Aims:The incidental dose to the internal mammary nodes (IMN) is understudied in patients treated with newer radiation therapy (RT) techniques. The aim of this study was to quantify the incidental IMN dose in a series of breast cancer (BC) patients receiving post-operative RT to the chest wall/breast and regional nodes (level III-IV). Methods:We retrospectively analyzed data from 95 high-risk BC patients treated between 2015 and 2022. Patients received RT (50 Gy/25fr or 40.05 Gy/15fr) to the breast/chest wall and nodal levels III-IV after mastectomy or breast conserving surgery (BCS). Exclusion criteria were IMN irradiation and pre-operative systemic therapy. One radiation oncologist contoured the CTV_IMN according to ESTRO guidelines and divided it into four sub-regions based on intercostal spaces (ICS): IMNupper, ICS1, ICS2, ICS3. Dosimetric parameters collected were Dmean, V90, V95, D90, and D95. The Dmean was correlated to tumor laterality and location, type of surgery and reconstruction, RT technique (3D-CRT, IMRT, helical RT) and boost. Results:Mean Dmean to IMN was 71.4 % (range 19.6-118.6) of the prescription dose. Among sub-region, ICS2 and ICS3 received significantly higher doses than ICS1 and IMN upper (p = 0.04). V90 of over 90 % was achieved in only 4/95 patients, 3 were treated with helical RT, and the other with IMRT. The mean V95 and V90 were 15.4 % and 26.2 % respectively. Univariate analysis showed that mastectomy (p = 0.002), omission of boost (p = 0.001), and helical RT (p < 0.0001) were associated with significantly higher IMN Dmean. No significant correlation emerged with laterality, tumor location and type of reconstruction. Conclusions:In our series, incidental IMN doses were highest after mastectomy and with helical RT delivery, possibly due to more medial margin in chest wall delineation and the helical dose distribution. Nevertheless, incidental doses to the IMN were below recommended doses, thus highlighting the need for IMN contouring when identified as targets.

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction II (MP63)1 Sep 2021MP63-13 URINARY DISTURBANCES AND PRESSURE-FLOW STUDY PATTERNS IN FEMALE MIXED URINARY INCONTINENCE Antonella Giannantoni, Marilena Gubbiotti, Matteo Balzarro, Emanuele Rubilotta, Raffaele Balsamo, Vito Mancini, Giuseppe Carrieri, Antonio Carbone, Antonio Pastore, and Vittorio Bini Antonella GiannantoniAntonella Giannantoni More articles by this author , Marilena GubbiottiMarilena Gubbiotti More articles by this author , Matteo BalzarroMatteo Balzarro More articles by this author , Emanuele RubilottaEmanuele Rubilotta More articles by this author , Raffaele BalsamoRaffaele Balsamo More articles by this author , Vito ManciniVito Mancini More articles by this author , Giuseppe CarrieriGiuseppe Carrieri More articles by this author , Antonio CarboneAntonio Carbone More articles by this author , Antonio PastoreAntonio Pastore More articles by this author , and Vittorio BiniVittorio Bini More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002103.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The assessment of mixed urinary incontinence (MUI) is based on patients’ reported symptoms, without consideration of physical and urodynamic results. Currently, no consistent information on voiding symptoms and pressure-flow (P/F) study are available on females affected by MUI. METHODS: In a multicentre, prospective study women presenting with a clinical history of MUI were classified into 3 sub-groups: stress-predominant or urge-predominant MUI (S-MUI; U-MUI) or MUI with equal symptoms’ presentations (E-MUI) and underwent physical examination, 3-day voiding diary and pressure flow-study. Projected Isovolumetric Pressure 1 (PIP1; normal range: 30-78 cmH20) and intubated flow Bladder Voiding Efficiency (IF-BVE) investigated detrusor contractility. Detrusor underactivity (DU) was defined as PIP <30 cmH20 and IF-BVE <90 %. Blaivas-Groutz nomogram was used to detect bladder outlet obstruction (BOO). A multivariate, logistic, regression analysis was applied to identify any predictive variables for the 3 MUI sub-groups. RESULTS: 144 women were evaluated: 74 with S-MUI, 66 with U-MUI, 4 with E-MUI (the latter were excluded from the analysis). Overall, reduced PIP and IF-BEV were observed in 31.2 and 15.6% of cases, respectively. PIP was significantly lower in S-MUI than in U-MUI (Table). No relationships were found between PIP, IF-BEV and voiding symptoms. Predictive variables for reduced PIP were urethral hypermobility: OR= 2.23, 95% C.I.=1.06-4.7, p=0.05, and positive Valsalva Leak Point Pressure: OR=3.01, 95%, C.I=1.34-6.8, p=0.011). CONCLUSIONS: Women with MUI have not negligible proportions of reduced detrusor contractility. Difference in the two measuring instruments can explain discrepant DU rates. Reduced PIP appears to be linked to urethral hypermobility and positive VLPP, both expression of low urethral resistance. Bladder behaviour in MUI is more complex than we previously hypothesized; detailed information would be required when these women are scheduled for anti-incontinence surgery. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1106-e1107 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Antonella Giannantoni More articles by this author Marilena Gubbiotti More articles by this author Matteo Balzarro More articles by this author Emanuele Rubilotta More articles by this author Raffaele Balsamo More articles by this author Vito Mancini More articles by this author Giuseppe Carrieri More articles by this author Antonio Carbone More articles by this author Antonio Pastore More articles by this author Vittorio Bini More articles by this author Expand All Advertisement PDF downloadLoading ...

OBJECTIVES:Immunological parameters exert a relevant diagnostic and prognostic role in primary Sjögren's syndrome (pSS) and may identify specific disease phenotypes. Among disease-associated immunological features, anti-La/SSB are rarely found without concomitant anti-Ro/SSA and their clinical significance in patients with pSS has been poorly investigated. Thus, we aimed to characterise the value of anti-La/SSB analysing clinical and serologic features of a wide cohort of pSS patients with both circulating anti-Ro/SSA and positive salivary gland biopsy (SGB).METHODS:Clinical and serological data of 600 pSS patients with both anti-Ro/SSA and SGB positivity and categorised according to anti-La/SSB status were retrospectively analysed. Comparisons between patients with and without circulating anti-La/SSB were performed.RESULTS:Among the whole cohort, 319 (53%) of patients were anti-La/SSB negative and 281 (47%) were anti-La/SSB positive. Anti-La/SSB positive patients were younger at disease diagnosis and had a longer disease duration. Moreover, anti-La/SSB positive patients had a higher prevalence of hypergammaglobulinaemia and circulating rheumatoid factor and of lymphoproliferative disorders in comparison to seronegative group. At multivariate analysis, hypergammaglobulinaemia (OR=1,7; 95% CI 1.17, 2.43), rheumatoid factor (OR=2.3; 95% CI 1.6, 3.3) and lymphoma (OR=2.6; 95% CI 1.12, 5.96) were identified as independent variables significantly associated with anti-La/SSB positivity.CONCLUSIONS:In patients with pSS and concomitant anti-Ro/SSA and SGB positivity, the presence of anti-La/SSB may help in identifying a disease subset with distinct prognostic features, especially in terms of higher risk of lymphoproliferative complications.

Metastasis-directed therapy (MDT) is an investigational treatment option in patients with oligorecurrent prostate cancer (PCa). The aim of this retrospective study is to report oncologic outcome and toxicity of elective nodal radiotherapy (ENRT) in PCa patients affected by pelvic nodal oligorecurrence. 41 consecutive patients were treated with salvage radiotherapy. At biochemical recurrence after primary treatment, oligorecurrent disease was detected by positron emission tomography (PET) in 94% of the patients. Image-guided intensity modulated radiation therapy (IMRT) was delivered using tomotherapy. 83% of the patients received androgen deprivation therapy (ADT) in combination with ENRT. Survival analysis was performed with Kaplan–Meier method, log-rank test was used to analyze associations between survival end-points and clinical parameters. Multivariate analysis was performed using Cox proportional hazards regression models. Toxicity was registered according to Common Terminology Criteria for Adverse Events (CTCAE) v4.0. The median at follow-up was 33.6 months. At 3 years, overall survival (OS), cancer-specific survival (CSS), and biochemical progression-free survival (b-PFS) were 89%, 92%, and 53%, respectively. At univariate analysis, all survival end-points were correlated with the number of positive pelvic lymph nodes at oligorecurrence (≤ 3 vs > 3). Biochemical-PFS was correlated with PSA (p = 0.034) and PSA doubling time (p = 0.004) at oligorecurrence. At multivariate analysis, no independent variable was statistically significant. No patient experienced grade ≥ 2 late toxicity after radiotherapy. The number of metastatic lymph nodes and PSA doubling time seems to be important prognostic factors in the pelvic oligorecurrent setting. Salvage radiotherapy combined with short-course ADT might be a valid treatment strategy.

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Purpose Fasting blood homocysteine is increased in PCOS women and is involved in several of its co-morbidities including cardiovascular disease and infertility. Corrective interventions based on the administration of supra-physiologic doses of folic acid work to a low extent. We aimed to test an alternative approach. Methods This was a prospective, randomized, parallel group, open label, controlled versus no treatment clinical study. PCOS women aged > 18, free from systemic diseases and from pharmacological treatments were randomized with a 2:1 ratio for treatment with activated micronutrients in support to the carbon cycle (Impryl, Parthenogen, Switzerland— n = 22) or no treatment ( n = 10) and followed-up for 3 months. Fasting blood homocysteine, AMH, testosterone, SHBGs, and the resulting FTI were tested before and at the end of the follow-up. Results The mean baseline fasting blood homocysteine was above the normal limit of 12 μMol/L and inversely correlated with SHBG. AMH was also increased, whereas testosterone, SHBG, and FTI were within the normal limit. The treatment achieved a significant reduction of homocysteine, that did not change in the control group, independently of the starting value. The treatment also caused an increase of AMH and a decrease of SHBGs only in the subgroup with a normal homocysteine at baseline. Conclusions In PCOS ladies, blood homocysteine is increased and inversely correlated with the SHBGs. Physiologic amounts of activated micronutrients in support to the carbon cycle achieve a reduction virtually in all exposed patients. Whether this is of clinical benefit remains to be established.