S842ESTRO 37Therefore, a systematic review on acute and late toxicity after postoperative HFRT was performed.Even outcome data in terms of local control (LC), overall survival (OS), and biochemical relapse-free survival (bRFS) were analyzed. Material and MethodsA systematic search based on PRISMA methodology was performed using PubMed.Only studies published in English reporting clinical results (toxicity and outcome) after adjuvant or salvage HFRT were included. ResultsA total of 1205 patients from 17 eligible studies were included.These retrospective (7) or prospective (10) studies had heterogeneous characteristics in terms of dose, fractionation, target definition, and combination with hormonal therapy.Median follow-up ranged between 11.5 and 111 months (median: 30.0 months).No case of grade ≥ 3 acute gastrointestinal (GI) toxicity was recorded.Grade ≥ 3 acute genitourinary (GU) toxicity ranged between 0.0% and 3.0% (median: 0%).Crude and actuarial rates of grade ≥ 2 late GI toxicity were 0.0% -8.7% (median: 3.8%) and 1.1% at 5-year, respectively.Crude and actuarial rates of grade ≥ 2 late GU toxicity were 0.0% -66.0%(median: 12.0%) and 7.3% at 5 years.LC was reported in only three studies: 93.7% as crude rate, and 69.0% and 94.9% at 5 years.Crude and actuarial rates of OS were 96.4% and 100% (median: 98.5%) and 91.0% at 10 years and 100% at 5 years.Actuarial rates of bRFS ranged between 83.7% and 92.0% at 1 year, 72.9 % and 83.0% at 2 years, and 74.0% and 94.0% (median: 84.0%), 67.0% and 75.0%, 86.5% at 3, 4 and 5 years, respectively. ConclusionAcute toxicity does not seem to be increased in patients with PCa receiving HFRT after radical prostatectomy (RP).Results in terms of late GU toxicity are conflicting and therefore further prospective studies are needed to clarify this issue before including postoperative HFRT in clinical practice.

Purpose/Objective(s)To analyze dosimetric parameters of patients candidates for adjuvant breast radiation therapy (RT) in the prone versus supine position.Materials/MethodsThirty-nine patients candidates for adjuvant breast RT with large and pendulous breasts, 23 right and 16 left sided, were included in the present study after obtaining informed consent. Age ranged from 30 to 74 (median 55 years) and BMI from 20 to 32 (median 24.2). All patients underwent CT-simulation in both prone and supine position. Clear-Vue breast board was used for prone and the breast Posiboard for supine patient setup. Target volumes and OARs (ipsilateral lung, heart, and left anterior descending [LAD] coronary artery for left sided breast) were outlined on CT simulation slices with 5 mm thickness. CTV was defined as the gland breast tissue starting 5 mm below the skin. PTV was obtained adding 5 mm margin to the CTV posteriorly and 10 mm cranial-caudally. The prescribed dose to the ICRU point was 50 Gy. Treatment plans were developed by applying 6-15 MV tangential photon fields. Dose homogeneity within the PTV was defined by the volume receiving at least 47.5 Gy but not less than 53.5 Gy (V95%-107%). Radiation exposure of the OARs (the volume of the ipsilateral lung, heart receiving more than 5 Gy, 10 Gy, and 20 Gy [V5 Gy, V10 Gy and V20 Gy], and the mean and maximum dose to the LAD) were registered in both positions.ResultsThe mean CTV in prone position (468 cc) was significantly larger than that in supine position (432 cc) (p = 0.02). PTV coverage in supine position (mean V95% = 98.0 ± 1.6) was significantly more homogeneous than in prone position (mean V95% = 96.5 ± 3.5; p = 0.04). Dmin, Dmean, Dmax, V105%, and V107% were not significantly different between the two setup positions. The lung V5, V10, and V20 were significantly less (p < 10−6) in prone than in supine position. The heart V5 Gy, V10 Gy, V20 Gy, and LAD Dmean and Dmax (analyzed in 16 left sided tumor patients) were less in prone than in supine position, but the difference was not statistically significant. The heart Dmax in patients with right breast was significantly lower in prone than in supine position (p = 0.001). Based on planning data and on patients' compliance, 27/39 patients (70%) were treated in prone position.ConclusionsProne position may offer an advantageous alternative for irradiation of mammary gland in patients with large and pendulous breasts in particular for lung tissue. The decreased dose in the OARs suggests that prone position could be useful also in patients with pulmonary and cardiac comorbidity. Purpose/Objective(s)To analyze dosimetric parameters of patients candidates for adjuvant breast radiation therapy (RT) in the prone versus supine position. To analyze dosimetric parameters of patients candidates for adjuvant breast radiation therapy (RT) in the prone versus supine position. Materials/MethodsThirty-nine patients candidates for adjuvant breast RT with large and pendulous breasts, 23 right and 16 left sided, were included in the present study after obtaining informed consent. Age ranged from 30 to 74 (median 55 years) and BMI from 20 to 32 (median 24.2). All patients underwent CT-simulation in both prone and supine position. Clear-Vue breast board was used for prone and the breast Posiboard for supine patient setup. Target volumes and OARs (ipsilateral lung, heart, and left anterior descending [LAD] coronary artery for left sided breast) were outlined on CT simulation slices with 5 mm thickness. CTV was defined as the gland breast tissue starting 5 mm below the skin. PTV was obtained adding 5 mm margin to the CTV posteriorly and 10 mm cranial-caudally. The prescribed dose to the ICRU point was 50 Gy. Treatment plans were developed by applying 6-15 MV tangential photon fields. Dose homogeneity within the PTV was defined by the volume receiving at least 47.5 Gy but not less than 53.5 Gy (V95%-107%). Radiation exposure of the OARs (the volume of the ipsilateral lung, heart receiving more than 5 Gy, 10 Gy, and 20 Gy [V5 Gy, V10 Gy and V20 Gy], and the mean and maximum dose to the LAD) were registered in both positions. Thirty-nine patients candidates for adjuvant breast RT with large and pendulous breasts, 23 right and 16 left sided, were included in the present study after obtaining informed consent. Age ranged from 30 to 74 (median 55 years) and BMI from 20 to 32 (median 24.2). All patients underwent CT-simulation in both prone and supine position. Clear-Vue breast board was used for prone and the breast Posiboard for supine patient setup. Target volumes and OARs (ipsilateral lung, heart, and left anterior descending [LAD] coronary artery for left sided breast) were outlined on CT simulation slices with 5 mm thickness. CTV was defined as the gland breast tissue starting 5 mm below the skin. PTV was obtained adding 5 mm margin to the CTV posteriorly and 10 mm cranial-caudally. The prescribed dose to the ICRU point was 50 Gy. Treatment plans were developed by applying 6-15 MV tangential photon fields. Dose homogeneity within the PTV was defined by the volume receiving at least 47.5 Gy but not less than 53.5 Gy (V95%-107%). Radiation exposure of the OARs (the volume of the ipsilateral lung, heart receiving more than 5 Gy, 10 Gy, and 20 Gy [V5 Gy, V10 Gy and V20 Gy], and the mean and maximum dose to the LAD) were registered in both positions. ResultsThe mean CTV in prone position (468 cc) was significantly larger than that in supine position (432 cc) (p = 0.02). PTV coverage in supine position (mean V95% = 98.0 ± 1.6) was significantly more homogeneous than in prone position (mean V95% = 96.5 ± 3.5; p = 0.04). Dmin, Dmean, Dmax, V105%, and V107% were not significantly different between the two setup positions. The lung V5, V10, and V20 were significantly less (p < 10−6) in prone than in supine position. The heart V5 Gy, V10 Gy, V20 Gy, and LAD Dmean and Dmax (analyzed in 16 left sided tumor patients) were less in prone than in supine position, but the difference was not statistically significant. The heart Dmax in patients with right breast was significantly lower in prone than in supine position (p = 0.001). Based on planning data and on patients' compliance, 27/39 patients (70%) were treated in prone position. The mean CTV in prone position (468 cc) was significantly larger than that in supine position (432 cc) (p = 0.02). PTV coverage in supine position (mean V95% = 98.0 ± 1.6) was significantly more homogeneous than in prone position (mean V95% = 96.5 ± 3.5; p = 0.04). Dmin, Dmean, Dmax, V105%, and V107% were not significantly different between the two setup positions. The lung V5, V10, and V20 were significantly less (p < 10−6) in prone than in supine position. The heart V5 Gy, V10 Gy, V20 Gy, and LAD Dmean and Dmax (analyzed in 16 left sided tumor patients) were less in prone than in supine position, but the difference was not statistically significant. The heart Dmax in patients with right breast was significantly lower in prone than in supine position (p = 0.001). Based on planning data and on patients' compliance, 27/39 patients (70%) were treated in prone position. ConclusionsProne position may offer an advantageous alternative for irradiation of mammary gland in patients with large and pendulous breasts in particular for lung tissue. The decreased dose in the OARs suggests that prone position could be useful also in patients with pulmonary and cardiac comorbidity. Prone position may offer an advantageous alternative for irradiation of mammary gland in patients with large and pendulous breasts in particular for lung tissue. The decreased dose in the OARs suggests that prone position could be useful also in patients with pulmonary and cardiac comorbidity.

Open pyeloplasty has been considered the referral standard of treatment for ureteropelvic junction obstruction (UPJO). Minimally invasive procedures, however, have evolved and have gradually replaced open surgery, with various success and complication rates. The ideal universal treatment for UPJO is still elusive and controversial.The current status of three surgical approaches to the treatment of UPJO are reviewed: laparoscopic pyeloplasty (LP), robotic-assisted pyeloplasty, and endopyelotomy.The interactive discussion among the expert presenters and urologists participating at the Second Congress on Controversies in Urology in Lisbon, Portugal, is summarized.A review of the relevant literature and the experts’ opinions seem to indicate that LP, either conventional or robotic, should be considered as the treatment of choice for UPJO, because it achieves the highest success rates (90%) while still offering the patient the advantages of minimally invasive surgery. The conventional laparoscopic approach demands a high level of surgical expertise and dedicated training that can be partially obviated by the robotic system. Evidence proving clear advantages of robotic pyeloplasty over conventional laparoscopy, however, is lacking due to short follow-up. Additionally, in its current version, the robotic system is financially prohibitive for many centers worldwide.In experienced hands, endopyelotomy performed either percutaneously or by the retrograde ureteroscopic approach can achieve long-standing satisfactory results in carefully selected patients (short strictures, minimal hydronephrosis, no crossing vessel). Additionally, endopyelotomy is the procedure of choice for failed pyeloplasty, with success rates of up to 80%.It can be concluded from the presented data that, given the surgical expertise, LP should be considered the current standard of care for UPJO, with high success rates comparable to the open procedure. The advantages of the robotic system for the patient remain to be proved by scientific data. Endopyelotomy is still indicated in selected cases as a primary therapeutic option and should be considered the procedure of choice for pyeloplasty failures.

ObjectivesProstate and breast cancer share many similarities: high lifetime prevalence, increasing frequency, role of environmental factors, long survival also in metastatic disease and possibility of screening. The aim of this work is to evaluate the characteristics related to the patients, disease and treatment which can affect HRQoL at the beginning and after radiotherapy.Methodssince June 2009, we have recruited patients, providing informed consent, before radiotherapy (T0). We assess demographic characteristic (age, qualification, work, marital status…); neoplastic staging and grading; radiation dose and other antineoplastic treatment (hormonal/chemio-therapy or surgery); concomitant medical disease and pharmacological therapy. We evaluate HRQoL by EORTC-QLQ-C30 and EORTC-QLQ-PR25 (prostate-specific) or EORTC-QLQ-BR23 (breast-specific). The protocol also includes HADS, Paykel Life Events Scale and EPQ-R. The work is ongoing and implies a follow-up at 6 and 12 months (T1/T2).ResultsThe majority of men have a localized disease with Gleason score between 6 and 8 and the median pretreatment PSA is 10.52 ng/mL; 70% will undergo adjuvant-RT; median age is 69.30 years. Women have a median age of 58.46 years, all underwent surgery and all have a localized disease and positive receptorial status. Global QoL is lightly higher in the man sample; both groups report a major deficit at Emotional Function and high levels of Fatigue. The personological characteristic more represented is “Extravertion”.ConclusionsThe results show an association between worse QoL, “Nevroticism” and high Anxiety levels only in the men sample at T0. At the moment, there is no significant relation in the women sample.

PURPOSE:To analyze the feasibility of intraoperative radiotherapy (IORT) in patients with high-risk prostate cancer and candidates for radical prostatectomy. METHODS AND MATERIALS:A total of 38 patients with locally advanced prostate cancer were enrolled. No patients had evidence of lymph node or distant metastases, probability of organ-confined disease >25%, or risk of lymph node involvement >15% according to the Memorial Sloan-Kettering Cancer Center Nomogram. The IORT was delivered after exposure of the prostate by a dedicated linear accelerator with beveled collimators using electrons of 9 to 12 MeV to a total dose of 10-12 Gy. Rectal dose was measured in vivo by radiochromic films placed on a rectal probe. Adminstration of IORT was followed by completion of radical prostatectomy and regional lymph node dissection. All cases with extracapsular extension and/or positive margins were scheduled for postoperative radiotherapy. Patients with pT3 to pT4 disease or positive nodes received adjuvant hormonal therapy. RESULTS:Mean dose detected by radiochromic films was 3.9 Gy (range, 0.4-8.9 Gy) to the anterior rectal wall. The IORT procedure lasted 31 min on average (range, 15-45 min). No major intra- or postoperative complications occurred. Minor complications were observed in 10/33 (30%) of cases. Of the 27/31 patients who completed the postoperative external beam radiotherapy, 3/27 experienced Grade 2 rectal toxicity and 1/27 experienced Grade 2 urinary toxicity. CONCLUSIONS:Use of IORT during radical prostatectomy is feasible and allows safe delivery of postoperative external beam radiotherapy to the tumor bed without relevant acute rectal toxicity.