Sentinel lymph node dissection in prostate cancer using superparamagnetic particles of iron oxide: early clinical experience.

PURPOSE: Superparamagnetic nanoparticles of iron oxide (SPION) were shown to be non-inferior to standard radioisotope tracer in breast cancer and may be used as an alternative to identify sentinel lymph nodes (SLN). The aim of this study was to assess the feasibility of sentinel lymph node dissection (SLND) using SPION in prostate cancer and to evaluate its diagnostic accuracy. METHODS: Twenty patients with intermediate- and high-risk prostate cancer were prospectively enrolled in 2016. After intraprostatic injection of SPION, SLND using magnetometer was performed the following day. Extended pelvic lymph node dissection (ePLND) was added as a reference standard test. The diagnostic performance of the test were evaluated, as well as the rate of in vivo detected SLN. Surgical times of SLND and ePLND were compared using paired two-sample t test. RESULTS: In total, 97 SLN were detected with median 5 (IQR 3-7) per patient. Non-diagnostic rate of the procedure was 5%. In total, 19 nodal metastases were found in 5 patients, of which 12 were located in SLN. The sensitivity per patient for the whole cohort was 80% and per node 56%. If only patients with at least one detected SLN were considered, the sensitivity per patient and per node reached 100 and 82%, respectively. A median of 20 LNs (IQR 18-22) were removed by subsequent ePLND. Surgical times of SLND and ePLND differed significantly, with medians of 17 and 39 min, respectively (p < 0.001). CONCLUSIONS: SLND with SPION is feasible and safe in prostate cancer and the diagnostic accuracy is comparable to the published results of radioguided procedures. In open surgery, SPION may be used as an alternative tracer with its main advantage being the lack of radiation hazard.

Clinically node-positive bladder cancer: oncological results of induction chemotherapy and consolidative surgery.

Patients with clinically node-positive bladder cancer have a poor prognosis, with many receiving only palliative chemo- therapy. We evaluated oncological results in bladder cancer patients with clinically regional and supraregional lymph- adenopathy treated with induction chemotherapy (IC) and consolidative cystectomy. Twenty-five patients with clinically node-positive bladder cancer (including pelvic and retroperitoneal nodes) were treated with 2-4 cycles of IC followed by consolidative cystectomy between 2010 and 2016. Pathologic complete response (pCR) was defined as no residual tumor in the final specimen (ypT0N0).The 3-year cancer-specific (CSS) and recurrence-free survival (RFS) for the whole cohort were 52% and 39%, respectively. The 3-year RFS differed according to volume of nodal metastases, the rates were 56% for minimal nodal disease (cN1) versus 33% for cN2-3 and 0% for cM1 disease (p<0.001). pCR was seen in 7 (28%) patients; 50% in cN1 versus 13% in cN3-M1. pCR associated with 3-year CSS of 80% versus 45% in patients with persistent disease after IC. In conclusion, a multimodal approach to patients with clinically node-positive bladder cancer, consisting of IC followed by consolidative surgery, may achieve long-term survival in selected patients. Better results may be expected in patients with initially minimal nodal burden and complete pathologic response to chemotherapy. Further studies are warranted to improve patient selection for consolidative surgery, especially with supra-regional metastases.