ABSTRACT
PURPOSE: To perform a comparative study of 500 consecutive (125)I seeds implants for intracapsular prostate carcinoma with two techniques differing in terms of both strand implantation and planning. MATERIAL AND METHODS: From 2002 to 2007 we performed 250 implants with fixed stranded seeds (RapidStrand™) and a preplanning system and from 2007 to 2010, 250 with real-time and ProLink™ system. Mean age was 68 and 66, respectively, median PSA (prostate-specific antigen) 7.3 and 7.2, stage T1-T2a in 98% and 94%, and Gleason ≤ 6 in 96% and 86%. Low risk cases were 81% and 71%. The prescribed dose was 145 Gy to the prostate volume, or 108 Gy plus EBRT 46 Gy in some intermediate risk cases. Hormonal treatment was given to 42% and 28%. RESULTS: Median follow-up was 48 and 47 months, respectively, 14 patients in the first group and 7 patients in the second developed biochemical failure (BF). Actuarial biochemical relapse-free survival (bRFS) at 5 years increased from 90.2% to 97.2% (low risk from 91.3% to 97.2%, intermediate risk from 84.2% to 97.1%). Biochemical failure was independent of hormone treatment. Rectal complications were G1-2 in 1.2% and 5.2%, respectively. A urinary catheter was necessary in 6.9% and 9.6%, and urethral resection in 1.9% and 4.4%. Genitourinary toxicity was G1-2 in 4.6% and 12%, G3-4 in 1.9% and 4.8%. An assessment of mean D90 in a sample of patients showed that the dosimetry in postoperative planning based on CT improved from a mean D90 of 143 Gy to 157 Gy. CONCLUSIONS: The outcome of patients with low risk prostate carcinoma treated with (125)I seed is very good with low complications rate. The real-time approach in our hands achieved a more precise seed implantation, better dosimetry, and a statistically non-significant better biochemical control. We have made this our standard technique.
ABSTRACT
OBJETIVO: El cáncer de pene tiene una diseminación predominantemente linfática. La afectación metastásica de los ganglios linfáticos condiciona el pronóstico de esta enfermedad y la linfadenectomía inguinal tiene tanto valor pronóstico como terapéutico. Los pacientes de riesgo alto e intermedio con ganglios no palpables se beneficiarán de un diagnóstico preciso mediante la biopsia selectiva de ganglio centinela (BDGC) con una mínima agresividad quirúrgica. MÉTODOS: Revisión retrospectiva de nuestra experiencia en biopsia dinámica de ganglio centinela en cáncer de pene desde noviembre de 1999 a julio de 2014. RESULTADOS: Hemos realizado este procedimiento en 33 pacientes, técnicamente con éxito en 29 (88%). Los pacientes no sometidos a linfadenectomía por BDGC positiva han sido seguidos una media de 60.4 meses (mediana 59, rango 5-145). En 20 pacientes se realizó BDGC de manera simultánea al tratamiento quirúrgico de la lesión primaria y en 13 con posterioridad. El tiempo transcurrido en estos casos fue de 5,5 meses (mediana 5, rango: 2-12). En 6 (18,8%) de los 29 pacientes biopsiados con éxito, se observó metástasis en alguno de sus ganglios identificados como centinela. Dos pacientes fueron Falsos Negativos (6,25%). La Sensibilidad (S), Especificidad (E), Valor Predictivo Positivo (VPP) y Valor Predictivo Negativo (VPN) de las BDGC llevadas a cabo con éxito ha sido de: 66, 100, 100 y 93%, respectivamente. Conclulsión: La BDCG permite un correcto estadiaje ganglionar evitando la morbilidad de la linfadenectomía inguinal. La tasa de fracaso técnico y de Falsos Negativos (FN) es baja y puede considerarse como técnica diagnóstica de elección en cáncer de pene de riesgo alto e intermedio con ganglios impalpables
OBJECTIVE: Penile cancer has a predominantly lymphatic dissemination. Lymph nodes metastatic involvement conditions disease prognosis and inguinal lymph node dissection has both prognostic and therapeutic value. High and intermediate risk patients with non-palpable lymph nodes will benefit of a precise diagnosis by means of selective sentinel node biopsy with minimal surgical aggressiveness. Methos: Retrospective review of our experience on dynamic sentinel node biopsy in penile cancer from November 1999 to July 2014. RESULTS: We performed this procedure in 33 patients, technically successful in 29 (88%). The patients who did not undergo lymph node dissection due to positive sentinel node biopsy have been followed a mean of 60.4 months (Median 59, range 5-145). 20 patients underwent simultaneous sentinel node biopsy and surgical treatment of the primary lesion and in 13 it was performed posteriorly. In these cases the time lapse was 5.5 months (median 5, range 2-12). In 6 (18.9%) of the 29 patients successfully biopsied, metastasis was founded in any of the lymph nodes identified as sentinel. Two patients were false negative (6,25%). Sensitivity (S), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of successfully performed sentinel node biopsies were 66, 100, 100 and 93%, respectively. CONCLUSION: Sentinel node biopsy enables a correct lymph node staging avoiding the morbidity of inguinal lymph node dissection. The rate of technical failure and false negative results is low and it may be considered the diagnostic technique of choice in high and intermediate risk penile cancer with non-palpable lymph nodes
Subject(s)
Humans , Male , Penile Neoplasms/pathology , Sentinel Lymph Node Biopsy/methods , Retrospective Studies , Lymph Node Excision , Lymphatic Metastasis/pathologyABSTRACT
OBJECTIVE: Penile cancer has a predominantly lymphatic dissemination. Lymph nodes metastatic involvement conditions disease prognosis and inguinal lymph node dissection has both prognostic and therapeutic value. High and intermediate risk patients with non-palpable lymph nodes will benefit of a precise diagnosis by means of selective sentinel node biopsy with minimal surgical aggressiveness. METHODS: Retrospective review of our experience on dynamic sentinel node biopsy in penile cancer from November 1999 to July 2014. RESULTS: We performed this procedure in 33 patients, technically successful in 29 (88%). The patients who did not undergo lymph node dissection due to positive sentinel node biopsy have been followed a mean of 60.4 months (Median 59, range 5-145). 20 patients underwent simultaneous sentinel node biopsy and surgical treatment of the primary lesion and in 13 it was performed posteriorly. In these cases the time lapse was 5.5 months (median 5, range 2-12). In 6 (18.9%) of the 29 patients successfully biopsied, metastasis was founded in any of the lymph nodes identified as sentinel. Two patients were false negative (6,25%). Sensitivity (S), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of successfully performed sentinel node biopsies were 66, 100, 100 and 93%, respectively. CONCLUSION: Sentinel node biopsy enables a correct lymph node staging avoiding the morbidity of inguinal lymph node dissection. The rate of technical failure and false negative results is low and it may be considered the diagnostic technique of choice in high and intermediate risk penile cancer with non-palpable lymph nodes.