Year : 2019 | Volume
: 15 | Issue : 9 | Page : 208--213
|How to cite this article:|
. Genito-Urinary.J Can Res Ther 2019;15:208-213
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. Genito-Urinary. J Can Res Ther [serial online] 2019 [cited 2021 Apr 12 ];15:208-213
Available from: https://www.cancerjournal.net/text.asp?2019/15/9/208/271708
Abstract: 142: Hepatocellular carcinoma patients with portal vein thrombosis treated with robotic radiosurgery: Interim results from a prospective study
Debnarayan Dutta, Tushar Tatineni, Ram Madhavan Panicker, G. Shibu, Rajesh Kannan, G. Sudhindran, Raghavendra Holla
Amrita Institute of Medical Science, Kochi, Kerala, India, E-mail: [email protected]
Purpose: Present prospective study evaluating role of Radiosurgery (CK) in Indian patients suffering from hepatocellular carcinoma with portal vein thrombosis. Materials and Methods: Inoperable HCC with PVT with good performance status, liver function were accrued after radiological diagnosis for CK (M6). Fiducial placement (3 no) done as per protocol. Triple phase contrast CT scan, planning done with Multiplan. PVT categorized as Chen classification. GTV is gross contrast enhancing mass within the main portal vein, its tributaries and adjacent parenchymal disease. PTV margin was 2-3 mm. Dose prescribed as per established risk stratification protocol (22-50Gy/5fr). Mean liver dose <15Gy & 800 cc liver <8Gy. Prognostication done with Chen, Child Pugh (CP), AFP, CLIP score, BCLC classification, RT dose and response to treatment. Results: 41 HCC with PVT accrued in the study till date [mean age 61.4 yrs (38-76 yrs), 98% male; Child Pugh A 61%, B 34%; BCLC C 95% & D 5%; PS0-1: 71%, KPS>80: 83%; co-morbidities 39%; infective 15%, Alcohol intake 24%]. Patients presented with abdominal pain (39%), ascitis (17%), fatigue (7%), and melena (7%). CP Score 5,6,7 & 8 was in 27%, 34%, 20% & 10% respectively. Focal disease with PVT in 15%, liver involvement >50% & <50% in 51% and 34%. 44% received adjuvant sorafinib after SBRT. PVT Chen classification VP2, VP3 & VP4 were in 34%, 32%, 32% respectively. CLIP score 1, 2, 3, 4, 5 was in 3%, 29%, 34%, 27% and 5% respectively. Mean follow up was 30.8 weeks (SD 25.8; range 2-107 weeks). Mean actuarial OS was 52.1 wks (95%CI: 38.4-65.5 wks). 6 month & 12 months actuarial OS 65% and 48% respectively. At last follow up, 22/41 (54%) were alive and 19/41 (46%) expired with disease progression. Among 34 patients evaluable for response assessment, 18 (45%) had complete PVT response 1 (3%) had response of IVC thrombus, 15 (36%) had no response to RT. One (3%) patient each had partial PVT response and bland thrombus. At last follow up, among 22 alive patients 9 (22%) had stable disease and 13 (32%) had progressive disease. Among 19 patients expired, 15 (85%) due to local progression, 4 (15%) due to metastasis. No death due to classical RILD. 19/41 (46%) patients had radiologically confirmed re-canalization [18 in PVT & 1 in IVC]. Post-CK, 3 (8%) patient underwent TACE and one (4%) had TARE. Mild GI toxicities (Gr-1-II) in 12 (29%), fatigue (Gr II-III) in 20 (48%) and grade III GI toxicity in 2 (5%) patient. Two (5%) patient had decompensation (<4 wk) after treatment. Actuarial OS in responders and non-responders were 70.5 wks (95%CI 50.7-90.2) and 35.4 (95%CI 21.7-49.1); p-value: 0.007. CLIP score and RT dose predicts improvement in OS (OS in CLIP Score 1-2 Vs 3-6: 35.6 Vs 27.6 wks; p-value 0.058 and RT dose <39Gy Vs >39Gy: 25.5 Vs 39.2 wks; p-value 0.245). Gender, infective etiology, alcohol intake, pre-CK AFP, BCLC stage, adjuvant Sorafinib did not influence survival functions. Conclusions: CyberKnife is safe & effective option in Indian HCC with PVT patients. Good PVT response, CP score, CLIP Score and RT dose have prognostic.
Abstract: 169: Leiomyosarcoma of urinary bladder: A case report
N. H. Hridaya, Lekha Nair, T. R. Preethi, J. Sivaranjith, Francis James
Regional Cancer Centre, Thiruvananthapuram, Kerala, India, E-mail: [email protected]
Background: Most of the bladder tumors arise from urothelium. Non epithelial tumours are less common and leiomyosarcomas are very rare accounting for less than 1% of all bladder malignancies. We report here a case of leiomyosarcoma urinary bladder. Case Report: A 45 year old pre menopausal lady was evaluated for complaints of hematuria. She was of good performance status and had no significant findings on clinical examination. CT abdomen and pelvis suggested soft tissue density lesion arising from base of urinary bladder. Cystoscopic biopsy was done and histopathology report was suggestive of leiomyosarcoma bladder. Transurethral resection of bladder tumour was done and histopathology report was confirmed as leiomyosarcoma bladder grade 2. CT thorax showed no lung metastases. Anterior exenteration (enbloc cystectomy + total abdominal hysterectomy + bilateral salpingo oophorectomy + ileal conduit + ileo ileal anastomosis) was done and surgical specimen showed no significant pathology. Adjuvant chemotherapy with 6 cycles of Ifosfamide + Doxorubicin was completed. Patient is currently asymptomatic with no evidence of disease and is being followed up clinically. Discussion and Conclusion: Leiomyosarcoma of the bladder is considered rare but is a highly ag¬gressive neoplasm associated with poor prognosis. Early identification is critical and surgery remains the mainstay of treatment. Role of adjuvant treatment is controversial.
Abstract: 180: A prospective study to see the feasibility, toxicity and efficacy of twice weekly interdigitated intracavitary brachytherapy in patients of carcinoma cervix stage IIB undergoing concurrent chemoradiation
Lekshmi Shenoi, Pritam Sardar
IPGMER and SSKM Hospital, Kolkata, West Bengal, India, E-mail: [email protected]
Purpose and Objective(s): For inoperable stage IIB Cervical carcinoma, the standard treatment is concurrent chemoradiation followed by intracavitary brachytherapy. To prevent accelerated repopulation, treatment should be completed within 8 weeks. In this study, we aim to further reduce the treatment time by interdigitating brachytherapy with concurrent chemoradiation. Objectives: To assess the response in terms of complete response, partial response, stable disease and progressive disease according to RECIST criteria, version 1.1 and acute toxicities according to the Radiation Therapy Oncology Group [RTOG] criteria. Materials and Methods: After undergoing pretreatment assessment with history, clinical examination, baseline laboratory investigations and imaging, patients with histologically proved squamous cell carcinoma cervix (FIGO stage IIB) without any evidence of distant metastasis were treated with concurrent chemoradiation with EBRT in a dose of 50 Gy in conventional fractionation and concurrent chemotherapy with i.v. inj. Cisplatin 40 mg/m2 weekly. After 17 fractions of radiotherapy patients were assessed clinically for the feasibility for intracavitary insertion. Patients received HDR brachytherapy twice weekly with a dose of 7.2 Gy/fraction in four fractions. No EBRT or chemotherapy were given on brachytherapy days. During treatment, patients were reviewed weekly clinically and with blood reports and thereafter 6 weekly for 3 months and 3 monthly till the end of the study. Results: 42 patients were included in the study. Mean age at diagnosis was 49.2±10.5 years, among them, 71.4% patients were post-menopausal and 28.6% were pre-menopausal. Most common histopathology in this study was moderately-differentiated squamous cell carcinoma (78.6%) followed by well-differentiated squamous cell carcinoma (14.3%). Average age of menarche of the patients was 12.9±0.9 years. Most of the patients in this study had a history of early age of marriage (16±1.9 years), early age of first child birth (17.2±2.1 years) and multigravida (3.7±1.2). Most common acute toxicity encountered was GI toxicity (78.6%) of grade 1 (42.9%) and grade 2 (28.6%). Followed by haematological toxicity (28.6%) of grade 1 and 2 (14.3% each) and skin toxicity (21.4%). Most grave toxicity was proctitis which was seen in 6 patients (14.3%). The overall response rate at 6 weeks post-treatment (complete response and partial response) was 100% with complete response (78.6%) and partial response (21.4%). The median duration of follow-up after initial 6 weeks post-treatment assessment was 6 months with minimum follow-up duration being 3 months-maximum 15 months. 7 patients were lost to follow-up. Out of 33 complete responders, 2 patients developed recurrence (6.1%) after 7.5 months and 11 months after completion of treatment. Conclusion: To conclude, this study is feasible as the toxicities are limited and manageable. Most of the patients responded well without significant recurrence. For further conclusion, large number of patients should be included and compared to a control arm.
Abstract: 190: Leiomyosarcoma of penis: A case report
A. J. Arun, Lekha Nair, K. Chandramohan, Anitha Mathews, Francis James
Regional Cancer Centre, Thiruvananthapuram, Kerala, India, E-mail: [email protected]
Introduction: Squamous cell carcinomas account for 95% of total penile malignancies whereas mesenchymal tumors are rare. We report here a case of leiomyosarcoma penis. Case Report: A 45-year-old male, with no comorbidities, presented with an ulceroindurative lesion at the tip of penis of 4 months duration. He reported that the lesion was rapidly progressing in size and gave no history of bleeding, loss of weight or appetite. General physical examination and systemic examination was within normal limits. Local examination showed a 3x3.5 cm ulceroindurative growth at the tip of the penis with induration involving 1 cm of the distal penile shaft. There was no significant inguinal lymphadenopathy. Biopsy from the lesion showed poorly differentiated malignant neoplasm, possibly of mesenchymal origin. Ultrasound examination showed normal liver and bilateral small volume inguinal lymph nodes with maintained fatty hilum. The patient underwent partial penectomy and histopathology was reported as high-grade spindle cell sarcoma, SMA+, consistent with leiomyosarcoma, infiltrating and ulcerating prepucal skin. He received 6 cycles of adjuvant chemotherapy with intravenous Ifosfamide and Adriamycin. He is now asymptomatic and is on routine follow-up with no evidence of disease. Discussion: Mesenchymal tumors of the penis are uncommon and among them, leiomyosarcoma is extremely rare. Based on the depth of the tumor, leiomyosarcomas are classified into two: superficial and deep leiomyosarcomas, with deep tumors having a poor prognosis. Surgery is the primary modality of treatment and the role of adjuvant therapy is of doubtful benefit.
Abstract: 267: Comparative dosimetric study between three different sets of 5-fields and 7-fields intensity modulated radiation therapy plans in prostate cancer
Mukesh Kumar Zope, Deepali Bhaskar Patil, Vinita Trivedi, Shekhar Kumar Keshri, Rajesh Kumar Singh
State Cancer Institute, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India, E-mail: [email protected]
Purpose and Objective(s): In more recent years, Intensity Modulated radiation Therapy (IMRT) has become the standard of care to deliver external beam RT to prostate cancer. IMRT allows for a higher dose of radiation to be delivered to the prostate while reducing dose to surrounding organs. The purpose of this study is to compare the dose to normal tissue and dose-limiting structures, conformity index, homogeneity index, number of monitor units required for the treatment of prostate cancer in 5-Field & 7-Field IMRT plans. Materials and Methods: In this study, different IMRT plans are created with the 3 different sets of 7-field gantry angles are 7B1 (00,510,1020,1530,2040,2550,3060), 7B2 (00,370,750,1350,2250,2850,3270), 7B3 (250,750,1300,1800,2300,2800,3350) and 3 different set of 5-field gantry angles are 5B1 (00,500,1000,2600,3100), 5B2 (450,1050,1800,2250,3150), 5B3 (00,750,1350,2250,2850). A total of 60 plans for 10 patients and Step & Shoot treatment delivery by using 80 leaf multileaf collimator. The IMRT plans were created using Xio TPS with 6MV photon and superposition algorithms. A hypo fractionated prescription dose of 70Gy/28# at 2.5 Gy/# was used. The plans were evaluated with the help of Dose Volume Histogram. Results: All IMRT plans, 3 different set of 7-fields and 3 different set of 5-field, differed slightly in the measured parameters, however none of them was statistically significant difference with each other. Conformity index, Homogeneity index and monitor units all showed non- significant (P>0.05) difference between the various groups of different IMRT plans. However, 5- field IMRT plans achieved a 14.9 % relative decrease in the mean number of monitor units for radiation delivery as compared to 7-field IMRT plans. Conclusion: Since 5- field IMRT plans use a lesser number of monitor units per treatment than 7- field IMRT plans. A decrease in monitor units also leads to the lesser linear accelerator beam-on time and consequently lesser treatment time and running cost. Thus, in a high-volume centre with 5 field technique we can treat more patients in lesser time.
Abstract: 274: Hypofractionation in carcinoma prostate
Rahul Misra, Rakesh Jadhav, K. N. Srikanth, Manoj Kumar
HCG, Vadodara, Gujarat, India, E-mail: [email protected]
Objective: A retrospective analysis of carcinoma prostate patients treated with androgen deprivation therapy and hypofractionated radiotherapy at HCG Cancer Centre, Vadodara from February 2018 to September 2019. Materials and Methods: 14 patients of carcinoma prostate were treated at HCG Cancer Centre, Vadodara between September 2017 to September 2019. The patients were investigated with prostatic biopsy, MRI Pelvis, Bone scan / PSMA PET CT, Serum PSA, Serum creatinine, CBC. After the initial workup the patients were risk stratified according to the risk categories. The treatment was decided as per the risk categories. The patients were explained all the treatment options available for their respective categories (Listed below) after proper discussion at the MDT. Very Low Risk: Active Surveillance/Radical RT/Radical Prostatectomy. Low Risk: Active Surveillance/Radical RT/Radical Prostatectomy. Favourable Intermediate Risk: Active Surveillance/Radical RT/Radical Prostatectomy. Unfavourable Intermediate Risk Group: Radical Rt+Adt (6 Months)/Radical Prostatectomy. High Risk Group: Radical Rt+ Adt (2 Years). UNFAVOURABLE HIGH RISK GROUP and HIGH RISK GROUP patients were subjected to neoadjuvant hormonal therapy before starting radiation. Radiation was delivered by IGRT as per the CHHIP PROTOCOL to a dose of 60 Gy in 20 fractions at 3 Gy per fraction 5 days a week over 4 weeks. Strict bladder and rectal protocols were followed with daily imaging with Cone Beam CT to verify the position of the target rectum and bladder. Results:
Complete response 13Partial response 1Total 14
Long term GI toxicity:
Grade 0: 8 patientsGrade 1: 6 patientsGrade 2: 0 patientsGrade 3: 0 patientsGrade 4: 0 patients
Long term bladder toxicity:
Grade 0: 4 patientsGrade 1: 8 patientsGrade 2: 2 patientsGrade 3: 0 patientsGrade 4: 0 patients
All patients tolerated the treatment well with no major acute toxicities. The patients had a good response rate. The patients were followed up for late toxicities as well and most of them have not developed any major complications so far with the most severe toxicity being grade 2 bladder toxicity in 2/14 patients. The major advantage was compliance as the patients were able to complete treatment in 4 weeks and had almost completed treatment by the time they started developing acute toxicities. Conclusion: These results help us conclude that hypofractionation is a safe, effective and practical treatment option for carcinoma prostate patients. However strict bladder rectal and imaging protocols need to be followed for safe delivery of treatment.
Abstract: 351: A retrospective study to evaluate the epidemiological characteristics of patients of germ cell tumor presenting to tertiary care centre
Arkaprava Sinha, Avik Mandal, Dharmendra Singh, Manika Verma, Amrita Rakesh, Pritanjali Singh
All India Institute of Medical Sciences, Patna, Bihar, India, E-mail: [email protected]
Introduction: Germ cell tumors comprise of heterogeneous group of tumors with respect to histology, age at diagnosis, anatomical site at presentation and prognosis. In India due to lack of good epidemiologic data of germ cell tumor, majority of the cases present at advanced stage. In general 80% of germ cell tumors are benign and 20% are malignant. Most of the germ cell tumor cases are young and most can be cured. Germ cell tumor may be of two types: I) Gonadal germ cell tumor II) Extra gonadal germ cell tumor. These are histologically classified into 1) Teratoma 2) Malignant germ cell tumor 3) Mixed germ cell tumor. Teratoma again divided into mature and immature teratoma. Malignant germ cell tumor is classified into i) Dysgerminoma and Non dysgerminoma. Non dysgerminoma is classified into yolk sac tumor, choriocarcinoma, embryonal carcinoma, gonadoblastoma, teratomatous, yolk sac tumor. Purpose: To evaluate the epidemiological characteristics of the germ cell tumor presented in department of Radiotherapy AIIMS, Patna. Materials and Methods: Sixty five histopahologically confirmed Germ cell tumors treated at our center from june 2014 to june 2019 were analysed retrospectively in our study. History, physical examination was done at presentation. Baseline CECT abdomen, thorax, USG whole abdomen, tumor markers (AFP, HCG, LDH), USG scrotum was done as staging workup. Complete blood count, Liver function test, Kidney function test, pulmonary function tests were done to assess other related organ functions. Operable patients underwent upfront surgery & Inoperable cases received neoadjuvant chemotherapy. Based on post operative histopathological report, histological classification was done according to WHO classification and staging was done as per AJCC TNM system. Results: In our study, 47.7% patients were male & 52.3% were female. Median age of presentation was 24 years (1-61) for germ cell tumors, among them 15 years (1-60) for teratomas, 33 years (12-61) for dysgerminoma, 21 years (4-60) for non dysgerminoma, 17 years (4-35) for mixed germ cell tumors. 25 (80.6%) of male patients presented with testicular mass, 3 (4.61%) with abdominal pain, 2 (3%) presented with hemoptysis and 1 (1.5%) with supraclavicular LNs. 17 (48.5%) of female patients presented with abdominal pain, 16 (45.7%) with abdominal lump, 1 (2.8%) with dysponea and 1 (2.8%) with irregular mensturation. Upfront surgery was performed in 45 (69.2%) cases and 20 (30.7%) were inoperable at presentation. 26 (40%) of patients presented with metastasis. 15 (33.33%) patients were in stage I, 19 (42%) in stage II and 11 (24.4%) in stage III among the operable cases respectively. Radiologically maximum tumor size was 21.6 cm and minimum size was 3 cm with median of 8 cm. Most common metastatic site was lung 7 (55.5%) followed by ascites 4 (22.2%), supraclavicular and inguinal LNs were 2 (11.11%) among metastatic cases. Average of AFP was 468, 1734 for HCG and 654 for LDH. Histopathologically 23% cases were teratoma out of which 33.3% were mature and 66.6% immature. 30.76% cases were seminoma and 20% nonseminoma, 18.4% cases constituted mixed germ cell tumor. Conclusion: Since Germ cell tumour is a heterogenous group of entity and as it is presented in an advanced stage, it is a challenge for Oncologists to give accurate and adequate treatment as most of the patients are young at presentation, still curable.
Abstract: 354: A case of paratesticular leiomyosarcoma: An institutional experience
P. V. Arunmohan
Ramaiah Medical College Hospital, Bengaluru, Karnataka, India, E-mail: [email protected]
Paratesticular sarcomas are rare neooplasms, which arising from testicular tunics, epididymis, spermatic cord, appendices and vaginal remnants are extremely rare. Para testicular masses is only 2-3% of all the scrotal masses. There's not much information regarding natural history, diagnosis criteria and treatment protocol. They are masses of indolent growth and most of them are benign. Here we present a case of 48 year old man with a history of painless enlargement of left testis. The ultrasound showed left scrotal mixed echoic hypervascular mass distorting the testis suspecting non seminomatous germcell tumour. Adjuvant radiation therapy is beneficial in para testicular leiomyosarcoma as locoregional failure reported is high. The patient underwent left high orchidectomy revealed left paratesticular tumour of spindle cell histology raised the possibility of benign smooth muscle tumour. The patient advised to undergo immunohistochemistry. Ki 67 index showed 10% of the tumour cells. The ECOG performance status of the patient was one and he was treated with 60 Gy in 30 fractions using IMRT technique as adjuvant therapy. PET CT was done which showed no obvious metabolically active residual or recurrent lesion and no metastatic disease. Such rare case has to be reported in medical literature for data acquisition and developing standard guidelines for the management in future.
Abstract: 359: Undetected cryptorchidism manifesting as a germ cell tumor in persistent Müllerian Duct syndrome
Bijjal Atreya, Joseph Sushil Rao, G. C. Raghunandan, Elvis Peter Joseph, Saloni Pawha
Mehdi Nawaz Jung Institute of Oncology Regional Cancer Institute, Hyderabad, Telangana, India, E-mail: [email protected]
Müllerian Inhibiting Substance/ Anti-Müllerian Hormone (AMH) is vital during the embryonic development and sexual differentiation of the fetus. Alterations to AMH or to the target receptors of AMH predisposes to Persistent Müllerian Duct Syndrome (PMDS). PMDS manifests as an autosomal recessive inheritance pattern presenting with cryptorchidism at infancy or childhood. Early detection of cryptorchidism and meticulous evaluation for PMDS is essential to preserve fertility and hinder malignant transformations of either the undescended testes or Müllerian remnants. We describe a 35-year-old gentleman who presented with a tender pelvic mass with a history of unsuccessful unilateral orchidopexy at 12 years of age in view of cryptorchidism. The pelvic mass was diagnosed with a germ cell tumor and responded effectively to neo-adjuvant chemotherapy. On surgical exploration for consented Retroperitoneal Lymph Node Dissection, a diagnosis of PMDS was made and confirmed on histology.
Abstract: 361: A clinical audit of image guided brachytherapy for locally advanced cervical cancer
Dinesh Makuny, C. P. Ranjith, M. P. Irfad, Mohammed Afzal, Shamsudheen Cholayil, M. Arunlal, Niyas Puzhakkal
MVR Cancer Centre and Research Institute, Kozhikode, Kerala, India, E-mail: [email protected]
Purpose and Objective(s): To assess the degree of compliance to the Image based brachytherapy guidelines proposed by the GEC-ESTRO group. Materials and Methods: A clinical audit was performed on 25 consecutive case of cervical cancer treated in the department during the period 2018-19. The 3D CT imaging was used to verify position of intrauterine tandem within uterine canal and they were graded as good, average or poor application depending on the position within the uterine cavity. The minimum equivalent doses in 2 Gy per fraction (EQD2) to point A or HRCTV should be 75-80 Gy. The maximum dose to OAR rectum 70-75 Gy (a/ß 3), sigmoid/bowel 70-75 Gy (a/ß 3) and bladder 90-95 Gy (a/ß 3). The clinical audit was conducted to see how much of compliance was attained to the pre-defined standards of care. Results: Stage 11B constituted over 90 percent of the cases. 90% of cases received 4 applications of 7Gy per fraction. The FIGO staging was upstaged in 30% of the cases in the MRI staging which was done in 90% of the cases for the initial staging. The initial MRI images served as a reference for the intermediate risk CTV and the clinical evaluation under spinal anaesthesia served as the surrogate for HRCTV delineations. The mean EQD2Gy was 82.55Gy (95 % should achieve minimum dose of 75 Gy EQD2 to point A/HRCTV of 75Gy). HRCTV contours were missing in over 50% of the cases. The sigmoid contours were missing in 50% percent of the cases and the Sigmoid maximum dose was 70Gy (1cc) and 67Gy (2cc). Conclusion: The dose constraints were well achieved as per the guidelines to the OARs. The EQD2Gy to the point A was achieved well above the recommended limits for stage 11B. The clinical audit showed poor detailing of the structures like the HRCTV, sigmoid colon in the contours delineated. The use of MR images in the fractionated brachytherapy applications was not undertaken due to it's limited utility and the costs involved. The vaginal dose points were not monitored in any of the plans as desired in the guidelines. A re-audit will be planned after 6 m after correcting the deficiencies especially the missing contours of sigmoid and the vaginal dose points.
Abstract: 372: A study on feasibility of organ preservation in muscle invasive urinary bladder cancer patients with intensity modulated radiotherapy with concurrent single agent cisplatin weekly
MNJIO RCC, Hyderabad, Telangana, India, E-mail: [email protected]
Purpose and Objective(s): The standard of care for muscle invasive bladder carcinoma (MIBC) in the United States for a long time was radical cystectomy where as in Europe, it is radical radiotherapy or multidrug regimen neoadjuvant chemotherapy followed by radiotherapy. In spite of the importance in terms of incidence, prognosis and cost, bladder cancer research remains significantly underfunded so the studies and data on organ preservation in MIBC in India are less and least explored. Objectives are locoregional response and disease free survival evaluation. Materials and Methods: We analyzed the data of 30 patients of MIBC at our Regional cancer center from 2016-2018 who underwent primary transurethral resection of bladder tumour (TURBT) followed by IMRT with 64.8 Gy and weekly cisplatin at a dose of 40 mg/m2 with median follow up of 10 months using inclusion and exclusion criteria. The role of various factors like tumour stage, histopathology, grade, complete TURBT, obstructive uropathy on locoregional response and disease free survival was evaluated. Local reactions were evaluated using CTCAE criteria version 5.0. Statistical analysis was done using SPSS version 23.0. Results: Demographic and disease characteristics:
Median – 68 yrs
Range – 52 – 80 yrs
Male – 86.7% (n=26)
Female – 13.3% (n=4)
Complete – 33.3% (n=10)
Incomplete – 66.7% (n=20)
Transitional – 86.6%(n=26)
Squamous – 6.7% (n=2)
ADENO CA – 6.7% (n=2)
Grade I - 6.7% (n=2)
Grade II - 26.6% (n=8)
Grade III - 66.7% (n=20)
6. Tumour stage:
T2 – 53.3 % (n=16)
T3 – 33.3 % (n=10)
T4 – 13.4 % (n=4)
7. Obstructive uropathy:
Present – 33.3 % (n=10)
Absent – 66.7% (n=20)
8. Locoregional response:
Complete – 73.3% (n=22)
Partial – 20% (n=6)
Progression – 6.7% (n=2).
After the treatment, the complete locoregional response was 73.3%. Early (T2 stage) tumours (p= 0.043) and patients without obstructive uropathy (p= 0.039) have shown significant locoregional response. Patients with complete TURBT, Low grade tumours have shown increased response though statistically not significant. The overall disease free survival in this study for the preserved bladder patients is 53.3%. Patients without obstructive uropathy have shown significant disease free survival of 70% (p=0.026). Improved DFS of patients with T2 stage tumours (75%), complete TURBT (60%), low grade tumours was observed though statistically not significant. Genito urinary toxicities like dysuria, burning micturition in 40% of patients followed by increased frequency of micturition in 20% of patients where as gastro intestinal toxicities like constipation (40%), pain abdomen (6.7%) were observed during followup and all these are grade I, II toxicities and managed well with supportive treatment. Conclusion: Bladder preservation in more than 70% of patients in this study supports the general concept of organ sparing treatment in oncology. The high response rate and DFS were observed in patients with complete TURBT, early stage tumours, no obstructive uropathy and low grade tumours. The genito urinary and gastro intestinal toxicities are comparatively less probably in view of using IMRT technique and single agent cisplatin.
Abstract: 386: Urachal carcinoma: A rare case report
Priyambat Dash, Jaiprakash Neema, Samarendra Dash
Apollo Hospitals International, Ahmedabad, Gujarat, India, E-mail: [email protected]
Purpose and Objective(s): Urachal carcinoma is rare and comprises 0.35 to 0.7% of all bladder cancers. Mostly it is adenocarcinoma. It arises from malignant transformation of rests of enteric epithelium in the urachus located between dome of the bladder and the umbilicus. We report a rare case of urachal carcinoma. Materials and Methods: A 76 years old male presented with complaints of swelling in lower abdomen associated with watery discharge for 3 months. On examination, there was a 10x8 cm hard, fixed, non-tender, non-pulsatile swelling at umbilical region and lower hypochondrium. An ultrasonography od abdomen was done which showed 10x6 cm solid lesion at umbilical region, involving lower abdominal wall with right inguinal lymphadenopathy. FNAC was done from right inguinal swelling, which showed metastasis of mucin secreting adenocarcinoma. Then CT scan showed 11.3x12.5x9.8 cm mass in midline extending from umbilicus and anterior abdominal wall and invades right rectus abdominis and dome of bladder, with 5.1x2x3.4 cm right inguinal enhancing lymph node. He underwent excision of mass with bladder wall and right inguinal node. The histopathology revealed high grade mucinous adenocarcinoma of urachus involving umbilical skin and bladder wall, with size 13.5x11.2x7.5 cm. The right inguinal node was positive for malignancy. He was delivered adjuvant radiotherapy by 3D-Conformal radiotherapy technique on Linear Accelerator with 6MV photon energy. A total dose of 50 Gy was given in 25 fractions to tumour bed, post-operative region and right inguinal region. Results: Patient is completely asymptomatic after 6 months. A PET-CT scan was done after 6 months, it showed no abnormality. Conclusion: Urachal carcinoma is an aggressive neoplasm. It recurs in 20-38% of patients, Surgery remains the mainstay of treatment. The role of adjuvant radiotherapy is not clear, but it has shown decrease in local recurrence rates with increased survival in some studies.
Abstract: 396: Long term disease control outcomes and predictors of relapse after moderately hypofractionated radiotherapy for high-risk localized prostate cancer
Shaurav Maulik, B. Arun, Indranil Mallick, Moses Arun Singh, Rimpa Achari, Santam Chakraborty, Sanjoy Chatterjee, Sriram Prasath
Tata Medical Centre, Kolkata, West Bengal, India, E-mail: [email protected]
Purpose and Objective(s): There is a paucity of data on long term outcomes with moderately hypofractionated radiotherapy (HypoRT) in high-risk localized prostate cancer. We report 5 year disease control outcomes in patients treated with long-term androgen deprivation therapy (ADT) and HypoRT. Materials and Methods: Patients with localized high risk prostate cancer were treated with a HypoRT regimen of 60Gy in 20 fractions over 4 weeks to the prostate with simultaneous elective irradiation of pelvic nodal volumes to a dose of 44Gy in 20 fractions. Androgen deprivation therapy comprised of either orchidectomy or medical ADT (total duration of two to three years) starting at least three months before radiation therapy. The disease control outcomes of the first 100 patients treated with this regimen were audited. The predictors of biochemical failure and distant metastases were analyzed. Results: The first 100 consecutive high risk patients treated with HypoRT between March 2012 and September 2015. Median follow up was 61 months. The crude number of biochemical relapses documented was 18. At biochemical progression, re-staging revealed distant metastases in 12 of 18 patients, 10 occurring within 3 years of HypoRT. Eight of 12 distant relapses involved non regional lymph nodes, and 5 of these were non regional adenopathy alone. Actuarial probability of remaining free from biochemical progression was 85% at 3 years and 79% at 5 years. Actuarial probability of freedom from local or pelvic nodal relapse / intra-pelvic nodal relapse at 5 years was 96% / 97% respectively. Of T stage, initial PSA, and Gleason score (GS), only GS>7 was found a significant prognosticator for biochemical control and distant metastases free survival. The majority (15 of 18) biochemical relapses occurred in the GS 8 and above group. Actuarial probability of biochemical control / freedom from distant metastases at 5 years was 90% / 93% versus 70% / 75% for GS 7 or less and GS 8 and above, respectively (p<0.01). In patients with GS 8 and above, actuarial probability of biochemical control / freedom from distant metastases at 5 years for permanent ADT with orchidectomy vs medical ADT for 2-3 years was 80% / 94% vs 55% / 60% respectively (p<0.01). Conclusion: Long term outcomes with HypoRT are at par with reported outcomes with standard fractionation in high risk disease, and can be considered a standard. There was excellent intrapelvic control. Gleason score 8 and above disease had worse outcomes, driven by development of metastases. The duration of ADT affected biochemical failure and metastases. It's impact on overall survival is being investigated.
Abstract: 416: Transrectal ultrasound guided high dose rate-one step brachytherapy boost in localized carcinoma of prostate
Vivek Anand, Sudesh Deshpande, Kannan Venkatesan, Suresh Naidu, Vinod Joshi, Ranjeet Bajpai, Ritika Harjani-Hinduja, Rohit Kabre, Kamalnayan Chauhan, Priyanka Alurkar
P. D. Hinduja Hospital and MRC, Mumbai, Maharashtra, India, E-mail: [email protected]
Purpose and Objective(s): Escalated radiation dose delivery has been the mainstay in tumor control of localized prostate cancer. Combined treatment by external beam radiotherapy (EBRT) and high-dose-rate brachytherapy boost (HDR-BT) in locally advanced prostate carcinoma has shown that dose escalation is possible for better tumor control and with fewer normal tissue complications. Materials and Methods: From 2009 to 2017, 70 patients with diagnosed adenocarcinoma of prostate were assigned to EBRT followed by HDR-BT. Patients were stratified as low, intermediate and high risk according to D'amico risk group stratification of prostate cancer. All 70 patients received androgen deprivation therapy, either short (six months) or long term (1- 2 years) according to the risk stratification. All patients received one or two fractions (8-15 Gy) of TRUS guided HDR brachytherapy boost by using TRUS guided one-step procedure (TRUS images are used for planning HDR-BT) either following EBRT doses of 37.75 to 60 Gy or prior to it. Overall survival (OS) and Biochemical recurrence-free survival (BRFS) were the primary endpoints. Secondary endpoints were, late Gastro-intestinal (GI) and Genito-urinary (GU) complications. Biochemical recurrence was defined according to the phoenix definition1. Results: Mean age of the patients was 69.4 years (49-84). Out of 70 patients, 8 (11.4%) were of intermediate risk and 62 (88.6%) patients of high-risk prostate cancer. After a median follow up of 55 months (7-111), one of 8 (92%) patients had failed biochemical control and OS was 8 of 8 (100%) in the intermediate risk group, 57 (91.9%) patients had BRFS and OS in 47 (75.8%) of the 62 patients among the high-risk group., GI complications of Grade (Gr) I were seen in 1.4%, Gr III in 1.4% of patients and GU complications of Gr I & II were seen in 42.8% and Gr III in 7.1% in the combined intermediate and high risk groups. Conclusion: Combination of HDR-BT and EBRT along with either with short- or long-term ADT achieves better dose escalation than any other modality in the radical radiotherapy of intermediate and high risk localised prostate cancer and could be an effective modality to achieve cost effective treatment for patients and healthcare system. With data suggesting substantial increase in long term biochemical relapse-free survival, reduced acute morbidity and no increase in late toxicity, our results con?rm that adding HDR-BT as a boost should be considered for intermediate and high-risk prostate cancer patients in future.
Abstract: 455: Squamous cell carcinoma of kidney
Dipen Mistry, U. Suryanarayan Sir, Ankita Parikh, Maitrik Mehta, Sonal Patel, Niketa Thakur, Jyoti Podar, Pooja Nandwani
Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India, E-mail: [email protected]
Introduction: Squamous cell carcinoma of primary renal origin is very rare as it presents in 0.5%-0.8% of all renal malignant tumors of renal origin. It poses diagnostic challenge due to its rarity and patients usually present in a advance stage. Only a single case of primary squamous cell carcinoma is reported till date to the best of our knowledge. So we are reporting a case of squamous cell carcinoma of kidney owing to its rarity. Case Report: A 37 year old male presented with complaints of abdominal pain for 3 months, vomiting, Renal angle swelling and fever for 20 days. Patient didn?t complain of hematuria, weight loss. Ultrasound showed a calculus in right kidney and was operated for the same. Patient had persistent symptoms. Further evaluation by computed tomography of thorax, abdomen & pelvis, which showed lesion in lower pole of right kidney, soft tissue lesion in right posterolateral abdominal wall with bilateral infraclavicular, axillary & paraaortic lymnode enlargement with multiple nodules in both lung. Biopsy was taken from renal mass as well as skin lesion. Biopsy and IHC showed squamous cell carcinoma, moderately differentiated. So for this conservative management was given and Palliative radiotherapy (30Gy/10#) to local renal mass and skin lesion was given, for management of pain. Discussion: Squamous cell carcinoma of renal pelvis is very rare (0.5-0.8%). Most common mechanism of development is chronic irritation, long term inflammation & infection. Long standing nephrolithiasis is the most common risk factor. Common age of presentation is 40-70 years with complains of abdominal pain, vomiting, abdominal mass, hematuria & weight loss. Radiologically seen as mass lesion in kidney with features of hydronephrosis & calcifications. Biopsy usually shows moderately or poorly differentiated squamous cell carcinoma, which usually invades paranephric tissue, muscle and skin also. So most of times it presents in a advance stage. Data regarding primary renal SCC is inadequate, it needs further evaluation.