[Radium 223 in castration resistant prostate cancer.] / Radio 223 en cáncer de próstata resistente a la castración.

OBJECTIVE: To analyze the available evidence on Radium 223 therapy, an alfa particle emitter with specific action on bone metastases, studied on patients with castration resistant prostate cancer. EVIDENCE ACQUISITION: We review the pivotal study ALSYMPCA, that served to get the drug approval for this phase of the disease, and the new data obtained from its use. We also performed a search of ongoing studies with Radium 223 alone or in combination with other molecules. EVIDENCE SINTHESIS: According to the ALSYMPCA study, Radium 223 significantly prolongs the overall survival of patients with castration resistant prostate cancer and bone metastases; approximately 3.6 months in comparison with patients who received placebo, which turns into a median life expectancy of 14.9 months, and a 36-month survival of 46%, associated with a 30% reduction in death risk. Overall survival results were consistent both in patients who receive Docetaxel previously and those who did not. RESULTS: for secondary variables support the positive effect of Radium 223 therapy on symptomatic skeletal events (for example, the use of external beam radiotherapy to alleviate pain) and bone markers, confirming its efficacy in bone metastases. CONCLUSIONS: Radium 223 is the first treatment directed to bone that has demonstrated significant improvement on overall survival. It also prolonged the time to the first skeletal event and the median time to PSA increase significantly. All this in addition to its manageable adverse effects, lower than those appeared in the placebo arm of the pivotal study ALSYMPCA.

Radio 223 en cáncer de próstata resistente a la castración / Radium 223 in castration resistant prostate cancer

OBJETIVO: Analizar la evidencia disponible del tratamiento con Radium-223, emisor de partículas alfa con acción específica sobre las metástasis óseas, estudiado en pacientes con cáncer de próstata resistente a la castración. Adquisición de la evidencia: Revisión del estudio pivotal ALSYMPCA, que sirvió para conseguir la aprobación del fármaco en esta fase de la enfermedad, y los nuevos datos obtenidos a partir del uso del mismo. También, hacer una búsqueda de los estudios en marcha con Radium-223, solo o en combinación con otras moléculas. Síntesis de la evidencia: Radium-223 según los resultados del estudio ALSYMPCA prolonga de forma significativa la supervivencia global en pacientes con cáncer de próstata resistente a la castración y metástasis óseas; aproximadamente 3,6 meses respecto a los tratados con placebo, lo que se traduce en una mediana de esperanza de vida de 14,9 meses, y una supervivencia a los 36 meses del 46% de los pacientes, asociado a una reducción del 30% en el riesgo de muerte. Los resultados de la variable supervivencia global, fueron consistentes tanto en pacientes que habían recibido previamente Docetaxel como en aquellos que no lo habían recibido. Los resultados de las variables secundarias apoyan el efecto positivo del tratamiento con Radium-223 en los eventos óseos sintomáticos (por ejemplo, el uso de la radioterapia externa para aliviar el dolor) y en los marcadores óseos, confirmando su eficacia en las metástasis óseas. CONCLUSIONES: Radium-223 es el primer tratamiento dirigido al hueso que ha demostrado mejoría significativa en supervivencia global. También prolongó de forma significativa, el tiempo hasta el primer evento óseo y la mediana de tiempo hasta aumento de PSA. Todo ello con unos efectos adversos manejables e inferiores a los producidos en el brazo placebo del estudio pivotal ALSYMCA

OBJECTIVE: To analyze the available evidence on Radium 223 therapy, an alfa particle emitter with specific action on bone metastases, studied on patients with castration resistant prostate cancer. Evidence acquisition:We review the pivotal study ALSYMPCA, that served to get the drug approval for this phase of the disease, and the new data obtained from its use. We also performed a search of ongoing studies with Radium 223 alone or in combination with other molecules. Evidence sinthesis: According to the ALSYMPCA study, Radium 223 significantly prolongs the overall survival of patients with castration resistant prostate cancer and bone metastases; approximately 3.6 months in comparison with patients who received placebo, which turns into a median life expectancy of 14.9 months, and a 36-month survival of 46%, associated with a 30% reduction in death risk. Overall survival results were consistent both in patients who receive Docetaxel previously and those who did not. RESULTS: for secondary variables support the positive effect of Radium 223 therapy on symptomatic skeletal events (for example, the use of external beam radiotherapy to alleviate pain) and bone markers, confirming its efficacy in bone metastases. CONCLUSIONS: Radium 223 is the first treatment directed to bone that has demonstrated significant improvement on overall survival. It also prolonged the time to the first skeletal event and the median time to PSA increase significantly. All this in addition to its manageable adverse effects, lower than those appeared in the placebo arm of the pivotal study ALSYMPCA

[New position for laparoscopic pyeloplasty. Our experience]. / Nuevo posicionamiento para realizar la pieloplastia laparoscópica. Nuestra experiencia.

OBJECTIVES: To share our experience performing laparoscopic pyeloplasty and our contributions to this surgery. METHODS: Between March 2004 and January 2006 we have performed 12 laparoscopic pyeloplasties in 12 patients. We modified our technique as we found difficulties during operations. By the only modification of patient position we have achieved a significant improve in our technique. RESULTS: We describe how we performed the operation in the first cases and how we do it today, with the new position. We also describe the advantages observed. CONCLUSIONS: With our technique we achieve an important surgical time reduction, improvements in safety and reduction of surgical complications.

Nuevo posicionamiento para realizar la pieloplastia laparoscópica. Nuestra experiencia / New position for laparoscopic pyeloplasty. Our experience

Objetivo: Nuestra intención con el presente artículo pretende compartir nuestra experiencia en relación con la realización de la pieloplastia laparoscópica y nuestras aportaciones en este sentido. Métodos: Hemos realizado 12 pielopastias laparoscópicas a otros tantos pacientes entre marzo del 2004 y enero 2006. A lo largo de nuestra serie hemos ido codificando la técnica quirúrgica a medida que nos hemos ido encontrando con dificultades durante la realización de la misma. Mediante la única modificación del posicionamiento del paciente hemos logrado una importante mejora en nuestra técnica. Resultados: Describimos en este artículo como realizábamos la intervención en nuestros primeros casos y de que forma estamos realizándola en este momento, gracias al nuevo posicionamiento. Asímismo damos cuenta de cuales son las ventajas que apreciamos. Conclusiones: Con nuestra técnica logramos una importante reducción en el tiempo quirúrgico, mejoras en cuanto a seguridad de la técnica y reducción de las complicaciones quirúrgicas (AU)

Objectives: To share our experience performing laparoscopic pyeloplasty and our contributions to this surgery. Methods: Between March 2004 and January 2006 we have performed 12 laparoscopic pyeloplasties in 12 patients. We modified our technique as we found difficulties during operations. By the only modification of patient position we have achieved a significant improve in our technique. Results: We describe how we performed the operation in the first cases and how we do it today, with the new position. We also describe the advantages observed. Conclusions: With our technique we achieve an important surgical time reduction, improvements in safety and reduction of surgical complications (AU)