with SCC of the
urinary bladder between 1999 and 2009, with an emphasis on stage, treatment and overall survival.
P124
Bladder endometriosis: Effectiveness of the clinical evaluation and diagnostic tests for an
accurate treatment and differential diagnosis with bladder carcinoma
Garcia-Rojo D.1, Hannaoui N.1, Vicente E.1, Pubill J.2, Gonzalez-Sala J.L.1, Muñoz J.1, Martos R.1, Barrio M.1,
Gual J.1, Abad C.1, Prera A.1, Cos R.2, Prats J.1
Hospital Sabadell, Dept. of Urology, Sabadell, Spain, 2Hospital Sabadell, Dept. of Gynecology, Sabadell,
Spain
1
Unmoderated Posters
Introduction & Objectives: The incidence of bladder endometriosis is generally considered about 1% or
less of endometriotic patients. The aim of this study is to evaluate the effectiveness of preoperative exams
and the treatment in these patients.
Material & Methods: In the period between January 2001 and December 2010, 574 patients underwent
surgery for endometriosis. In 8 cases (1.4%), bladder endometriosis was confirmed at histopathological
examination. All patients underwent transvaginal preoperative ultrasonography. Selected patients underwent CT, MRI or cystoscopy. A modified American Urologic Association Symptom Index (AUASI) questionnaire was performed with the aim of assessing the presence of specific catamenial symptoms. The cut-off
greater than 9 was considered suspicius of bladder endometriosis.
Results: Mean patient age: 33.1 years-old. Urinary symptomatology was present in 7 cases (87.5%). The
mean questionnaire´s score for patients with bladder endometriosis was 15,75 (6-19). The preoperative
radiologic investigation predicted endometriotic bladder invasion in seven cases (87.5%). Treatment consisted of partial cystectomy in 6 patients and transurethral resection of the bladder in 2 patients. No patient
who underwent a partial cystectomy recurred. One of the patients who underwent only transurethral
resection of the bladder experienced a relapse.
Conclusions: Urinary tract endometriosis is an uncommon pathologic finding. Most of our cases had
urinary symptoms with a high score on the modified AUASI questionnaire. The cystoscopic evaluation is
very important for the assessment of these lesions and to perform a differential diagnosis with bladder
carcinoma. Surgery is the treatment of choice. It is possible to perform a transurethral resection of the
tumour, but we believe laparoscopic or open partial cystectomy should be considered the best option in
mosts cases.
154
P125
Diagnostic value of an urine based tumor marker for screening lower urinary tract in low-risk
patients with asymptomatic microscopic hematuria
Sagnak L., Ersoy H., Gucuk O., Ozok U., Topaloglu H.
Diskapi Yildirim Beyazit Education and Research Hospital, 3rd Urology Clinic, Ankara, Turkey
Material & Methods: From October 2005 to September 2007, 164 patients (56 male & 108 female)
were included in the study for evaluation. Patients with risk factors according to AUA Best Practice Policy
Recomendations on AMH were strictly excluded from the study. For upper urinary tract imaging, ultrasonography was performed and prior to cystoscopic procedure freshly voided urine was sampled for urine
cytology and NMP22BC assay in all patients. Biopsy was performed if suspicious lesions were seen or if (+)
cytology was obtained.
Results: The mean age was 30.8 years. As some benign urological pathologies were detected in 21 patients by ultrasonography, NMP22BC was (+) in 26 patients where the cytology was confirmed as atypia in
5. Two TaG1 tumor were detected cystoscopically in a 39 years old man and a 33 years old women where
the NMP22BC test was (+) and the cytology was (-) in both of them. NMP22BC test’s sensitivity, PPV and
NPV were detected higher than cytology.
Conclusions: We recommend in evaluation of low-risk patients with AMH that, as an initial tests, two
non-invasive and cost-effective method can be chosen: first of all, an upper tract imaging by usg as recommended by guidelines, followed by NMP22BC test for lower tract investigation instead of urine cytology; in
a controversy with guidelines.
155
Unmoderated Posters
Introduction & Objectives: To evaluate the use of NMP22BladderChek in comparison by voided urine
cytology for screening subjects with asymptomatic microscopic hematuria (AMH); younger than 40 years
who are at low risk for bladder cancer based on non-smoking history; by discussing the guidelines on this
subject.
P126
[F-18]-fluorodeoxyglucose FDG-PET/CT for the preoperative lymph node staging of muscle
invasive bladder cancer: Single centre experience
Mete U.K.1, Praveen P.K.1, Bhattacharya A.2, Kakkar N.3, Mandal A.K.1
PGIMER, Dept. of Urology, Chandigarh, India, 2PGIMER, Dept. of Nuclear Medicine, Chandigarh, India,
PGIMER, Dept. of Pathology, Chandigarh, India
1
3
Unmoderated Posters
Introduction & Objectives: In patients with muscle invasive Transitional Cell Carcinoma (TCC) of urinary
bladder, undergoing cystectomy, nodal tumor burden with pathologic evidence of lymph node metastasis
is a major prognostic variable. Therefore, the accuracy of lymph nodal staging plays a pivotal element in
therapeutic decision making. The reported accuracy of CT/MRI for nodal staging ranges from 70-90% with
false negative rates of 25%-40%. Therefore, there is a need for alternative functional imaging modality like
PET/CT. The aim of this study was to evaluate wheather the use of [F-18]-FDG-PET/CT can increase the
reliability of preoperative lymph node staging in patients with muscle invasive bladder cancer.
Material & Methods: Fifteen patients with muscle invasive bladder cancer were included in this study. All
patients underwent FDG-PET/CT scan from the skull base to the mid-thighs after IV injection of 6.5 MBq(
Mega-Becquerel)/Kg of FDG. After intravenous hydration IV furosemide was given to overcome the difficulties posed by urinary excretion of 18F-FDG. PET/CT data were analyzed as PET and CT images studied
separately as well as fused PET/CT images. The imaging findings were correlated with the histopathology
of the nodes (gold standard).
Results: CT and FDG- PET had demonstrated positive findings in 9 & 8 patients respectively. Among the
15 patients 3 had metastatically involved locoregional lymph nodes diagnosed on histopathology. Both CT
and PET could detect the nodes in all these 3 patients meaning thereby both of them were 100% sensitive.
Nodes were histologically negative amongst 6 & 5 patients who had node involvement by CT and PET
respectively. Therefore, specificity, positive predictive value (PPV) & negative predictive value ( NPV) for CT
and PET/CT were 50%, 33.3%, 100% and 58.3%, 37.5%, 100% respectively.
Conclusions: The theoretical advantage of this cutting edge technology for whole body imaging has not
been translated into clinical practice as we found minimal advantage of combined FDG-PET/CT over CT
alone for node staging of muscle invasive bladder cancer. This may be due to substantial overlap between
standardized uptake values (SUVs) from active inflammatory processes ( both of infectious and non-infectious origin) with those of malignant lesion. More studies are required before recommending this costly PET/
CT as the sole evaluation tool while managing the patients with TCC of urinary bladder.
156
P127
Evaluation of the value of combined urine cytology and cystoscopy for follow up of superficial
transitional cell carcinoma of the urinary bladder
Aly A.M.1, Bilal B.D.2, Tahoon T.A.3
Introduction & Objectives: Cystoscopic biopsy is the most accurate technique used to assess the efficacy of treatment and to detect recurrence of superficial TCC of urinary bladder. Implementation of voided
urine cytology to detect tumor cells in urine samples may represent an additional tool. The aims of this
study are: (1) to estimate the reliability of combined cystoscopy and urine cytology examination in the follow up of cases of superficial urinary bladder carcinoma, which might help to restrict cystoscopic biopsies
for these cases with its morbidity and cost, (2) to discuss the diagnostic pitfalls of cytologic examination in
these cases.
Material & Methods: This is a prospective study, on 93 patients with superficial TCC of urinary bladder who were initially treated by complete TUR with or without adjuvant intravesical therapy with Bacillus
Calmette-Guérin (BCG) (120 mg/instillation) every week for 6 weeks. Cystoscopic findings, urine cytology
and histologic results of cystoscopic biopsies were assessed.
Results: By histologic examination, 41 (44%) cases were recurrent TCC and 52 (56%) were reported as
negative for recurrence. By cystoscopic examination there were 36 positive cases, 4 of them were false
positive. Out of the 57 negative cases for recurrence cystoscopically, 9 were histologically positive and
were considered as false negative results. By cytology, 28 cases were positive, 3 were false positive,
and 65 were negative for recurrence, 16 of them were false negative. Most of false negative cases were
low grade TCC. Sensitivity of cytology and cystoscopy in the detection of recurrence was 61% and 78%;
respectively. When the two examinations were combined, sensitivity was 100%, and specificity was 92.3%.
Conclusions: For follow up of superficial bladder carcinoma, the combination of negative cystoscopic
findings and negative urine cytology may replace routine biopsies with their morbidity and cost.
157
Unmoderated Posters
1
National Cancer Institute Cairo University, Dept. of Surgery, Cairo, Egypt, 2National Cancer Institute Cairo
University, Dept. of Statistics, Cairo, Egypt, 3National Cancer Institute Cairo University, Dept. of Cytopathology, Cairo, Egypt
P128
A novel approach to diagnosis and staging of bladder tumors by waterjet hydrodissection
Kugler M.A.P.M.1, Nicklas A.P.1, Walcher U.1, Imkamp F.2, Mikuz G.3, Herrmann T.R.W.2, Nagele U.1
LKH Hall In Tirol, Dept. of Urology and Andrology, Hall In Tirol, Austria, 2Hannover Medical School, Dept.
of Urology and Urooncology, Hannover, Germany, 3Medical University Innsbruck, Dept. of Pathology,
Innsbruck, Austria
1
Unmoderated Posters
Introduction & Objectives: The standard approach to tumors of the bladder is the TURB, even though
this technique suffers frome some disadvantages when considered from an oncological point of view.
Waterjet hydrodissection is an emerging procedure for removing superficial tumors in the gastronitestinal
tract and recently published long term studies have shown its efficacy in tumors of the colon. One of the
most promising features is the preservation of histological structures and the potential for an en bloc
resection. Our goal was to show the feasibility and applicability of waterjet hydrodissection for removing
bladder tumors.
Material & Methods: A transurethral submucosal dissection was performed in five patients using a T-type
I-jet Hybrid Knife (Erbe, Tuebingen). Resection edges were labelled by means of electrical coagulation with
the hybrid knife. A submucosal fluid cushion specific to the tissue layer was subsequently formed using the
waterjet implementation of the hybrid knife thus elevating the tumorous tissue. The tumor was endoscopically extracted with a retrieval bag. Biopsy specimens of the tumor edges and base were subsequentially
collected.
Results: We were able to resect all tumors en bloc and the lamina propria was intact in all specimens,
thereby permitting the uropathologist to clearly distinguish between superficial and invasive tumors. R0resection was confirmed in all obtained samples. Compared to conventional TURB, this novel technique
permits the pathologist to assess the whole lamina propria as well as the resection edges and determine
the invasiveness as well as R0 versus R1 resection with the obvious subsequent treatment decisions.
Conclusions: Waterjet hydrodissection is a relatively new approach to the treatment of tumors; our initial
results prove its practicality and feasibility in removing superficial bladder tumors. Further studies are needed to prove its long term efficacy and its histopathological reliability in prospective subsequent studies.
158
P130
Radiotherapy in squamous cell carcinoma of the penis: A review of the data from a tertiary
referral centre
Kosmin M.A., Woolf D.K., Aggarwal A., Abdul N., Payne H.A., Mitra A.
University College London Hospitals NHS Foundation Trust, Dept. of Clinical Oncology, London, United
Kingdom
Material & Methods: Patients with a histological diagnosis of squamous cell carcinoma of the penis who
had been treated with radiotherapy were studied. Radiotherapy dose and fractionation data were obtained.
Date of diagnosis, age, stage of disease, pathology and date of death were obtained from the hospital
computerised records.
Results: 25 patients (median age 62.5 years) were treated with radiotherapy. 12 (48%) were treated with
palliative intent, and 13 (52%) were treated with adjuvant radiotherapy with radical intent. Patients were
considered for adjuvant radiotherapy when histological analysis of inguinal and pelvic lymph node dissection demonstrated lymph node extracapsular spread, or if two or more lymph nodes were positive for
disease. Patients were considered for palliative radiotherapy for symptom control. 92% of patients treated
with adjuvant radiotherapy had undergone an inguinal lymph node dissection, with only one patient undergoing a pelvic lymph node dissection. Within the group of patients receiving adjuvant radiotherapy, the 1
year survival from diagnosis was 100% and from radiotherapy was 90%. 3 year survival from diagnosis was
88% and from radiotherapy was 67%. Of those treated with palliative intent 1 year survival from diagnosis
was 73% and from radiotherapy was 40%. 3 year survival from diagnosis was 38% and from radiotherapy
was 38%. Data for site of radiotherapy treatment and dose fractionation are shown in the tables below.
Conclusions: This study has shown the variable use of radiotherapy dose fractionation for local and
advanced penile cancer at our centre. This variability is in part influenced by the lack of good randomised published evidence with which to guide clinical practice. Overall survival data in those treated with
radical intent appears encouraging, especially considering that all patients in this group had lymph node
metastases. This study further reinforces the need for good randomised trial data to aid with management
decisions in this group of patients.
159
Unmoderated Posters
Introduction & Objectives: Penile cancer is a rare malignancy with approximately 400 cases seen
annually in the United Kingdom. The evidence base for the management of this disease is not extensive.
A retrospective review of the cases managed with radiotherapy at University College London Hospital
between the years 2000-2010 is presented.
P131
Markedly increasing incidence and improved survival of testicular cancer in the Netherlands
Verhoeven R.H.A.1, Karim-Kos H.E.2, Coebergh J.W.W.3, Brink M.4, Horenblas S.5, De Wit R.6,
Kiemeney L.A.L.M.7
Eindhoven Cancer Registry / Comprehensive Cancer Centre South, Dept. of Research, Eindhoven, The
Netherlands, 2Erasmus MC University Medical Centre Rotterdam, Dept. of Public Health, Rotterdam, The
Netherlands, 3Eindhoven Cancer Registry / Comprehensive Cancer Centre South Dept. of Research & Erasmus MC Univers, Dept. of Public Heatlh, Eindhoven & Rotterdam, The Netherlands, 4Comprehensive Cancer
Centre The Netherlands, Dept. of Research, Utrecht, The Netherlands, 5The Netherlands Cancer Institute –
Antoni Van Leeuwenhoek Hospital, Dept. of Urology, Amsterdam, The Netherlands, 6Erasmus MC University
Medical Centre Rotterdam, Dept. of Medical Oncology, Rotterdam, The Netherlands, 7Radboud University
Nijmegen Medical Centre, Dept. of Epidemiology, Biostatistics and HTA & Dept. of Urology, Nijmegen, The
Netherlands
Unmoderated Posters
1
Introduction & Objectives: Worldwide notable changes have been observed in the incidence and survival
of testicular cancer (TC) during the last decades. We conducted a study on trends in TC incidence, treatment, survival, and mortality in the Netherlands during the period 1989-2009 with specific focus on trends
by age, histology and stage of disease.
Material & Methods: Nationwide data from the Netherlands Cancer Registry and Statistics Netherlands
were used. Three-year moving average age-adjusted incidence and mortality rates and 5-year relative survival were calculated. Incidence and survival rates were presented by calendar period, age, histology and
stage. Treatment was categorized in five major groups and analyzed by period, histology and stage.
Results: TC incidence showed a substantial annual increase of 3.9% in the period 1989-2009. The
incidence increased for all stages of both seminoma and non-seminoma TC. Stage distribution for the nonseminoma patients is shifted towards more localized tumors. Most patients received primary treatment
according to the guidelines. Five-year relative survival improved for most groups of stage and histology.
A clinically significant improvement of 15% (from 73% to 88%) was found for seminoma TC patients with
distant metastases. TC mortality dropped sharply in the 1970s and 1980s and remained relatively stable
(around the 0.3 per 100,000 person-years) thereafter.
Conclusions: This study shows that incidence of TC has increased sharply in the Netherlands. Relative
survival is high and is improving in most disease stages. There is a growing demand of medical care for
newly diagnosed TC patients and for the rapidly increasing number of prevalent TC patients who require a
long active follow-up and might experience long-term side-effects of the radiotherapy and chemotherapy
treatment.
160
P132
Adjuvant radiotherapy ST I-II seminoma: Prognostic factors, toxicity and long-term results
Cabeza Rodriguez M.A., Cascales García M.A., Martinez R., D’ambrosi R., Bartolome A., Ruiz A., Perez
Regadera J., Lanzos E.
Hospital Universitario 12 De Octubre, Dept. of Radiation Oncology, Madrid, Spain
Material & Methods: Retrospective analysis of 76 patients with ST I-II seminoma treated with RT after
orchiectomy between 1980 and 2008. Mean age was 36 + / -12 years. 13% had a history of cryptorchidism. 96% were diagnosed by local symptoms. There was an elevated B-HCG and / or LDH before surgery
in 5% of patients. Inguinal orchiectomy was used in 90% of patients. Spermatocytic variant was found in 3
patients, having the rest classic seminoma. Median tumor diameter 4.8 cm (r: 1-14). 78% were ST I, 22%
ST II. In 74% of patients the PTV included para-aortic nodes and ipsilateral iliac. Median Total Dose was
25.2 Gy (range 40-20). Fractionation ranged from 1.8 to 2 Gy / day. Patients have continued regular clinical
controls.
Results: Median follow-up was 109 months (range 4-334 months). There was a systemic failure at 37
months after treatment ends. The DFS at 10 and 20 years was 98%; with a 10-year OS of 100% and 20
years OS of 90%. Acute toxicity according to CTCAE-v4 scale was: 17% Gastrointestinal G II, G III 1%. Blood
G II 1%. No chronic toxicity was observed. Three patients have developed second malignancies outside the
treatment field at 9, 12 and 25 years respectively.
Conclusions: Adjuvant RT after inguinal orchiectomy is an effective and safe in testicular seminoma ST I-II
with excellent long-term results in terms of DFS and OS as well as the absence of chronic toxicity, providing
an excellent quality of life in these patients.
161
Unmoderated Posters
Introduction & Objectives: Standard treatment of ST I-II seminoma is radical orchiectomy followed by
adjuvant radiotherapy (RT). Objective: Retrospective analysis of long-term results in terms of overall survival (OS), disease-free survival (DFS), acute and chronic toxicity and incidence of second malignancies in a
cohort of patients with seminoma treated with RT after orchiectomy.
P133
Treatment of metastatic tumor after testicular cancer via Faradarmani
Esmaeili E., Ashrafi-Amineh F., Saie Joeghan S.
Association of Faradarmani & Psymentology, Dept. of Complementary and alternative medicine, Tehran,
Iran
Unmoderated Posters
Introduction & Objectives: Given the occurrence of relapse and side effects of medical treatments for
testicular carcinoma, Faradarmani could be regarded as an optimum complementary and alternative medicine. Faradarmani is based on the theory of “the consciousness of the parts” or “ parts having consciousness in common”(Taheri, 2009).
Material & Methods: The patient is a 45 year old man, with history of unsuccessful medical treatments,
who was diagnosed with seminoma (testicular cancer) and abdominal & pelvic metastases in February
2008. He was introduced to Faradarmani. Procedure: in this treatment the patient is asked to close
his eyes (optional) and examine the sensations. In the therapy, the patient becomes connected to the
interuniversal consciousness (the network of awareness and consciousness governing the universe-Divine
intelligence) via Fara-therapist. Following this procedure, the patient undergoes the Scanning process; in
other words the universal intelligence begins to assess and scan the individual. Due to the nature of this
connection, some information is conveyed and the defective and impaired parts are treated.
Results: In abdominal sonography on 2008/04/29 no solid or cystic tumor was detected and the kidneys
and pancreas were also normal.
Conclusions: This report confirms the effectiveness of Faradarmani for treatment of metastitac tumor
after testicular cancer. Up to this date no treatment method has been able to totally eradicate such massive tumors without any invasive method in such a short time, in addition, with no cost or side effect and
regardless of patient’s age or their condition. Mohammad Ali Taheri, Human from another outlook, Bijan
publication 2009.
162
P134
Improvement in age-specific survival of testicular cancer in Europe and the USA
Verhoeven R.H.A.1, Gondos A.2, Janssen-Heijnen M.L.G.3, Brewster D.H.4, Crocetti E.5, Rosso S.6,
Hakulinen T.7, Aareleid T.8, Brenner H.2, EUNICE Survival Working Group
Netherlands, 2German Cancer Research Center, Division of Clinical Epidemiology and Aging Research,
Heidelberg, Germany, 3Eindhoven Cancer Registry / Comprehensive Cancer Centre South Dept. of
Research & Viecuri Medical Centre, Dept. of Clinical Epidemiology, Eindhoven & Venlo, The Netherlands,
4
Scottish Cancer Registry, NHS National Services Scotland, Information Services Division, Edinburgh,
United Kingdom, 5Institute for Study and Cancer Prevention (ISPO), Clinical and Descriptive Epidemiology
Unit, Dept. of Research, Florence, Italy, 6CPO - Piedmont Cancer Registry, Dept. of Research, Torino, Italy,
7
Finnish Cancer Registry, Dept. of Research, Helsinki, Finland, 8National Institute for Health Development,
Dept. of Epidemiology and Biostatistics, Tallinn, Estonia
Introduction & Objectives: Due to the introduction of cisplatin-based chemotherapy in the late 1970s
testicular cancer (TC) is currently one of the most curable cancers. Howvever, survival for TC patients
older than 50 years of age seems to be lower than that for younger men. In this study age-specific trends
of TC were estimated using large population-based databases of European and American cancer patients.
Material & Methods: Age-specific survival trends of TC between 1990-1994 and 2000-2004 were
examined with data from 12 cancer registries from diverse areas of Europe and the American SEER 9
database. All European registries were grouped together to ensure that the older age categories contained
enough patients to produce valid survival estimates.
Results: A total of 11,704 European and 10,752 American TC patients were included in this study. In the
period 2000-2004 the relative 5-year survival of TC patients aged 15 to 44 years was at least 94% in both
European and American patients. While survival for patients aged 45 to 54 in the U.S.A. was comparable
to that of the younger patients, it was somewhat lower for European patients aged 45-54 as compared to
younger patients. Survival for all patients aged 55 years or older was lower in contrast to the patients aged
20 to 44 in both Europe and the USA, especially the patients aged 65 or older showed a large decrease in
survival.
Conclusions: For European TC patients, it should be feasible to achieve similar survival for those aged
45 to 54 as for younger patients. Additional research is warranted to determine underlying factors for the
poorer survival of patients aged over 54 years of age.
163
Unmoderated Posters
1
P135
Population-based survival of penile cancer patients in Europe and the USA since 1990
Verhoeven R.H.A.1, Gondos A.2, Janssen-Heijnen M.L.G.3, Zanetti R.4, Caldarella A.5, Brewster D.H.6,
Hakulinen T.7, Brenner H.2, EUNICE Survival Working Group
Netherlands, 2German Cancer Research Center, Division of Clinical Epidemiology and Aging Research, Heidelberg, Germany, 3Eindhoven Cancer Registry / Comprehensive Cancer Centre South Dept. of Research
& Viecuri Medical Centre, Dept. of Clinical Epidemiology, Eindhoven & Venlo, The Netherlands, 4Piedmont
Cancer Registry / CPO - Centre For Epidemiology and Prevention In Oncology, Turin, Italy, 5Tuscan Cancer
Registry, Florence, Italy, 6Scottish Cancer Registry, Information Services Division, NHS National Services
Scotland, Edinburgh, United Kingdom, 7Finnish Cancer Registry, Dept. of Research, Helsinki, Finland
Unmoderated Posters
1
Introduction & Objectives: Penile cancer is a rare neoplasm in western countries, and most published
survival estimates are based on potentially selective hospital series only. Detailed studies on trends in
population-based survival of penile cancer have never been published before. We examine populationbased trends in survival of large samples of penile cancer patients in Europe and the United States (US).
Material & Methods: Using data from 12 European cancer registries and the SEER Program of the US,
we examined relative survival trends among penile cancer patients between 1990-1994 and 2000-2004.
Trends were examined for 4 geographic regions (North, East, Central and South, and West) in Europe, as
well as overall and for the age groups 15-54, 55-64, 65-74 and 75+ for both populations.
Results: Overall, 5-year relative survival was 66% and 67% among European and US patients, respectively.
Changes in overall survival over time were not significant and did not indicate any improvement in either
Europe or the US. Differences between European regions were non-significant in 2000-04. In Europe, the
survival of patients aged 15-54 years was significantly higher than among patients over 75 years of age
(73% vs. 62%).
Conclusions: Our population based survival trend analysis indicates that survival for penile cancer
patients has remained stable for both Europe and the U.S.A. since at least 1990. Stronger international
cooperation in clinical research may be important to facilitate clinical progress in treatment of this rare
malignancy.
164
165
Unmoderated Posters
166
Exhibition
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Company Profiles
167
168
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AMGEN EUROPE GMBH
Dammstrasse 23, 6300 Zug, Switzerland
T : +41 41 3690 300
F : +41 41 3690 400
W: www.amgen.com
E : [email protected]
Amgen discovers, develops, manufactures, and delivers innovative human therapeutics. A biotechnology
pioneer since 1980, Amgen was one of the first companies to realize the new science’s promise by
bringing safe, effective medicines from lab to manufacturing plant to patient. Amgen therapeutics have
changed the practice of medicine, helping millions of people around the world in the fight against cancer,
kidney disease, rheumatoid arthritis, bone disease, and other serious illnesses. With a deep and broad
pipeline of potential new medicines, Amgen remains committed to advancing science to dramatically
improve people’s lives. To learn more about our pioneering science and vital medicines, visit
www.amgen.com. Follow us on www.twitter.com/amgen.
ASTELLAS PHARMA EUROPE LTD.
Lovett House, Lovett Road, Staines, Middlesex TW18 3AZ, United Kingdom
T : +44 1784 419 400
F : +44 1784 419 401
W: www.astellas.eu
Astellas is one of the leading pharmaceutical companies in the world. As a young, forward thinking
company with a rich heritage, Astellas is dedicated to improving peoples’ lives through the introduction
of innovative and reliable pharmaceutical products. In everything we do we are guided by our ethos of
Changing tomorrow to create a brighter future for all our stakeholders – above all for patients.
In Europe, Astellas’ strategic focus and core expertise lie in the therapy areas of Transplantation, Urology,
Dermatology, Anti-Infectives and Pain Management. In addition, Astellas is committed to growing a strong
presence in the field of Oncology.
Exhibition
DENDREON
1301 2nd Avenue, Suite 3200, Seattle, Washington 98101, United States of America
T : +1 8772 564 545
F : +1 2062 560 571
W: www.dendreon.com
Dendreon Corporation is a biotechnology company whose mission is to target cancer and transform
lives through the discovery, development and commercialization of novel therapeutics. The Company
applies its expertise in antigen identification, engineering and cell processing to produce active cellular
immunotherapy product candidates designed to stimulate an immune response.
EUROPEAN ASSOCIATION OF UROLOGY (EAU)
Mr. E.N. van Kleffensstraat 5, 6842 CV Arnhem, the Netherlands
T : +31 2638 906 80
F : +31 2638 906 74
W: www.uroweb.org
Founded in 1972, the European Association of Urology (EAU) is now entering its fourth decade; a period
marked by growth in its membership with the goal to create a dynamic network of medical professionals.
Membership has been extended and is now open to urologists-in-training, urological scientists and to
related disciplines in Europe and abroad.
All registered European urologists, European urologists-in-training and medical professionals in affiliated
fields are eligible for EAU membership. Joining the EAU is not only about European urology; it is also about
enhancing and ensuring the future of our speciality with the ultimate goal to provide the best patient care.
To learn more about the EAU and its membership, visit www.uroweb.org.
169
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EUROPEAN SOCIETY FOR MEDICAL ONCOLOGY (ESMO)
via L. Taddei 4, 6962 Viganello-Lugano, Switzerland
T : +41 9197 31 900
F : +41 9197 31 902
W: www.esmo.org
The European Society for Medical Oncology (ESMO) is the leading European professional organization
committed to advancing the specialty of medical oncology and promoting a multidisciplinary approach to
cancer treatment. Since 1975 ESMO’s mission has been to advance cancer care. We achieve this through
supporting best science, medicine and practice.
The ESMO community is a powerful alliance of more than 7,000 committed oncology professionals from
over 120 countries.
ESMO’s scientific journal, Annals of Oncology, ranks among the top clinical oncology journals worldwide.
ESMO events are the meeting place in Europe for medical oncologists to update their knowledge, network
and exchange ideas.
EUROPEAN SOCIETY FOR RADIOTHERAPY & ONCOLOGY (ESTRO)
Avenue E. Mounierlaan 83, 1200 Brussels, Belgium
T : +32 2775 93 40
F : +32 2779 54 94
W: www.estro.org
The purpose of ESTRO, a non-profit, scientific organisation, shall be to foster, in all its aspects,
radiotherapy (also known as radiation oncology), clinical oncology and related subjects, including physics
as applied to radiotherapy, radiation technology and radiobiology.
To fulfill its purpose ESTRO will:
- Develop and promote standards of education in radiotherapy and clinical oncology;
- Promote standards of practice in radiotherapy, clinical oncology and related subjects;
- Stimulate the exchange of scientific knowledge in all related fields;
- Strengthen the clinical specialty of radiotherapy and clinical oncology in relation to other specialties
and professions involved in cancer management;
- Encourage co-operation with international, regional and national societies and bodies representing
radiotherapy, clinical oncology and related subjects;
- Facilitate research and development in radiotherapy, clinical oncology and related subjects.
More information on www.estro.org
JANSSEN PHARMACEUTICA NV
p/a Turnhoutseweg 30, 2340 Beerse, Belgium
T : +32 1460 21 11
F : +32 1460 28 41
W: www.janssen-emea.com
Janssen Pharmaceutical Companies of Johnson & Johnson are dedicated to addressing and solving the
most important unmet medical needs of our time, including oncology (e.g. multiple myeloma and prostate
cancer), immunology (e.g. psoriasis),neuroscience (e.g. schizophrenia, dementia and pain), infectious
disease (e.g. HIV/AIDS, Hepatitis C and tuberculosis), and cardiovascular and metabolic diseases (e.g.
diabetes).
Driven by our commitment to patients, we develop sustainable, integrated healthcare solutions by working
side-by-side with healthcare stakeholders, based on partnerships of trust and transparency.
More information can be found at www.janssencountry.com
170
KYOWA HAKKO KIRIN UK LTD.
258 Bath Road, Slough, Berkshire, SL1 4DX United Kingdom
T : +44 1753 566 020
F : +44 1753 566 030
W: www.kyowa-kirin.co.jp/english
Kyowa Hakko Kirin is a Japan based global specialty pharmaceutical company contributing to human health
and well-being worldwide through innovative drug discovery and global commercialization. This is driven
by state of the art antibody technologies mainly in the core therapeutic areas of oncology, nephrology and
immunology. Kyowa Hakko Kirin currently offers drugs for Oncological use including Mitomycin-C Kyowa.
Mitomycin-C is an established chemotherapeutic agent in the treatment of Non-Muscle Invasive Bladder
Cancer. Kyowa Hakko Kirin has established sales operations in the UK, Italy and Asia.
Visit our stand at EMUC 2011 for information on prescribing and new developments.
WISEPRESS MEDICAL BOOKSHOP
25 High Path, Merton Abbey, London, SW19 2JL, United Kingdom
T : +44 20 8715 1812
F : +44 20 8715 1722
W: www.wisepress.com
Wisepress.com, Europe’s leading conference bookseller, has a complete range of books and journals
relevant to the themes of the meeting. Books can be purchased at the stand or, if you would rather not
carry them, posted to you – Wisepress will deliver worldwide. In addition to attending 200 conferences per
year, Wisepress has a comprehensive medical and scientific bookshop online with great offers.
171
Exhibition
NUCLETRON
Waardgelder 1, 3905 TH Veenendaal, The Netherlands
T : +31 3185 571 33
W: www.nucletron.com
Nucletron provides state of the art radiotherapy solutions for cancer treatment that meet the evolving
needs of patients, their caregivers and healthcare professionals around the world. Nucletron has
unmatched global leadership in brachytherapy, a very precise, highly effective and well-tolerated treatment
option for healthcare providers, tailored to the needs of individual patients. The company works with
clinical teams to constantly improve and develop an innovative portfolio of integrated products, software
and services that assures excellent patient outcomes. Headquartered in Veenendaal, The Netherlands,
Nucletron employs more than 500 employees, with offices in 18 countries, and products available in more
than 100 countries around the world. Website: http://www.nucletron.com/
172
Exhibition
About the Organisers
European Association of Urology (EAU)
European Society for Medical Oncology (ESMO)
Organisers
European Society for Radiotherapy & Oncology (ESTRO)
173
174
Organisers
About the European Association
of Urology (EAU)
A vibrant network of urological professionals
Founded in 1972, the European Association of Urology (EAU) is now entering its fourth decade, a period
marked by growth in its membership, thanks to the efforts made in the mid-1990s to modernise the EAU’s
structure and widen its activities.
With the goal to create a dynamic network of medical professionals, membership has been extended and
is now open to urologists-in-training, urological scientists and to related disciplines in Europe and abroad.
Moreover, the EAU has increased the number of EAU activities that could be of benefit to other medical
professionals. Today, the estimated number of practicing urologists in Europe is at 16,000, a significant
and fast-growing medical community in which the EAU aims to be a leading partner in discussions that
impact on global urological affairs.
Facilitating growth
With the crucial goal to enhance patient care, the EAU’s core mission is to act as the representative
body for all European urologists, thus facilitating the continuous development of urology and all its
subspecialties. In order to maintain the high standards of urological care throughout Europe, the
EAU stimulates urological research and helps disseminate the results. Another key goal is promoting
contributions by its members to medical and scientific literature, thereby highlighting European urological
achievements. The EAU also focuses on establishing training and urological practice standards and help
contribute in defining European urological health care policies.
Committed involvement
Over one hundred European urologists are involved in the boards of the EAU Offices and Committees who
all meet periodically to assess the strategies and plans mapped out within the EAU. As administrative body,
the EAU Central Office, supports the EC and the EAU offices. An Executive Management team supervises
the EAU Central Office with the Operational Manager (Jacqueline Roelofswaard) directing and organising
all operational affairs of the EAU Central Office and the Business Manager (Maurice Schlief) implementing
the financial and business plans. Located in Arnhem, the Netherlands, the EAU Central Office employs
approximately 55 staff.
Active representation
The General Assembly, held annually as the official meeting for EAU members coincides with the Annual
EAU Congress. All active EAU members can exercise their vote at the General Assembly where decisions
are made by a majority of votes from all who are present. The General Assembly also votes or approves
new and honorary members of the EAU, elect members of the EC and nominates new board members.
Fulfilling key tasks
Education and postgraduate training are essential tasks of the EAU. With the aim to promote quality
urological education across Europe, the EAU’s education programmes are easily accessible and affordable
to all European urologists and urologists-in-training. Strategies and goals for education are developed,
organised and supervised by the European School of Urology (ESU), the EAU’s official education office. The
ESU organises courses during the Annual EAU Congress and in collaboration with the European National
Urological Associations.
175
Organisers
A centralised structure
The EAU’s governing structure is the EAU Board composed of an Executive Committee (EC) and the chairs of
the EAU Offices. Chaired by the Secretary General Per Anders Abrahamsson and together with the other EC
members, the EC oversees the implementation of all programmes and activities. Constituting the current EC
are Chris Chapple, Manfred Wirth and Walter Artibani who all lend their support to the EAU Secretary General.
A key task of the EAU is to support scientific activities. The Scientific Congress Office prepares the
scientific programme of the Annual EAU Congress and its aim is to ensure a high quality level programme.
Research fellowship programmes are funded through the European Urological Scholarship Programme
(EUSP). Recently, the EAU has also set up a Foundation for Urological Research which aims to serve as a
dynamic link between the industry on one hand and scientific and medical research communities on the
other hand.
Communicating achievements
Providing effective communication links to promote and disseminate scientific results and information
amongst European urologists remains vital. European Urology is the EAU’s official scientific journal, widely
disseminated and highly regarded by readers. The EAU Video Committee is the editorial body responsible
for the European Urology Video Journal, which distributes selected new videos on urological diseases and
techniques.
The official EAU newsletter, European Urology Today, publishes a range of information on European urology
and activities as well as specialised information provided by affiliated European urological associations and
organisations. Finally, the EAU maintains dedicated Internet sites such as Uroweb (www.uroweb.org), which
provides general information resources to members, and Urosource (www.urosource.com) which offers a
wide database of urological and scientific information.
Joining the EAU
All registered European urologists, European urologists-in-training and medical professionals in affiliated
fields are eligible for EAU membership. We are not only on the lookout for innovative talent but our doors
are also open to interested non-European urologists. Joining the EAU is not only about European urology; it
is also about enhancing and ensuring the future of our speciality with the ultimate goal to provide the best
patient care.
Organisers
To learn more about the EAU and its membership, visit www.uroweb.org. For a complete overview of all
EAU courses and meetings please visit www.uroweb.org/events.
176
About the European Society for
Medical Oncology (ESMO)
The European Society for Medical Oncology (ESMO) is the leading European professional organization,
committed to advancing the specialty of medical oncology and promoting a multidisciplinary approach to
cancer treatment and care.
Since its founding in 1975 as a non-profit organization, ESMO’s mission has been to advance cancer care
and cure. We achieve this through fostering and disseminating good science that leads to better medicine
and determines best practice. In this way ESMO fulfils its goal to support oncology professionals in
providing people with cancer with the most effective treatments available and the high-quality care they
deserve.
The ESMO community is a powerful alliance of more than 7,000 committed oncology professionals from
over 120 countries. As a trusted organization with 35 years of experience and over 500 expert committee
members, ESMO serves its members and the oncology community through:
• leadership in transforming evidence-based research into standards of cancer care in Europe
• dedicated efforts to foster a more favorable environment for scientific research
• innovative international platforms to share expertise, best practices and disseminate the most
up-to-date scientific research to as wide an audience as possible.
ESMO’s scientific journal, Annals of Oncology, ranks among the top clinical oncology journals worldwide.
ESMO events are the meeting place in Europe for medical oncologists to update their knowledge, network
and exchange ideas. ESMO also unites key oncology stakeholders and forges strategic partnerships to
address critical issues related to the profession and practice of medical oncology. Recognized as an
authoritative voice in the fight against cancer, ESMO is pleased to offer consultative expertise to oncology
organizations and European authorities on important issues related to cancer research, prevention,
diagnosis, treatment and care.
Organisers
Join the ESMO community today! Please visit www.esmo.org to learn more.
177
About the European Society for
Radiotherapy and Oncology (ESTRO)
Founded in 1980, the European Society for Radiotherapy and Oncology, ESTRO, is a non-profit, scientific
organisation whose role shall be to foster, in all its aspects, radiation oncology, clinical oncology and
related subjects, including physics as applied to radiotherapy, radiation technology and radiobiology.
To fulfill its purpose, ESTRO will:
• Develop and promote standards of education in radiotherapy and clinical oncology;
• Promote standards of practice in radiotherapy, clinical oncology and related subjects;
• Stimulate the exchange of scientific knowledge in all related fields;
• Strengthen the clinical specialty of radiotherapy and clinical oncology in relation to other specialties
and professions involved in cancer management;
• Encourage co-operation with international, regional and national societies and bodies representing
radiotherapy, clinical oncology and related subjects;
• Facilitate research and development in radiotherapy, clinical oncology and related subjects.
ESTRO Conferences
ESTRO has established an international reputation for organising events covering all aspects of radiation
oncology and the multidisciplinary treatment of cancer. From major conferences with several thousand
delegates to meetings for smaller, or highly specialised groups, ESTRO can be relied upon to provide an
excellent scientific programme and the opportunity for networking focused on research initiatives and
developments leading to excellence in patient care.
Organisers
2012 ESTRO conferences:
Two jointly organised meetings will take place in Barcelona, Spain, in May 2012, and are of utmost
importance for the radiotherapy community:
• ESTRO 31, 9-13 May 2012, Barcelona
Annual congress of the Society
• World Congress of Brachytherapy, 10-12 May 2012, Barcelona
Joint meeting with world brachytherapy societies
Also in 2012:
• MIRO, Molecular Imaging in Radiation Oncology, 29-31 March 2012, Vienna, Austria
Joint conference with EANM (European Association of Nuclear Medicine)
• Novel Targeting drugs and Radiotherapy, 13-14 September 2012, Toulouse, France
• EURECCA, 13-16 December 2012, Perugia, Italy
Find out more on ESTRO events on www.estro-events.org
ESTRO School
Since its first teaching course in 1985, the ESTRO School has become an internationally recognised
provider of high quality education to meet the need for basic training and continuing professional
development in radiotherapy and oncology.
The ESTRO School promotes multidisciplinary education in oncology, with the objective of standardising
knowledge and clinical practice, whilst recognising the diversity of radiation oncology practice in different
parts of the world.
178
ESTRO/EANM educational seminar on PET in
radiation oncology
Multidisciplinary management of breast cancer
Physics for clinical radiotherapy
Modern treatment of cervical cancer with a special
focus on 3D image based brachytherapy
Dose modelling and verification for external beam
radiotherapy
Treatment planning for 3D conformal radiotherapy
with a focus on positioning, set-up and verification
Combined drug-radiation treatment: biological
basis, current applications and perspectives
Radiotherapy with protons and ions
Multidisciplinary teaching course on prostate
cancer
Modern brachytherapy techniques
Molecular oncology for the radiation oncologist
Evidence- based radiation oncology: a clinical
course with a methodological basis
IMRT and other conformal techniques in practice
Imaging and target volume determination in
radiotherapy
Multidisciplinary management of head and neck
oncology
Advanced Treatment Planning
Brachytherapy for prostate cancer
Bringing new RT technology into the clinic; an
evidence based approach
Best practice in radiation oncology. A workshop to
train RTT trainers
Stereotactics
Multidisciplinary teaching course on lung cancer
Basic Clinical Radiobiology
Evidence- based radiation oncology: a clinical
course with a methodological basis
Advanced imaging for physicists
Evidence and new challenges in rectal cancer
Image-guided radiotherapy and chemotherapy
in gynaecological cancer - focus on adaptive
brachytherapy
Advanced technologies
Multidisc approach of cancer imaging
ESO/ESTRO MasterClass in radiation oncology
Risk Management
Image guided radiotherapy in clinical practice
EANM/ESTRO educational seminar on PET in
radiation oncology
Modelling
Physics for clinical radiotherapy
Brussels
Belgium
3-4 February
Cairo
Ghent
Egypt
Belgium
11-14 February
12-16 February
Beijing
China
4-7 March
Izmir
Turkey
11-15 March
Dublin
Ireland
12-16 March
Gdansk
Poland
17-20 March
Uppsala
Sweden
25-29 March
Lyon
France
25-29 March
London
Florence
UK
Italy
1-4 April
15-19 April
Ljubljana
Slovenia
15-20 April
Amsterdam
NL
3-7 June
Porto
Portugal
10-14 June
Cordoba
Spain
16-19 June
Prague
Lisbon
CZ
Portugal
24-28 June
28-30 June
St Petersburg Russia
1-4 July
Vienna
Austria
3-7 September
Wurzburg
Brussels
Athens
Germany
Belgium
Greece
2-6 September
6-8 September
23-27 September
Viña del Mar
Chile
24-28 September
Izmir
Madrid
Turkey
Spain
30 Sept - 4 October
7-10 October
Budapest
Hungary
9-13 October
New Dehli
Rome
Milano
Brugges
Lausanne
India
Italy
Italy
Belgium
Switzerland
14-18 October
18-20 October
4-8 November
15-17 November
18-22 November
Vienna
Austria
23-24 November
Copenhagen
Bangkok
Denmark
Thailand
2-4 December
5-9 December
Organisers
Calendar of the 2012 teaching courses:
Find out more on the ESTRO School on www.estro-education.org.
179
ESTRO Membership
With over 5000 members in and outside Europe, ESTRO represents all Radiotherapy professionals:
Radiation Oncologists, Medical Physicists in the field of Radiotherapy, Radiobiologists and RTT
(Radiotherapy Technologists). Membership is also open to other Oncology specialists such as Medical
Oncologists, Surgeons, Nuclear Medicine Physicians...
In joining ESTRO, members get a host of benefits designed to support their career: they receive
Radiotherapy & Oncology, the so called Green Journal, get a discount to conferences and teaching
courses, get the opportunity to meet and maybe collaborate with professionals of the community.
Find out more on ESTRO membership on www.estro-members.org
ESTRO Board of Directors
President V. Valentini (Roma, Italy)
Past-president J. Bourhis (Paris, France)
President-elect D. Hollywood (Dublin, Ireland)
Treasurer K. Haustermans (Leuven, Belgium)
Editor in Chief J. Overgaard (Aarhus, Denmark)
Councillors 2011 - 2012:
C. Belka (Munich, Germany)
M. Coffey (Dublin, Ireland)
C. Haie-Meder (Paris, France)
C. Marijnen (Leiden, The Netherlands)
D.R. Olsen (Bergen, Norway)
F. Stewart (Amsterdam, The Netherlands)
D. Verellen (Brussels, Belgium)
Committees Chairpersons 2011 - 2012
Clinical Committee
D. Hollywood (Dublin, Ireland)
GEC-ESTRO (Brachytherapy)
C. Haie-Meder (Paris, France)
Physicists
T. Knöös (Lund, Sweden)
RTT
F. Garcia Moura (Lisbon, Portugal)
Radiobiology
B. Wouters (Toronto, Canada)
Education
R. Pötter (Vienna, Austria)
EIR (European Institute of Radiotherapy) V. Khoo (London, UK) and B. Mijnheer (Amsterdam, The Netherlands)
Organisers
EBR (European Board of Radiotherapy)
180
J. W. Leer (Nijmegen, The Netherlands)
Indices
Abstract Authors
Abstracts sorted per Topic
Indices
Faculty List
181
182
Indices
A.
Aareleid, T.
P134
Abad, C.
P124
Abbas, H.M.
P108
Abbasi Eslaloo, A.
P113
Abbasi Eslaloo, M.A.
P113
Abdelbaky, A.M.
P095
Abdul, N.
P130
Aboziada, A.
P108
Abu Eid, R.
P068
Afshari, M.
P070, P071
Aggarwal, A.
P130
Aguayo, M.
P024, P045
Agus, D.B.
O7
Al-Ai, G.
P009
Alam, Z.A.
P111
Albitskiy, I.
P058
Alekseev, B.Ya.
P003, P090, P091,
P120
Aleksic, P.
P114
Aliu, H.
P036
Altaf Hashmi, P106
Alvarez, A.
O6
Alvarez Maestro, M.
P015
Aly, A.A.
P107, P127
Amato, R.J.
P092
Anand, A.
P054
Anderson, J.
P009
Andreeva, Yu.Yu.
P003, P120
Andres, I.
P024, P045
Anischenko, A.O.
O2
Antunes, L.A.
P065
Antunes, M.I.
P033
Antunez-Plaza, P.
P005
Arango, O.
P026
Arenas, M.
P024, P045
Arguello, J.
P028
Argüello, J.C.
P021
Ariad, S.
P010, P048, P094
Arrabal-Martin, M.
P064
Arrabal-Polo, M.A.
P064, P116
Ashrafi-Amineh, F.
P133
Ather, M.H.
P097
Ather, M.H.
P111
Avuzzi, B.
P012, P023, P078
Ayoub, N.
P017
Azelie, C.
P031
B.
Baccolini, M.
P043
Bahl, A.
P103
Baiocchi, C.
P013
Balestrini, D.
P027
Balslev, I.
P063
Balyan, J.
P115
Bancevic, V.
P114
Banzola, I.
P121
Barber, K.
P052
Barbero, S.
P081
Barney, B.M.
P088
Barreiros, M.
P033
Barrio, M.
P124
Bartolome, A.
P132
Bartrina, J.M.
P030
Baskin-Bey, E.S.
P007, P050, P052,
P059, P079
Bayley, A.
P016
Bedini, N.
P012, P023, P078
Beer, T.M.
P054
Behzadi, M.
P121
Béjar Luque, A.
P039
Bellamy, P.
P042
Bellardita, L.
P012, P075, P077,
P078
Bellmunt, J.
P049
Bento, M.J.B.
P065
Berenguer, R.
P024, P045
Beresford, M.
P103
Berille, J.
P051
BhargavaO2
Bhattacharya, A.
P126
Bianchi, C.
P043
Biasoni, D.
P023, P078
Białozyt, M.
P066, P067
Bielsa, O.
P026
Bilal, B.D.
P127
Bilbao, P.
P038
Billiet, I.
P007
Blais, N.
O4
Boladeras, A.
O6, P007, P019,
P021, P081
Bolla, M.
P007
Bolzicco, G.
P013
Borre, M.
P074
Bosch, J.L.H.R.
O3
Bosset, J.F.
P007
Bossi, A.
P007, P079
Botelho, F.J.S.
P001, P002, P083
Bóveda, E.
P038
183
Indices
Abstract Authors
Indices
Braclik, I.
Braczkowska, B.B.
Braczkowski, R.S.S.
Brenner, H.
Brewster, D.H.
Breza Sn., J.
Brink, M.
Bristow, R.G.
Brown, M.D.
Brugnara, S.
Budach, W.
Bulbul, M.
Butoescu, V.
P029
P066
P066, P067
P134, P135
P134, P135
P062
P131
P016
P087
P084
P007
P017
P073
C.
Cabeza, A.
O6
Cabeza Rodriguez, M.A.
P041, P061, P132
Cafferty, F.H.
O1
Caffo, O.
P084
Cagna, E.
P043
Cagna, E.
P044
Cai, Z.
O5
Calandrino, R.
P057
Caldara, A.
P084
Caldarella, A.
P135
Call, J.A.
P035, P088
Calvo, F.A.
O6
Campara, Z.
P114
Caraceni, A.
P075
Carcaterra, M.
P006
Carlson, R.E.
P035
Carnell, E.J.
P069
Carrizo, M.V.
P024, P045
Caruso, C.
P053
Carvajal, C.C.
P038
Carvalho, I.C.
P065
Casamayor, M.
P060
CasasO6
Cascales García, M.A.
P132
Cascales García, M.A.
P041, P061
Casquero, F.
P038
Catania, S.
P023
Catro Peña, P.
P025
Catto, J.
P119
Catton, C.
P016
Caussa, L.
P025
Cerovic, S.
P114
Chacko, R.T.
O2
Chadwick, E.
P046
Chakraborti, A.
P115
Chapman, A.
P101
Cheng, T.
O4
184
Chinita, P.
Chiostrini, C.
Chissov, V.I.
Cho, J.H.
Choi, H.Y.
Choo, C.R.
Choudhury, A.
Chung, P.W.
Cianciulli, M.
Ciechowicz, J.
Ciuffreda, A.
Clarke, N.W.
Clavel Claver, M.
Coebergh, J.W.W.
Cohen, Z.
Colecchia, M.
Collette, L.
Colli, E.
Cormier, L.
Cos, R.
Cotreau, M.M.
Cozzarini, C.
Cree, A.A.
Créhange, G.
Crocetti, E.
Cruz, F.
Culine, S.
P033
P053
P003, P090, P091
P080
P089
P035
P018, P022
P016
P053
P029
P027
P087
P061
P131
P104
P023, P075
P007
P009
P031
P124
P092
P057
P022
P031
P134
P001, P002, P083
P051
D.
D’ambrosi, R.
D’ambrosio, M.S.
Datsenko, P.V.
Davis, B.J.
De Blas, R.
De La Vara, V.
De Meerleer, G.
De Wit, R.
Debus, J.
Degli Esposti, C.
Del Carpio, A.
Del Hoyo, O.
Delage, F.
Deli, A.M.
Dell’oca, I.
Denis, L.
Deome, P.
Di Muzio, N.G.
Di Pasquale, M.C.
Díez Rodríguez, J.
Dinerman, M.
Doñate Iñíguez, G.
Donato, V.
P041, P132
P006
P058
P035
P081
P024, P045
P007
P131
P008
P027
P021, P081
P038
P011, P014
P057
P057
P079
P073
P057
P084
P015
P094
P004
P053
E.
Earnest, A.
Efstathiou, E.
El Khoury, C.
El-Gamal, A.
El-Gehani, F.
Elliott, P.A.
Elwanis, E.
Enache, M.A.
Erauso, A.
Ersoy, H.
Esmaeili, E.
Espino, M.
Esteves, B.
EUNICE Survival Working
Group
F.
Faria, D.
Faure Walker, N.A.
Favretto, M.S.
Fellin, G.
Fernandez, A.
Ferrer, F.
Ferro, A.
Festuccia, C.
Filonenko, E.V.
Finkbeiner, M.
Fiorentino, G.
Fiorino, C.
Fischer, B.
Fishman, M.N.
Fitzpatrick, J.
Fleisher, M.
Flora Anna, M.
Fodor, A.
Font Ugalde, P.
Fournier, G.
Francés, A.
Frank, G.A.
Frezza, G.
Frisinghelli, M.
Fumadó, Ll.
P077
P007
O2
P112
P112
O7
P066, P067
P094
P076
P054
P017
P108
P123
P022
P108
P112
P011, P014
P125
P133
P030
O2, P092
P134, P135
P033
P103
P013
P043, P044
P028
P019, P021, P081
P084
P069, P085
P120
P016
P006
P043, P044, P057
P121
P092
P079
P054
P043
P057
P039
P011, P014
P026
P003
P027
P084
P026
G.
Gabe, R.
O1
Galdon, G.
P030
Galligioni, E.
P084
Garcia, E.
P081
Garcia, I.
P021, P081
Garcia-Criado, F.J.
P005
Garcia-Rojo, D.
P124
García Cabezas, S.
P039
Gat, Y.
P072
Gauthier, M.
P031
Gehl, J.
P122
Giardino, F.
P075
Gicor, O6
Gil-Vicente, A.
P005
Girelli, G.
P043
Golovashchenko, M.
P003, P090, P091, P120
Golub, S.V.
P058
Gómez Gómez, G.
P004
Gómez Iturriaga, A.
P038
Goncalves, F.M.
P062
Gondos, A.
P134, P135
Gonzalez-Sala, J.L.
P124
González, M.N.
P021
González San Segundo, C.
O6
Gornish, M.
P072
Gospodarowicz, M.
P016
Gravina, G.L.
P069, P085
Gross, M.
O7
Gual, J.B.
P009
Gual, J.
P124
Guardado, S.
P041
Gucuk, O.
P125
Guedea, F.
P019, P021, P081
Guerro, A.
O6
Gui, Y.
O5
Guix, B.
P030
Guix, I.
P030
Guo, G.
O5
Gusakova, I.
P010, P048
Gutierrez, C.
P019, P021, P081
Gutierrrez-Fernandez, J.
P116
H.
Ha, H.K.
Habibian, M.
Habl, G.
Hafeez, K.H.
Haghdoost, A.A.
Hakulinen, T.
Hannaoui, N.
P118
P051
P008
P097
P070, P071
P134, P135
P124
Indices
Donegani, S.
Doneux, A.
Doval, D.
Dragoescu, N.A.
Dragoescu, P.O.
Dreicer, R.
Duda, W.
Dudnik, J.
185
Indices
Hart, C.A.
Hasanzad, M.
Hauke, R.J.
Hawrylewicz, L.
Haxhiu, A.
Haxhiu, E.
Haxhiu, I.
Hegele, A.
Heidenreich, A.
Heinrich, G.
Helou, J.
Herfarth, K.
Hermann, G.
Hernandez Arteaga, O.M.
Herrera, F.
Herrmann, T.R.W.
Heshmati, F.
Higano, C.S.
Hillman, D.W.
Hilman, S.
Hinkelbein, W.
Hirmand, M.
Hoejgaard, M.
Hofmann, R.
Holm, M.
Holmstrom, S.
Holtkamp, G.M.
Hong, J.H.
Hongo, F. Horenblas, S.
Hu, X.
Huang, S.M.
Huang, Y.
Huddart, R.A.
Huzarska, M.
P087
P070, P071
P092
P029
P036
P036
P036
P037
P049, P052
P025
P017
P008
P122
P041
P007
P128
P121
P054
P035
P103
P007
P054
P063
P037, P068
P042
P060
P050
P089, P098
P093
P131
O5
P096
O5
O1
P066
Jo, M.
Johansen, T.E.B.
Johnson, I.
Johnson, P.
Joniau, S.
Joseph, K.
Joshua, S.
Jovanovic, M.
Jung, B.C.
P032
P074
P101
P095
P079
P123
P072
P114
P089
K.
Kabbinavar, F.F.
Kakkar, N.
Kalachev, A.A.
Kalpinskiy, A.S.
Kamal, M.
Kamali, K.
Kamoi, K.
Kang, K.
Karim-Kos, H.E.
Karunaratne, M.
Kawauchi, A.
Kharchenko, V.P.
Kiemeney, L.A.L.M.
Kim, J.M.
Kirk, R.
Kitsios, P.
Koo Ng, J.
Kosevic, B.
Kosmin, M.A.
Kotov, V.A.
Kribus, S.
Kroeze, S.G.C.
Kruijssen, L.W.J.
Kugler, M.A.P.M.
Kwak, C.
P092
P115, P126
P099
P003, P090, P091
P123
P113
P093
P096
P131
P052
P093
P058
P131
P096
P069
P007
P095
P114
P130
P105
P068
O3
O3
P128
P089, P098
I.
Imkamp, F.
Isa, N.
P128
P028
J.
Jamaldini, S.H.
Jannini, E.A.
Jans, J.J.M.
Janssen-Heijnen, M.L.G.
Javed, S.
Jegannathen, A.
Jeon, S.S.
Jespersen, C.G.
Jimenez, E.
Jimenez-Pacheco, A.
Jimenez-Pacheco, A.
P070, P071
P069
O3
P134, P135
P046
P018
P089
P074
P024, P045
P064, P116
P116
L.
Laack, N.N.
Lacorte, T.
Lahoz-Garcia, C.
Laing, R.W.
Lammering, G.
Lang, Z.
Langley, S.E.M.
Lanzos, E.
Le Fur, E.
Lechuga, C.
Lee, C.G.
Lee, H.J.
Lee, H.M.
Lee, I.J.
P088
P030
P064, P116
P046
P007
P104
P046
P041, P061, P132
P011, P014
P041
P080
P096
P089
P080
186
M.
Machiels, J.P.
Macia, M.
MacLean, D.
Macías, V.
Magic, Z.
Magnani, T.
Maingon, P.
Majewski, W.
Majstorovic, I.
Maldonado, X.
Malhaire, J.P.
Malinverni, G.
Mandal, A.K.
Mangili, P.
Marampon, F.
Marenghi, C.
Maria, C.
Maric, P.
Martens, M.
Martin, E.
Martin, J.
Martinez, E.
Martinez, R.
P073
P019
O7
O6
P114
P012, P023, P075,
P077, P078
P007, P031
P029
P114
O6
P011, P014
P044
P126
P057
P069, P085
P012, P023
P112
P114
P007
P031
P016
P021
P041, P132
Martins Da Silva, A.
Martos, A.
Martos, R.
Martín De Vidales, C.
Martínez Paredes, M.
Martínez-Piñeiro, L.
Mason, M.
Massey, C.
Mateo, D.
Matute, R.
Mauro, F.A.
Mazurek, E.
Mazzuoli, L.
Mcgovern, J.
Ménard, C.
Menegotti, L.
Merhej, S.
Mermershtain, W.
Mete, U.
Mette, M.
Mikami, K.
Miki, T.
Mikines, K.J.
Mikuz, G.
Miller, R.C.
Milosevic, R.
Milovic, N.
Mirjolet, C.
Miszczyk, L.
Misztal, L.
Mitra, A.
Mocovic, D.
Modollel, I.
Mok, G.C.
Mokhtar, A.
Monaco, A.
Monti, A.
Morales, A.
Moreno Alarcón, C.
Mortimer, P.
Motta, M.
Moukarzel, M.
Mourad, F.
Moïse, P.
Mukherjee, S.
Muñoz, J.
Murgia, V.
Murina, P.
Muruzabal, I.
Muzi, P.
P033
P024, P045
P124
O6
P039
P015
P049
P016
P081
P028
P044
P067
P006
P018
P016
P043
P017
P010, P048, P094
P115, P126
P074
P093
P093
P063
P128
P088
P114
P114
P031
P029
P029
P130
P114
P081
P016
P108
P053
P043
P104
P004
07
P085
P017
P108
P060
O4
P124
P084
P025
P038
P069, P085
187
Indices
Lee, J.Z.
P118
Lee, J.Y.
P098
Lee, S.D.
P118
Li, L.
P076
Liang, Z.L.
P096
Lihou, C.
P104
Lim, J.S.
P096
Lim, K.H.C.
P076
Linares Quevedo, A.
P015
Lipatov, O.N.
O2
Livsey, J.
P018
Loffreda, M.
P006
Londres, B.
P081
Lopes, I.
P002
Lopes, T.
P083
López Cubillana, P.
P004
López González, P.A.
P004
López-Tello, J.
P015
Lorente, J.A.
P026
Lorenzo-Gomez, M.F.
P005
Lozano, J.
P007
Lucas, A.
P019
Luna-Del Castillo, J.
P116
Lunet, N.
P001, P002, P065,
P083
Lyulko, A.A.
O2
Indices
N.
Nagele, U.
Nahas, O.
Naitoh, Y.
Nakamura, T.
Nam, H.J.
Nasr, E.
Nativ, O.
Navarro, V.
Negri-Cesi, P.
Nehme-Nasr, D.
Nemr, E.
Nicklas, A.P.
Nicolai, N.
Nielsen, F.C.
Nijkamp, M.W.
Nikolic, I.
Nogueras-Ocaña, M.
North, S.
Nosov, D.A.
Nuñez, A.
Nuñez, M.
Nyushko, K.M.
P128
P017
P093
P093
P118
P017
P094
P019
P085
P017
P017
P128
P012, P078
P063
O3
P114
P064
O4
O2
P024, P045
P021
P003, P090, P091
O.
Odeyemi, I.
Olarte Barragán, E.H.
Olbert, P.
Olivier, K.R.
Ordoñez, D.
Ouatas, T.
Oudard, S.
Ozok, U.
P055
P004
P037
P088
P081
P050, P052
P049
P125
P.
Pacheco-Figueiredo, L.F.
Padilla-Fernandez, B.
Palacios Eito, A.
Palombarini, M.
Panshin, G.A.
Panus, A.
Paolini, B.
Papin, G.
Pappagallo, G.
Park, J.
Parnaby, A.
Pashkova, E.V.
Pasquino, M.
Payne, H.A.
Pedro Olivé, A.
Peeters, P.
Peignaux-Casasnovas, K.
P065
P005
P039
P027
P058
P112
P023
P011, P014
P084
P032
P049
P120
P043
P130
O6
P060
P031
188
Pene-Baverez, D.
P011, P014
Pera, J.
P019, P021, P081
Pera, M.
P026
Pereira, A.
P033
Perez Regadera, J.
P061, P132
Perrouin-Verbe, M.A.
P011, P014
Persson, B.E.
P009
Pertschy, D.
P123
Pervez, N.
P123
Peter, S.
P119
Phung, D.
P050
Piccolella, M.
P085
Pina, F.M.
P001, P002, P083
Pirogov, A.V.
P120
Plato, M.
P067
Plesea, I.E.
P112
Pollock, P.
O1
Polo, A.
P019
Polyakov, V.A.
P090
Pompei, L.
P006
Pooya, M.
P121
Popov, D.S.
P099
Pouillon, V.
P007
Pradier, O.
P011, P014
Prats, J.
P124
Praveen, P.K.
P126
Prera, A.
P124
Procopio, G.
P075
Prostate Program
Multidisciplinary Clinic Team P078
Provenzano, M.
P121
Pubill, J.
P124
Puebla, F.
P028
Pylkkanen, L.H.
P007
Q.
Quinzaños, L.
Quispe, K.
Quni, Xh.
P030
P021, P081
P036
R.
Rancati, T.
Ratho, R.
Raza, S.J.
Rembak-Szymkiewicz, J.
Rembielak, A.
Renard, L.
Retsa, P.
Ricevuto, E.
Richetti, A.
Rijo, E.
P012, P023, P043,
P044, P075, P078
P115
P111
P029
P018
P007
P055
P069
P007
P026
P015
P075
P024, P045
P039
P051
P061
P039
P039
P061
P072
P006
P134
P011, P014
P010, P048
P051
P132
P004
P085
P006
S.
Sabater, S.
P024, P045
Sagnak, L.
P125
Saie Joeghan, S.
P133
Sais, G.
P121
Salam, B.S.
P097
Salomon, L.
P051
Salvioni, R.
P012, P023, P075,
P077
Samzadeh, M.
P070, P071
Sanchez, C.
P025
Sanchez Gomez, F.J.
P015
Scalchi, P.
P013
Schafhauser, W.
P068
Schelesko, A.A.
P091
Scher, H.I.
P054
Scholten, A.
P007
Schubert, K.
P008
Schulman, C.C.
P059
Scremin, E.
P013
Sedighi, S.S.
P070, P071
Sefchi, C.
P056
Seo, S.I.
P089, P098
Server Pastor, G.
P004
Sevillano, M.
P024, P045
Shamash, J.
O1
Shenvi, S.
P115
Shevrin, D.
O7
Shimpi, R.K.S.
P110
Shore, N.
P052
Sidhu, M.
P055
Silva, R.
P033
Silva-Abuin, J.M.
Simic, D.
Singh, M.P.
Slichenmyer, W.J.
Slosarek, K.
Smirnov, A.N.
Smith, M.R.
Søgaard, M.
Soh, J.
Soini, B.
Solodkiy, V.A.
Song, K.
Sorlozano-Puerto, A.
Soulié, M.
Spasic, A.
Srinivas, S.
Stagni, S.
Stakhovskyi, A.E.
Stakhovskyi, E.A.
Stanculeanu, D.L.
Stanojevic, I.
Stasi, M.
Stauder, M.C.
Steele, C.
Stenning, S.P.
Stepanov, S.O.
Strahs, A.L.
Stratford, J.
Stuschke, M.
Suh, C.O.
Sulser, T.
Swindell, R.
Syed, S.M.
T.
Tahoon, T.A.
Tan, P.W.
Taplin, M.E.
Tasca, A.
Tawadros, T.
Te Slaa, E.
TE23 Trial Management
Group and Collaborators
Tello, J.I.
Teodorovic, G.
Teplov, A.A.
Testolin, A.
Tey, J.C.S.
The Prostate Cancer Clinical
Trials Consortium
Thomas, J.
Thomas, V.S.
P005
P114
P115
O2
P029
P099
P050
P074
P093
P084
P058
P032
P116
P051
P114
P092
P078
P105
P105
P056
P114
P043
P088
P042
O1
P091
O2, P092
P018
P007
P080
P121
P018
P097
P127
P076
P054
P013
P087
P007
O1
P030
P114
P120
P013
P076
Indices
Rios Gonzalez, E.
Ripamonti, C.
Rivera, M.
Rivin Del Campo, E.
Roca, L.
Rodriguez Antolin, A.
Rodríguez Liñán, M.
Romeo Olmedo, J.L.
Romero Otero, J.
Rosenbaum, E.
Rosetto, M.E.
Rosso, S.
Rousseau, B.
Rouvinov, K.
Rozet, F.
Ruiz, A.
Ruiz Morcillo, J.C.
Ruscica, M.
Russo, M.
P054
P042
P047
189
Tomatis, S.
P043
Tombal, B.
P050, P055, P059,
P073
Tombolini, V.
P069, P085
Tomescu, P.I.
P112
Topaloglu, H.
P125
Toulouzan, M.
P011, P014
Trepicchio, W.L.
O7
Truc, G.
P031
Tsimafeyeu, I.V.
P099
Tunio, M.A.
P106
Indices
U.
Uhl, M.
Ullmann, F.
Urbanczyk, H.A.
P008
P056
P029
V.
Valdagni, R.
P012, P023, P043,
P044, P075, P077,
P078
Valduga, F.
P084
Valeri, A.
P011, P014
Valle-Diaz De La Guardia, F.
P064, P116
Van Den Bergh, A.C.M.
P007
Van Der Meulen, E.
P009
Van Diest, P.J.
O3
Van Melick, H.H.E.
O3
Van Poppel, H.
P007
Van Thienen, A.
P073
Vasquez, J.L.
P122
Vavassori, V.
P043, P044
Vazquez De La Torre, M.L.
O6
Veccia, A.
P084
Veiga, F.G.
P009
Vekemans, K.
P007
Venencia, D.
P025
Verhagen, P.
P007
Verhoeven, R.H.A.
P131, P134, P135
Vicente, E.
P124
Videira, A.
P033
Vikeså, J.
P063
Villa, S.
P007, P019
Villa, S.
P012, P023, P075,
P078
Villafranca Iturre, A.E.
P007
Villani, D.
P012, P078
Villas, M.V.
P024, P045
Vinikovetskaya, A.V.
P058
Vitruk, Y.V.
P105
Vojvodic, D.
P114
190
Vorobyev, N.V.
Voylenko, O.A.
P003, P090
P105
W.
Walcher, U.
Waliszewski, P.
Wang, J.
Warde, P.
Webb, I.
Wex, J.
Weytjens, R.
White, J.D.
Wieczorek, K.
Wilson, P.
Winquist, E.
Wirth, M.
Woodward, M.
Woolf, D.K.
P128
P037, P068
O7
P016
O7
P055
P007
O1
P066
P103
O4
P009
P018
P130
Y.
Yoon, S.
You, S.H.
Yu, E.Y.
P096
P080
P054
Z.
Zaffaroni, N.
Zalcberg, Y.
Zanetti, R.
Zapatero, A.
Ziaei, S.A.M.
Žiaran, S.
Zuluaga-Gomez, A.
Zunino, S.
P075
P048
P135
O6
P070, P071
P062
P064
P025
191
Indices
Abstracts sorted by Topic
Localized Prostate Cancer
Diagnosing/Staging:
P001, P002, P003, P004, P005
Treatment:
P006, P007, P008, P009, P010, P011, P012, P014, P015, P016, P017, P018, P019, P021, P022, P023,
P024, P025, P026, P027, P028, P029, P030, P031, P032, P033
Prevention/Prognosis:
P035, P036
Follow Up:
P037, P038, P039, P041
Quality of life:
P042, P043, P044, P045, P046, P047
Advanced Prostate Cancer
Treatment:
O7, P048, P049, P050, P051, P052, P053, P054, P055, P056, P057, P058
Quality of life:
P059, P060, P061, P062
Diagnosing/Staging:
P063
Prostate Cancer
Research:
O6, P064, P065, P066, P067
Basic:
P068, P069, P070, P071, P072
Clinical:
P073, P074, P075, P076, P077, P078, P079, P080, P081, P083, P084
Indices
Basic/Translational:
P085, P087
192
Renal Cell Carcinoma
Treatment:
O2, P088, P089, P090, P091, P092, P093, P094
Prognosis:
P095, P096
Diagnosis/Staging:
P097
Follow Up:
P098
Clinical/Basis research:
O3, P099
Bladder Cancer
Treatment:
P101, P103, P104, P105, P106, P107, P108, P110
Follow Up:
P111
Prognosis:
P112, P113, P114
Clinical/Basis research:
O4, O5, P115, P116, P118, P119, P120, P121, P122, P123
Diagnosis/Staging:
P124, P125, P126, P127, P128
Testicular Cancer
Treatment:
O1, P130, P131, P132, P133
Indices
Prognosis:
P134, P135
193
Faculty List
Indices
P-A. Abrahamsson, Malmö (SE)
P. Albertsen, Farmington (US)
A. Alcaraz, Barcelona (ES)
M. Babjuk, Prague (CZ)
C. Bangma, Rotterdam (NL)
J. Barentsz, Nijmegen (NL)
A. Bossi, Villejuif (FR)
M. Brausi, Modena (IT)
N. Clarke, Manchester (GB)
P. Dahm, Gainesville (US)
J. De Bono, Sutton (GB)
G. De Meerleer, Ghent (BE)
T. De Reijke, Amsterdam (NL)
M. De Santis, Vienna (AT)
M. Emberton, London (GB)
S. Fossa, Oslo (NO)
F. Frauscher, Innsbruck (AT)
C. Haie Meder, Villejuif (FR)
194
O. Hakenberg, Rostock (DE)
A. Heidenreich, Aachen (DE)
G. Janetschek, Salzburg (AT)
V. Khoo, London (GB)
J. Kotzerke, Dresden (DE)
N. Maitland, York (GB)
M. Marberger, Vienna (AT)
A. Mottrie, Aalst (BE)
P. Mulders, Nijmegen (NL)
A. Polo, Madrid (ES)
A. Stenzl, Tübingen (DE)
H. Van Poppel, Leuven (BE)
N. Wernert, Bonn (DE)
T. Wiegel, Ulm (DE)

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