Comparison of conventionally fractionated and hypofractionated schedule for post-prostatectomy salvage radiotherapy: Early results from non-randomized observational study

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Background: Data on hypofractionated radiotherapy in definitive treatment of prostate cancer are maturing; however, limited information is available for hypofractionated radiotherapy after prostatectomy. We aimed to compare hypofractionated and conventionally fractionated radiotherapy in salvage setting for biochemically recurrent prostate cancer. Methods: A retrospective analysis was performed in 106 patients with proven PSA recurrence treated to the prostate bed. Patients were non-randomly, in a alternating fashion, subjected to either 52.5 Gy in 20 fractions of 2.625 Gy over 4 weeks (N = 57, hypofractionated group) or 66 Gy in 33 fractions of 2 Gy over 6.5 weeks (N = 49, conventionally fractionated group). There was no statistically significant difference in pathologic T-stage and Gleason score distribution between the groups. In the conventionally fractionated group there were more patients with positive margins (p = 0.01), more prevalent concomitant hormonal therapy (50.9% vs 61.2%, p = 0.001), but less long-term hormonal therapy (21.4% vs 81%, p < 0.001), compared to hypofractionated group. Median follow-up was 20 months (range 6-36 months). Failure (PSA nadir+0.2) rates between the groups were compared using Cox proportional hazards model. Radiation-related side-effects were assessed using RTOG scoring scale. Results: At this early point, 13 patients (22.8%), and 6 patients (12.2%) experienced treatment failure in the hypofractionated group and conventionally fractionated group, respectively (HR 3.1, 95%CI (1.5-6.3)). More late grade 2 gastrointestinal and genitourinary side-effects were observed in conventionally fractionated group (4.1% vs 1.8%, and 2% vs 0%, p = 0.01, respectively). No grade 3 toxicities were observed. Conclusions: More initial biochemical failures were observed in hypofractionated group compared to conventionally fractionated group. However, baseline heterogeneity between the groups and short follow-up preclude any causal observation of differential efficacy between these two schedules. Randomized phase II trial is planned to prospectively compare these two regimens.

[Therapeutic efficiency in multisegmental fusions of the lumbar spine]

AIM

The aim of this study was to evaluate of the efficiency of an internal fixateur used since 1998 in multisegmental spondylodesis of the lumbar spine.

METHOD

The prospective study included 105 patients with degenerative changes or instabilities of the lumbar spine, who underwent an anterior and posterior stabilisation of more than two segments. The minimum period of follow-up was more than 6 months. There were several objective scores used for the evaluation of the efficiency (Oswestry score/visual analogue scale [VAS]). In addition, the quality of the new internal implant was assessed concerning the rate of loosening and failure of the implant. This new internal fixateur, produced as a titanium alloy, consists of pedicle screws and longitudinal rods with 5 mm diameter and connection elements. Upon pulling the nut a square stabilised situation is created. Altogether the three-segmental stabilisations predominated (n=77), 23 patients received a four-segmental, four patients a five-segmental stabilisation and one received a stabilisation of six levels, mainly involving the segments L3/4 to L5/S1. Because of severe deformities in 14 cases the pedicle screws were applied by computer-assisted navigation (Navitrak).

RESULTS

In 12 patients (11.4%) radiological signs of loosening of the inserted pedicle screws in the vertebra were diagnosed. The radiological analysis resulted in pseudarthrosis of 4 (1.2%) of the 349 amalgamated segments. There were no cases of material failure. The average value of the pain score preoperatively (VAS) was 7.7 (5-10, SA 1.3) and postoperatively 4.6 (1-10, SA 1.8). With regard to the Oswestry disability index the preoperative average value amounted to 51.9% (30-91, SA 11.8) and postoperatively 35% (12-74, SA 11.8). In all 98 (93.3%) patients were satisfied, 7 (6.7%) patients reported a decline of the subjective outcome.

CONCLUSION

This system achieved a high degree of patient satisfaction and showed a low rate of pseudarthrosis. Furthermore, it can be inserted for short and long fusions, as well in deformities.

[Epithelioid hemangioma of the popliteal artery]

We report the case of a 37-year-old patient with an epithelioid haemangioma arising from the third segment of the popliteal artery and the tibio-peroneal trunk. As far as we know this is the first description of this tumour originating in an artery of this order. One year after excision of the tumour mass and vascular reconstruction the patient has recovered and shows no evidence of recurrence. Clinical manifestation and morphological characteristics of this rare lesion are described in this article.