ABSTRACT
AIM: To assess the prognostic value of magnetic resonance imaging (MRI) before salvage high-intensity focused ultrasound (HIFU) for locally recurrent prostate cancer after external-beam radiotherapy (EBRT). MATERIALS AND METHODS: Forty-six patients who underwent prostate MRI before salvage HIFU for locally recurrent prostate cancer after EBRT were retrospectively studied. HIFU failure was defined as a prostate-specific antigen (PSA) value >nadir + 2 ng/ml (Phoenix criteria) or positive follow-up biopsy or initiation of any other salvage therapy. The following prognostic parameters were assessed: neoadjuvant hormone therapy, clinical stage and Gleason score of recurrence, PSA level and velocity at HIFU treatment, and six MRI-derived parameters (prostate volume, tumour volume, extracapsular extension, seminal vesicle invasion, tumour extension into the apex or anterior to the urethra). RESULTS: Two factors were significant independent predictors of salvage HIFU failure: the PSA level at HIFU treatment (p < 0.012; risk ratio: 1.15, 95% CI: 1.03-1.29) and the tumour extension anterior to the urethra, as assessed by MRI (p = 0.046, risk ratio: 2.51, 95% CI: 1.02-6.16). CONCLUSION: The location of cancer recurrence anterior to the urethra on MRI is an independent significant predictor of salvage HIFU failure for locally recurrent prostate cancer after EBRT. Therefore, MRI may be useful for patient selection before post-EBRT salvage HIFU ablation.
Subject(s)
High-Intensity Focused Ultrasound Ablation/methods , Neoplasm Recurrence, Local/therapy , Prostatic Neoplasms/therapy , Salvage Therapy/methods , Humans , Magnetic Resonance Imaging , Male , Neoplasm Recurrence, Local/radiotherapy , Prognosis , Prostate-Specific Antigen/metabolism , Prostatic Neoplasms/blood , Prostatic Neoplasms/radiotherapy , Retrospective StudiesSubject(s)
AIDS-Related Opportunistic Infections/complications , Colitis/complications , Cytomegalovirus Infections/complications , HIV Infections/complications , Wernicke Encephalopathy/etiology , AIDS-Related Opportunistic Infections/pathology , Colitis/pathology , Colitis/virology , Cytomegalovirus Infections/pathology , Fatal Outcome , HIV Infections/pathology , HIV-1 , Humans , Male , Middle Aged , Thiamine Deficiency/complications , Thiamine Deficiency/pathology , Wernicke Encephalopathy/pathology , Wernicke Encephalopathy/virologySubject(s)
Aneurysm, Ruptured/complications , Hematemesis/etiology , Splenic Artery , Aneurysm, Ruptured/diagnostic imaging , Aneurysm, Ruptured/surgery , Child , Humans , Male , Splenectomy , Splenic Artery/diagnostic imaging , Splenic Artery/surgery , Tomography, X-Ray Computed , Treatment Outcome , Ultrasonography, DopplerABSTRACT
BACKGROUND AND PURPOSE: Neuroglial cysts are uncommon congenital lesion with own wall, which can be confined into or outside the central nervous system. In the central nervous system the cyst is located commonly in the brain. Spinal intramedullary neuroglial cyst are exceptional. Our objective is to present a case of intramedullary neuroglial cyst, to discuss the differentiels diagnosis and to show difficulties of its medical taking care. CASE REPORT: A 60 year-old man, without past history, was admitted to the hospital with a compression of conus medullaris since one year. The clinical examination revealed paraparesis and genito-sphincterian disorders. MRI of the spine revealed intramedullary cyst at T12-L1 level. The patient underwent cystic evacuation, a large marsupialization of the cavity and a wall biopsy. Histopathological examination confirmed the diagnosis of neuroglial cyst. The postoperative outcome was favourable with a partial improvement of motor weakness. Postoperative MRI showed a persistent residual cavity. CONCLUSION: Neuroglial intramedullary cyst is uncommon. It is a benign lesion. Complete surgical resection is very difficult seen the absence of defined plan cleavage.