A systematic review of contemporary management of oligometastatic prostate cancer: fighting a challenge or tilting at windmills?

PURPOSE: Amongst the unanswered questions regarding prostate cancer (PCa), the optimal management of oligometastatic disease remains one of the major concerns of the scientific community. The very existence of this category is still subject to controversy. Aim of this systematic review is to summarize current available data on the most appropriate management of oligometastatic PCa. EVIDENCE ACQUISITION: All relevant studies published in English up to November the 1st were identified through systematic searches in PubMed, EMBASE, Cochrane Library, CINAHL, Google Scholar and Ovid database. A search was performed including the combination of following words: (prostate cancer) and (metastatic) and [(oligo) or (PSMA) or (cytoreductive) or (stereotaxic radiotherapy) or (prostatectomy)]. 3335 articles were reviewed. After title screening and abstract reading, 118 papers were considered for full reading, leaving a total of 36 articles for the systematic review. EVIDENCE SYNTHESIS: There is still no consensus on the definition of oligometastatic disease, nor on the imaging modalities used for its detection. While retrospective studies suggest an added benefit with the treatment the primitive tumor by cytoreductive prostatectomy (55% survival rate vs 21%, p < 0.001), prospective studies do not validate the same outcome. Nonetheless, most studies have reported a reduction in local complications after cytoreductive prostatectomy (< 10%) compared to the best systemic treatment (25-30%). Concerning radiotherapy, an overall survival benefit for patients with a low metastatic burden was found in STAMPEDE (HR 0.68, 95% CI 0.52-0.90; p = 0.007) and suggested in subgroup analysis of the HORRAD trial. Regarding the impact of metastases-directed therapy (MDT), the STOMP and ORIOLE trials suggested that metastatic disease control might improve androgen deprivation therapy-free survival (in STOMP: 21 vs 13 months for MDT vs standard of care). Nonetheless, the impact of MDT on long-term oncologic results remains unclear. Finally, oligometastatic disease appears to be a biologically different entity compared to high-burden metastatic disease. New findings on exosomes appear to make them intriguing biomarkers in the early phases of oligometastatic PCa. CONCLUSION: Oligometastatic PCa is today a poorly understood disease. The implementation of new imaging techniques as whole-body MRI and PSMA PET/CT has increased exponentially the number of oligometastatic patients detected. Data of available trials suggest a benefit from cytoreductive prostatectomy to reduce local complication, though its impact on survival remains unknown. Radiotherapy may be beneficial for patients with low-burden metastatic PCa, while MDT may delay the need for androgen deprivation therapy. Results from ongoing trials data are eagerly awaited to draw reliable recommendations.

Pelvic salvage (SBRT) radiotherapy based on 68Ga-PSMA PET/CT: About a case.

Very few patients with a biochemical failure after radical prostatectomy respond to prostatic bed irradiation. In this setting, 68Ga-PSMA PET/CT seems to be a useful tool for the detection of lesions remaining occult to conventional imaging work-up, changing the treatment strategy in a significant percentage of patients. we report the case of a patient in whom the PSMA PET allowed orientation of the SBRT. To date the patient has no recurrence.

Thrombotic microangiopathy with skin localization secondary to cytarabine-daunorubicin association: report of a case.

The thrombotic microangiopathy is a syndrome characterized by the combination of mechanical hemolytic anemia, peripheral thrombocytopenia, and organ failure of variable severity. In addition to the idiopathic form, several cases are identified as secondary to pregnancy, infections, disease systems, organ transplants, and cancer. Other forms are secondary to drugs including antimitotics. We report the case of a patient followed for acute myelogenous leukemia. She received induction chemotherapy combining daunorubicin and cytarabine, complicated by thrombotic thrombocytopenic purpura.

[Intermaxillary tooth size discrepancies with reference to the Bolton index in a Moroccan population]. / Etude de la dysharmonie dento-dentaire à travers l'indice de BOLTON dans une population Marocaine.

This study has for purpose the evaluation of the frequency of inter-dental disharmony in a Moroccan population via the BOLTON index. Using image processing of their dental moulds, the BOLTON index was measured in 30 patients at the Dentol-Facial Orthopedics Department of Rabat. It results that a high percentage of patients was outside the 2 SD BOLTON interval. Several patients presented significant disharmony that could affect their orthodontic treatments and should be taken into consideration while establishing the proper treatment.

Les moulages en orthopedie dento-faciale: apport en informatique

Etant un element incontournable de la demarche diagnostique en orthopedie dento-faciale; et par consequence de la decision therapeutique et du plan de traitement; les moulages orthodontiques resteront toujours un precieux document du dossier d'un patient. Depuis plusieurs annees; la technologie numerique a ete introduite en orthodontie; d'abord avec la photographie; ensuite avec la radiologie et; plus recemment avec les moulages. Les resultats diagnostiques; offerts par les logiciels de traitement des moulages numerises; peuvent etre plus precis que ceux obtenus par des examens conventionnels sur des modeles en platre; et surtout avec une manipulation simplifiee et rapide