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Croghan SM, Cullen IM, Raheem O. Functional outcomes and health-related quality of life following penile cancer surgery: a comprehensive review. Sex Med Rev 2023; 11:441-459. [PMID: 37204120 DOI: 10.1093/sxmrev/qead021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Organ-sparing surgery (OSS) in penile cancer management aspires to maintain organ form and function and preserve health-related quality of life (HRQoL), yet there is a lack of integrated evidence exploring these outcomes. OBJECTIVES The aim sought to review HRQoL, functional, aesthetic, and psychological outcomes following OSS or radical penectomy for penile cancer. METHODS A systematic review of MEDLINE and Cochrane databases included studies reporting on function (sexual, urinary or sensory), genital appearance or HRQoL/psychological well-being following surgical treatment of primary penile cancer. English-language reports (2000-2022), incorporating patient-reported or objective clinical outcome measures, were eligible. Studies of nonsurgical treatment strategies and those in the context of metastatic disease were excluded. Data were compiled and analyzed. RESULTS Twenty-six studies were included. Sexual function was the most studied outcome (754 pooled respondents; 19 studies), most frequently with the original 15-item and abridged 5-item International Index of Erectile Function. Preservation of erectile function following OSS is generally described, with some reduction in overall sexual satisfaction cited. Heterogeneous assessment of voiding function with little preoperative evaluation render interstudy comparison difficult. Most patients appear able to void from a standing position following OSS, with spraying the most common symptom. Maintenance of some sensory function is described with both split-thickness skin grafting and urethral glanduloplasty following radical glansectomy. Limited studies suggest reasonable patient satisfaction with genital cosmesis post-OSS. A negative impact on HRQoL is described in most studies following penile cancer surgery, variably correlated with aggressiveness of penile surgery and addition of lymphadenectomy. Anxiety, depression, and reduced self-esteem have been reported in penile cancer survivors. Relationship well-being varies, with some survivors reporting this to be unchanged. CONCLUSION OSS can preserve elements of sexual, urinary, and sensory function, supporting advantages over radical penectomy for eligible patients. However, a comprehensive understanding remains limited due to small, heterogeneous patient cohorts, challenges in obtaining premorbid data, and variability in outcome measures. Standardization of patient-reported outcomes following OSS is desirable.
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Affiliation(s)
- Stefanie M Croghan
- Department of Surgery, Royal College of Surgeons, Dublin D02 YN77, Ireland
- Department of Urology, Blackrock Clinic, Dublin A94 E4X7, Ireland
| | - Ivor M Cullen
- Department of Urology, Blackrock Clinic, Dublin A94 E4X7, Ireland
- Department of Urology, Beaumont Hospital, Dublin D09V2N0, Ireland
| | - Omer Raheem
- Department of Surgery, Section of Urology, University of Chicago Medicine, Chicago, IL 60637, United States
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García Rojo E, Giannarini G, García Gómez B, Feltes Ochoa JA, Guerrero Ramos F, Alonso Isa M, Brime Menendez R, Saenz Calzada DM, Justo Quintas J, Fraile A, Manfredi C, Romero Otero J. Organ-Sparing Surgery for Testicular Germ Cell Tumors: A Current Perspective. Medicina (Kaunas) 2023; 59:1249. [PMID: 37512061 PMCID: PMC10386486 DOI: 10.3390/medicina59071249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: We aimed to evaluate the oncological and functional outcomes of organ-sparing surgery for testicular germ cell tumors, a procedure that seeks to strike a balance between effective cancer control and organ preservation, in the treatment of testicular tumors. We aimed to discuss the surgical technique and complications, and determine the appropriate candidate selection for this approach. Material and Methods: A comprehensive literature search was conducted to identify relevant studies on organ-sparing surgery for testicular tumors. Various databases, including PubMed, Embase, and Cochrane Library, were used. Studies reporting on surgical techniques, complications, and oncologic and functional outcomes were included for analysis. Results: Current evidence suggests that organ-sparing surgery for testicular germ cell tumors can be considered a safe and efficacious alternative to radical orchiectomy. The procedure is associated with adequate oncological control, as indicated by low recurrence rates and low complication rates. Endocrine testicular function can be preserved in around 80-90% of patients and paternity can be achieved in approximately half of the patients. Candidate selection for this surgery is typically based on the following criteria: pre-surgery normal levels of testosterone and luteinizing hormone, synchronous or metachronous bilateral tumors, tumor in a solitary testis, and tumor size less than 50% of the testis. Conclusions: Organ-sparing surgery for testicular germ cell tumors offers a promising approach that balances oncological control and preservation of testicular function. Further research, including large-scale prospective studies and long-term follow-ups, is warranted to validate the effectiveness and durability of organ-sparing surgery and to identify optimal patient selection criteria.
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Affiliation(s)
- Esther García Rojo
- Department of Urology, Hospital Universitario HM Sanchinarro, 28050 Madrid, Spain
- ROC Clinic Direction, Martínez Campos 17, 28010 Madrid, Spain
| | - Gianluca Giannarini
- Urology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Borja García Gómez
- ROC Clinic Direction, Martínez Campos 17, 28010 Madrid, Spain
- Department of Urology, Hospital Universitario HM Montepríncipe, 28660 Madrid, Spain
| | - Javier Amalio Feltes Ochoa
- ROC Clinic Direction, Martínez Campos 17, 28010 Madrid, Spain
- Department of Urology, Hospital Universitario HM Puerta del Sur, 28938 Madrid, Spain
| | - Félix Guerrero Ramos
- Department of Urology, Hospital Universitario HM Sanchinarro, 28050 Madrid, Spain
- ROC Clinic Direction, Martínez Campos 17, 28010 Madrid, Spain
| | - Manuel Alonso Isa
- ROC Clinic Direction, Martínez Campos 17, 28010 Madrid, Spain
- Department of Urology, Hospital Universitario HM Puerta del Sur, 28938 Madrid, Spain
| | - Ricardo Brime Menendez
- Department of Urology, Hospital Universitario HM Sanchinarro, 28050 Madrid, Spain
- ROC Clinic Direction, Martínez Campos 17, 28010 Madrid, Spain
| | - David Manuel Saenz Calzada
- ROC Clinic Direction, Martínez Campos 17, 28010 Madrid, Spain
- Department of Urology, Hospital Universitario HM Puerta del Sur, 28938 Madrid, Spain
| | - Juan Justo Quintas
- Department of Urology, Hospital Universitario HM Sanchinarro, 28050 Madrid, Spain
- ROC Clinic Direction, Martínez Campos 17, 28010 Madrid, Spain
| | - Agustín Fraile
- ROC Clinic Direction, Martínez Campos 17, 28010 Madrid, Spain
- Department of Urology, Hospital Universitario HM Rivas, 28521 Madrid, Spain
| | - Celeste Manfredi
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 81100 Naples, Italy
| | - Javier Romero Otero
- Department of Urology, Hospital Universitario HM Sanchinarro, 28050 Madrid, Spain
- ROC Clinic Direction, Martínez Campos 17, 28010 Madrid, Spain
- Department of Urology, Hospital Universitario HM Montepríncipe, 28660 Madrid, Spain
- Department of Urology, Hospital Universitario HM Puerta del Sur, 28938 Madrid, Spain
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Clay R, Shaunak R, Raj S, Light A, Malde S, Thurairaja R, El‐Hage O, Dasgupta P, Khan MS, Nair R. Oncological and functional outcomes of organ-preserving cystectomy versus standard radical cystectomy: A systematic review and meta-analysis. BJUI Compass 2022; 4:135-155. [PMID: 36816151 PMCID: PMC9931545 DOI: 10.1002/bco2.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/04/2022] [Accepted: 08/14/2022] [Indexed: 02/17/2023] Open
Abstract
Introduction Radical cystectomy (RC) is historically considered the gold standard treatment for muscle invasive and high-risk non-muscle invasive bladder cancer. However, this technique leaves the majority of patients of both sexes with poor sexual and urinary function. Organ-sparing cystectomy (OSC) techniques are emerging as an alternative to the standard procedure to preserve these functions, without compromising the oncological outcomes. We present a systematic review and meta-analysis of the published literature. Methods MEDLINE, Embase and Web of Science were systematically searched for eligible studies on 6 April 2021. Primary outcomes studied were both oncological outcomes, specifically overall recurrence, and functional outcomes, specifically sexual function, and daytime and nighttime continence. Odds ratios (OR) with 95% confidence intervals (95% CI) were calculated. The PROSPERO registration reference number was CRD42018118897. Results From 13 894 identified abstracts, 19 studies (1886 male and 305 female patients) were eligible for inclusion in this review. These studies included patients who underwent either whole prostate, prostate capsule, seminal vesicle, nerve, uterus, ovary, vagina and fallopian tube sparing techniques. Four studies included only female patients.Thirteen studies reported oncological outcomes, and overall recurrence rate was similar between the two groups (five studies; OR 0.73; 95% CI 0.38-1.40, p = 0.34). Thirteen studies reported on male sexual function. In men, OSC had significantly greater odds of retaining potency (five studies; OR 9.05; 95% CI 5.07-16.16, p < 0.00001). Fourteen studies (13 on males and 1 female) reported urinary outcomes. In men, OSC demonstrated greater odds of daytime (seven studies; OR 2.61; 95% CI 1.74 to 3.92, p < 0.00001) and nighttime continence (seven studies; OR 2.62; 95% CI 1.76 to 3.89, p < 0.00001). Conclusion In carefully selected patients, OSC allows the potential to provide better sexual and urinary function without compromising oncological outcomes. There remains, however, a paucity of OSC studies in females. Further studies are required to make recommendations based on robust clinical evidence.
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Affiliation(s)
- Reece Clay
- GKT School of Medical EducationKing's College LondonLondonUK,William Harvey HospitalEast Kent Hospital University Foundation TrustKentUK
| | - Raghav Shaunak
- GKT School of Medical EducationKing's College LondonLondonUK,St Peter's HospitalAshford and St Peter's Hospital NHS TrustChertseyUK
| | - Siddarth Raj
- GKT School of Medical EducationKing's College LondonLondonUK,University HospitalUniversity Hospitals Coventry and Warwickshire NHS TrustCoventryUK
| | - Alexander Light
- Imperial College LondonLondonUK,Department of Surgery and CancerImperial College Healthcare NHS TrustLondonUK
| | - Sachin Malde
- The Urology Centre, Guy's and St. Thomas' NHS Foundation TrustGuy's HospitalLondonUK
| | - Ramesh Thurairaja
- The Urology Centre, Guy's and St. Thomas' NHS Foundation TrustGuy's HospitalLondonUK
| | - Oussama El‐Hage
- The Urology Centre, Guy's and St. Thomas' NHS Foundation TrustGuy's HospitalLondonUK
| | - Prokar Dasgupta
- The Urology Centre, Guy's and St. Thomas' NHS Foundation TrustGuy's HospitalLondonUK
| | - Muhammed Shamim Khan
- The Urology Centre, Guy's and St. Thomas' NHS Foundation TrustGuy's HospitalLondonUK
| | - Rajesh Nair
- The Urology Centre, Guy's and St. Thomas' NHS Foundation TrustGuy's HospitalLondonUK
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Moghaddasi L, Reid P, Bezak E, Marcu LG. Radiobiological and Treatment-Related Aspects of Spatially Fractionated Radiotherapy. Int J Mol Sci 2022; 23:3366. [PMID: 35328787 PMCID: PMC8954016 DOI: 10.3390/ijms23063366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/13/2022] [Accepted: 03/17/2022] [Indexed: 11/17/2022] Open
Abstract
The continuously evolving field of radiotherapy aims to devise and implement techniques that allow for greater tumour control and better sparing of critical organs. Investigations into the complexity of tumour radiobiology confirmed the high heterogeneity of tumours as being responsible for the often poor treatment outcome. Hypoxic subvolumes, a subpopulation of cancer stem cells, as well as the inherent or acquired radioresistance define tumour aggressiveness and metastatic potential, which remain a therapeutic challenge. Non-conventional irradiation techniques, such as spatially fractionated radiotherapy, have been developed to tackle some of these challenges and to offer a high therapeutic index when treating radioresistant tumours. The goal of this article was to highlight the current knowledge on the molecular and radiobiological mechanisms behind spatially fractionated radiotherapy and to present the up-to-date preclinical and clinical evidence towards the therapeutic potential of this technique involving both photon and proton beams.
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Affiliation(s)
- Leyla Moghaddasi
- Department of Medical Physics, Austin Health, Ballarat, VIC 3350, Australia;
- School of Physical Sciences, University of Adelaide, Adelaide, SA 5001, Australia;
| | - Paul Reid
- Radiation Health, Environment Protection Authority, Adelaide, SA 5000, Australia;
| | - Eva Bezak
- School of Physical Sciences, University of Adelaide, Adelaide, SA 5001, Australia;
- Cancer Research Institute, University of South Australia, Adelaide, SA 5001, Australia
| | - Loredana G. Marcu
- Cancer Research Institute, University of South Australia, Adelaide, SA 5001, Australia
- Faculty of Informatics and Science, University of Oradea, 1 Universitatii Str., 410087 Oradea, Romania
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5
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Buciuman N, Marcu LG. Dosimetric justification for the use of volumetric modulated arc therapy in head and neck cancer-A systematic review of the literature. Laryngoscope Investig Otolaryngol 2021; 6:999-1007. [PMID: 34667842 PMCID: PMC8513433 DOI: 10.1002/lio2.642] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/08/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Radiotherapy for head and neck cancer (HNC) has evolved rapidly in the past decades from conformal three-dimensional technique (3D-CRT) to intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT). This paper presents a dosimetric comparative study between VMAT and IMRT delivery based on current literature, while also presenting the potential challenges encountered with volumetric arc therapy. METHODS A systematic search of the scientific literature was conducted within Medline/Pubmed databases. A number of 13 papers fulfilled the search criteria which was based on the main objective to evaluate dosimetric characteristics of comparative treatment delivery with VMAT vs IMRT in HNC. RESULTS Overall, from a dosimetric perspective, dose delivery via VMAT and IMRT present comparable results. Beside the delivery technique, target volume coverage also depends on the planner's expertise as well as the employed planning algorithm. At times, the superiority of VMAT emerges from the improved sparing of normal tissue, reduction of monitor units (MU) and of treatment delivery time. Similar to IMRT, one of the most important challenges of VMAT is the risk of developing secondary cancer due to the higher number of MUs compared to 3D-CRT. CONCLUSIONS Based on the comparative results with the more established IMRT, VMAT in HNC can be safely delivered either as a single treatment or combined with other techniques.
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Affiliation(s)
- Nikolett Buciuman
- Faculty of PhysicsWest University of TimisoaraTimisoaraRomania
- OncoHelp FoundationTimisoaraRomania
| | - Loredana G. Marcu
- Faculty of PhysicsWest University of TimisoaraTimisoaraRomania
- Faculty of Informatics & ScienceUniversity of OradeaOradeaRomania
- Cancer Research InstituteUniversity of South AustraliaAdelaideSouth AustraliaAustralia
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Abstract
Penile cancers are rare malignancies. Traditional surgical options, including partial and total penectomy, can dramatically affect a patient's quality of life and mental health. In select patients, penile sparing techniques (PST) have the potential to remove the primary tumor with comparable oncologic outcomes while maintaining penile length, sexual function, and urinary function. In this review, we aim to discuss the indications, advantages, and outcomes of the various PST currently available for men seeking an organ-preserving option for their penile cancer.
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Affiliation(s)
- Andrew Fang
- The University of Alabama, Birmingham School of Medicine- Urology , Birmingham, AL, USA
| | - James Ferguson
- The University of Alabama, Birmingham School of Medicine- Urology , Birmingham, AL, USA.,The University of Alabama, Birmingham School of Medicine- O'Neal Comprehensive Cancer Center , Birmingham, AL, USA
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7
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Ratnatunga K, Singh S, Bolckmans R, Goodbrand S, Gorissen K, Jones O, Lindsey I, Cunningham C. Minimally invasive organ-preserving approaches in the management of mesh erosion after laparoscopic ventral mesh rectopexy. Colorectal Dis 2020; 22:1642-1648. [PMID: 32654403 DOI: 10.1111/codi.15257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 06/22/2020] [Indexed: 01/03/2023]
Abstract
AIM This is a systematic approach for minimally invasive methods in the management of mesh erosion after laparoscopic ventral mesh rectopexy. METHODS All patients managed with organ-preserving techniques for mesh erosion were identified from a prospective database and clinical records were reviewed. Each patient was contacted via telephone and a structured questionnaire was applied. A Likert score was used to assess patient symptoms and overall satisfaction with management. One or more of the following techniques were used: (i) transanal or transvaginal trimming/excision of exposed mesh and sutures, with or without using transanal endoscopic micro surgery or transanal minimally invasive surgery; (ii) laparoscopic pelvic assessment and detachment of mesh from the sacral promontory. RESULTS Eleven patients were managed for mesh erosion with organ-preserving techniques. All were women with a median age of 60 years [interquartile range (IQR) 53.5-68.5]. Vaginal, rectal, perineal erosion and recto-vaginal fistulation occurred in five, four, one and one patient respectively. Vaginal erosions presented at a median of 51 months (IQR 36-56) after index laparoscopic ventral mesh rectopexy compared to 17.5 months (IQR 14.5-27.25) for the rectal erosions. Median follow-up time was 24 months (IQR 19-49). Four of the meshes (36%) were removed completely whereas seven (63%) were partially removed. Vaginal erosions required a median of two procedures to achieve resolution as opposed to five for rectal. Out of 11 patients, eight were satisfied with the outcome of their management, whereas two were not and one remained ambivalent. CONCLUSION An organ-sparing minimally invasive approach is feasible in managing mesh erosions but requires multiple procedures and months to complete.
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Affiliation(s)
- K Ratnatunga
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - S Singh
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - R Bolckmans
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - S Goodbrand
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - K Gorissen
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - O Jones
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - I Lindsey
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - C Cunningham
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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8
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Poe AR, Xu Y, Zhang C, Lei J, Li K, Labib D, Han C. Low FoxO expression in Drosophila somatosensory neurons protects dendrite growth under nutrient restriction. eLife 2020; 9:53351. [PMID: 32427101 PMCID: PMC7308081 DOI: 10.7554/elife.53351] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 05/18/2020] [Indexed: 12/22/2022] Open
Abstract
During prolonged nutrient restriction, developing animals redistribute vital nutrients to favor brain growth at the expense of other organs. In Drosophila, such brain sparing relies on a glia-derived growth factor to sustain proliferation of neural stem cells. However, whether other aspects of neural development are also spared under nutrient restriction is unknown. Here we show that dynamically growing somatosensory neurons in the Drosophila peripheral nervous system exhibit organ sparing at the level of arbor growth: Under nutrient stress, sensory dendrites preferentially grow as compared to neighboring non-neural tissues, resulting in dendrite overgrowth. These neurons express lower levels of the stress sensor FoxO than neighboring epidermal cells, and hence exhibit no marked induction of autophagy and a milder suppression of Tor signaling under nutrient stress. Preferential dendrite growth allows for heightened animal responses to sensory stimuli, indicative of a potential survival advantage under environmental challenges.
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Affiliation(s)
- Amy R Poe
- Weill Institute for Cell and Molecular Biology and Department of Molecular Biology and Genetics, Cornell University, Ithaca, United States
| | - Yineng Xu
- Weill Institute for Cell and Molecular Biology and Department of Molecular Biology and Genetics, Cornell University, Ithaca, United States
| | - Christine Zhang
- Weill Institute for Cell and Molecular Biology and Department of Molecular Biology and Genetics, Cornell University, Ithaca, United States
| | - Joyce Lei
- Weill Institute for Cell and Molecular Biology and Department of Molecular Biology and Genetics, Cornell University, Ithaca, United States
| | - Kailyn Li
- Weill Institute for Cell and Molecular Biology and Department of Molecular Biology and Genetics, Cornell University, Ithaca, United States
| | - David Labib
- Weill Institute for Cell and Molecular Biology and Department of Molecular Biology and Genetics, Cornell University, Ithaca, United States
| | - Chun Han
- Weill Institute for Cell and Molecular Biology and Department of Molecular Biology and Genetics, Cornell University, Ithaca, United States
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Abstract
Background Total mesorectal excision (tme) is the current standard of care for the treatment of rectal cancer. However, that surgery is associated with significant morbidity and mortality. Clinicians and patients are seeking alternatives to radical resection. Currently, prevalent organ-sparing strategies under investigation include local excision and nonoperative management (nom). Methods We reviewed the current evidence in the literature to create an overview of the use of transanal endoscopic surgery and watch-and-wait strategies in the modern management of rectal cancer. Results Compared with radical resection, transanal endoscopic surgery in patients with early rectal cancer (cT1) having favourable histopathologic features is associated with an increased risk of local recurrence, but no difference in 5-year survival. In patients with T2 or early T3 cancer, strategies that use neoadjuvant or adjuvant therapy as adjuncts to local excision are under evaluation. Nonoperative management is a new option for patients who experience a complete clinical response after neoadjuvant chemoradiotherapy (ncrt). The selection criteria that will appropriately identify patients for whom nom will succeed are not established. Conclusions Local excision is appropriate for early rectal cancer with favourable histopathologic features. Although organ-preserving strategies are promising, the quality of the evidence to date is insufficient to replace the current standard care in most patients. Patients should be offered nom in the safe setting of a clinical trial or registry. Rigorous follow-up, including endoscopy and imaging at frequent intervals is recommended when radical resection is forgone.
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Affiliation(s)
- F Rouleau-Fournier
- Department of Surgery, St. Paul's Hospital, Providence Health Care, Vancouver, BC
| | - C J Brown
- Department of Surgery, St. Paul's Hospital, Providence Health Care, Vancouver, BC
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10
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Weibl P, Herwig R. Superficial penile cancer treated with complete excision of the glans epithelium and coverage with a tissue sealant matrix (TachoSil®). Cent European J Urol 2019; 72:204-208. [PMID: 31482031 PMCID: PMC6715082 DOI: 10.5173/ceju.2019.1626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/31/2018] [Accepted: 06/17/2019] [Indexed: 11/22/2022] Open
Abstract
Introduction The aim of our work was to demonstrate the feasibility and clinical outcomes after partial excision of the epithelial and subepithelial layer of the glans with subsequent tissue sealant matrix coverage (TachoSil®). Material and methods We enrolled 11 consecutive patients with superficial penile cancer. Under the microscopic guidance, the tumor in the glans area was excised continuously with a minimal lateral margin of 5 mm. The cosmetic result was accessed using a 5-graded scale ranging from very dissatisfied to very satisfied. Results The median patient's age at the presentation was 46 years (range 38-53). Histopathological examination of the specimen confirmed squamous cell carcinoma and tumor-free surgical margins were obtained in all cases. Overall, the tumors were TaG1 in 3 patients, TaG2 in 1 patient, TisG1 in 2 patients, TisG2 in 2 patient, T1aG1 in 2 patients, and T1aG2 in 1 patient. All patients had clinically negative lymph-node status - cN0 (confirmed by aabdominopelvic computed tomography (CT) scan with contrast). During the follow-up of 6 to 36 months (median 18), local recurrence occurred in 1 patient with carcinoma in situ six months after surgery, which was managed by a second glans-preserving surgery without recurrence. The others showed no signs of local recurrence or metastasis during the period of observation. Conclusions These preliminary data suggests that glans-preserving surgical technique using TachoSil® as a defect coverage is technically feasible, functionally safe and cosmetically satisfying. However, well-designed prospective-randomized trial is warranted, to further confirm the clinical utility of our approach.
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Affiliation(s)
- Peter Weibl
- Landesklinikum Korneuburg - Teaching Hospital, Department of Urology, Korneuburg, Austria
| | - Ralf Herwig
- Department of Reconstructive Urology, Andrology and Mens's Health, Vienna Urology Foundation, Vienna, Austria
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11
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Mazzola R, Ricchetti F, Fersino S, Fiorentino A, Giaj Levra N, Di Paola G, Ruggieri R, Alongi F. Predictors of mucositis in oropharyngeal and oral cavity cancer in patients treated with volumetric modulated radiation treatment: A dose-volume analysis. Head Neck 2015; 38 Suppl 1:E815-9. [PMID: 25920015 DOI: 10.1002/hed.24106] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2015] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess predictors of mucositis in oropharyngeal and oral cavity cancer after definitive or adjuvant volumetric modulated arc radiotherapy (VMAT) +/- chemotherapy. METHODS Fifty patients were evaluated. Statistical analysis was performed for the following parameters as potential predictors of mucositis ≥ G2: total oral mucosa and oral mucosa minus target high-low radiation dose regions (planning target volumes [PTVs]), mean dose (Dmean ), maximum dose (Dmax ), chemotherapy, weight loss, and dysphagia. RESULTS Mucositis ≥ G2 was found to be statistically related to chemotherapy, weight loss, dysphagia ≥ G2, total oral mucosa Dmean ≥50 Gy and Dmax ≥65 Gy, V45 Gy >40%, V50 Gy >30%, and V55 Gy >20% of the oral mucosa minus target PTVs. A ratio between total oral mucosa and oral mucosa minus target PTVs >2.5 is related to G3 mucositis (p = .03). CONCLUSION New parameters were found as predictors of moderate-severe mucositis. © 2015 Wiley Periodicals, Inc. Head Neck 38: E815-E819, 2016.
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Affiliation(s)
- Rosario Mazzola
- Department of Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy.,Department of Radiation Oncology School, University of Palermo, Palermo, Italy
| | - Francesco Ricchetti
- Department of Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| | - Sergio Fersino
- Department of Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| | - Alba Fiorentino
- Department of Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| | - Niccolò Giaj Levra
- Department of Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| | | | - Ruggero Ruggieri
- Department of Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| | - Filippo Alongi
- Department of Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
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12
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Wojtarowicz M, Słojewski M, Gołąb A, Petrasz P. Retroperitoneoscopic renal pelvis resection as treatment of the urothelial tumor in a solitary kidney. Cent European J Urol 2013; 66:299-302. [PMID: 24707368 PMCID: PMC3974472 DOI: 10.5173/ceju.2013.03.art12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 04/28/2013] [Accepted: 05/16/2013] [Indexed: 12/11/2022] Open
Abstract
Urothelial carcinoma of the upper urinary tract is relatively rare. The standard treatment is invariably radical nephroureterectomy. In selected cases organ sparing surgery is justified. We present the case of the tumor of the kidney pelvis in a solitary organ where laparoscopic approach was successfully applied.
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Affiliation(s)
- Mateusz Wojtarowicz
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Marcin Słojewski
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Adam Gołąb
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Piotr Petrasz
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
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