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ABSTRACTS XIV Congresso Nazionale Società Italiana di Urologia Oncologicalutamide 150 mg. La radioterapia è stata eseguita con elettronidi energia di 6-12 MeV con frazione singola di 1000cGy,con campo unico di dimensioni variabili, in relazione all’anatomiadel paziente, per erogare almeno il 90% della dose fra lacute e la gabbia toracica. I pazienti sono stati sottoposti a controlloclinico ogni 3 mesi per valutare l’eventuale comparsa el’entità della ginecomastia e della mastodinia. Dopo un followupdi almeno 12 mesi 33 pazienti valutabili non presentanoattualmente ginecomastia e/o mastodinia; in 4 casi dove il trattamentoè stato eseguito con situazione iniziale di ginecomastiae mastodinia, è stata ottenuta la scomparsa del dolore eduna stabilizzazione della ginecomastia. I dati preliminari suggerisconoche il trattamento radiante profilattico delle ghiandolemammarie in corso di ormonoterapia con bicalutamide150mg riduca significativamente l’insorgenza e l’entità dellaginecomastia e della mastodinia in assenza di effetti collateraliradioindotti. In considerazione di questi dati incoraggianti si èritenuto di attivare uno studio randomizzato teso a confrontarel’efficacia della radioterapia versus Nolvadex nella prevenzionedella ginecomastia e mastodinia da bicalutamide.Comunicazioni n. 99INTRA-OPERATIVE RADIOTHERAPY AFTER RADICALPROSTATECTOMY (RP) IN PROSTATE CANCER AT HIGHRISK OF LOCAL FAILUREArcangeli G., Saracino B., De carli P., Albino G., SorianiA., Marzi S., Petrongari M.G., Farella A., Gomellini S.,Gallucci G.Istituto Regina Elena, RomaPurpose: The rate of local recurrence after RP ranges from 4%to 23% in T1/2 and is grater than 40% in T3 tumors. Localrecurrence occurs more frequently in the bladder-urethralanastomosis (66%), bladder neck (16%) and retro-trigonalarea (13%). A high risk of local failure after RP includespatients with one or two risk factors (PSA > 10 ng/ml, Gleasonscore (GS) 7, positivity in almost 2/3 bioptic specimens, clinicalstage T2b). Recent studies established that the ratio in prostatecancer is 1.5-2 Gy, i.d., lower than assumed for lateresponsive normal tissues. Therefore, the administration of asingle dose should represent a more convenient irradiationmethod. We began a dose-escalation study (based onFibonacci method) by employing IORT after RP in patientswith intermediate risk prostate cancer. Acute and late toxicitiesfollowing escalating doses were monitored.Materials and Methods: 18 pts received IORT at escalatingdoses of 16 Gy, 18 Gy and 20 Gy. The inclusive criteria were:age < 75 years, clinical stage N0 and 1 or 2 of the above-saidrisk factors. As toxicity was absent in further 10 pts treatedwith 20 Gy, a dose escalation to 22 Gy was carried on, accordingto the planned strategy. IORT was delivered after RP,bladder-urethral anastomosis manufacture and bilateral obturatornodes sampling, by means of a dedicated Linac (Novac 7Hitesys, highest energy 9 MeV). The treatment port includingthe surgical bed and the anastomosis was irradiated through asterile applicator with a 22 angled edge and diameter of 4-6cm. The electron energy was selected in order to include allthe structures in 90% isodose. An in vivo dosimetry was performedby introducing a Mosfet dosimeter in a rectal catheterand a Mosfet micro-dosimeter placed close to the anastomosisthrough a Foley catheter.Results and Conclusions: Our cases analysis showed a pathologicupgrade as to the clinical data in 63.9% of cases, while adowngrade or an unchanged stage was seen in 15.3% and20.8%, respectively. Positive margins were found in only 2cases (7%). Pathological GS compared to biopsy GS washigher in 43% of cases, lower in 18% and unchanged in a further39%. In all cases, in vivo dosimetry showed an absorbeddose to the rectum wall < 1%. The presently available datashow that the highest level of dose-finding was well tolerated,without any detectable rectal or vesical toxicity or anastomoticleakage protraction. A longest follow-up is necessary to verifythe real impact of IORT in prostate cancer in term of late toxicityand loco-regional control.Poster n. 100THALIDOMIDE (TH) AND METRONOMIC DOCETAXEL (D)IN CHEMO-IMMUNOREFRACTORY METASTATIC RENALCANCER (MRC): A REPORT OF FOUR CASES.Boccalon M. 1 , Lo Re G. 1 , Sangiorgio A. 2 , Merlo A. 2 , RusticiC. 2 , Lenardon O. 2 , Buttazzi L. 2 , Garbeglio A. 2 , Tumolo S. 11Oncology Unit; 2 Urology, G.H. “S. Maria degli Angeli”, PordenoneIntroduction: The metastatic renal cancer (MRC) is a chemoresistanttumour but represent an immunoresponsive disease.Thalidomide (Th), a sedative drug with anti-angiogenetic properties,has been shown activity in multiple myeloma and solidtumours. Experimental studies of metronomic chemotherapydemonstrate suppression of angiogenesis in animal models anda synergistic anti-angiogenetic activity for Docetaxel (D) combinedto monoclonal antibody against VEGF was reported(Sweeney CJ et al., Cancer Res. 2001).Aim of the study: Evaluation of feasibility, toxicity and activity oflow dose D in combination to Th in metastatic renal cancer.Patients and Methods: Between 3/03 and 7/03 four patients weretreated. Two were male and 2 female. PS was >2 in 3 pts and =2in one pt. Age was 44,50,54 and 71 years respectively. Allpatients were pretreated with chemo-immunotherapy (CIT)including IL-2, IFN-a2a and 5-FU (Atzpodien regimen) and 3pts with Th alone. Sites of metastases were caval thrombosis in2, liver in 3, lung in 2, lymphnodes, soft tissue and bone in 1 ptrespectively. Chronic disseminated intravascular coagulation waspresent in 2 pts and idiopathic oral mucosal disorder in 1 pt.Treatment: Th was administered at 100-200 mg daily on thenight and D 5-20 mg weekly until toxicity or progression.Results: One of 3 pts with poor PS, unresponsive to previousCIT and Th alone, obtained an objective response on soft tissue,platelets and mucosal recovery, LDH normalization and PSimprovement. Duration of response was 2 months. Of 3 otherspts, two obtained stable disease with subjective response inone and the third patient was unresponsive to therapy. Nosevere toxicity was encountered. Survival was 1, 3, 3.5 and 7months respectively.Conclusions: Combination of metronomic D to Th can representa new way of CT administration in metastatic progressive renalcancer. These preliminary clinical data need a larger evaluationin adequate cohort of patients to verify the clinical translationof the experimental results obtained in the animal models.Poster n. 101ESAME INTRAOPERATORIO NELLE LESIONI SOSPETTEDEL TESTICOLOGazzano G. 1 , Carmignani L. 2 , Gadda F. 2 , Nerva F. 3 , ManciniM. 3 , Colpi G.M. 3 , Coggi G. 1 , Rocco F. 2 , Bosari S. 11Dipartimento di Medicina Chirurgia e Odontoiatria, II Cattedra diAnatomia e Istologia Patologica, Ospedale San Paolo di Milano; 2 IIClinica Urologica, Ospedale Maggiore di Milano IRCCS; 3 Unità diAndrologia, Ospedale San Paolo di MilanoIntroduzione e Obiettivi: Numerosi autori riportano unaumento dell’incidenza di lesioni benigne in particolare neireperti incidentali di lesione testicolare. Negli ultimi anni siè quindi rafforzato sempre più il ruolo dell’esame intraope-Archivio Italiano di Urologia e Andrologia 2004; 76, 3, Supplemento 137