bluuebunny/crossref_metadata_2025 huggingface dataset:
Pelvic SABR with HDR boost in intermediate- and high-risk prostate cancer (SPARE): Favorable early toxicity and quality-of-life outcomes.
Authors: Musunuru Hima Bindu , Deabreu Andrea , Davidson Melanie , Ravi Ananth , Helou Joelle Antoine , Ho Ling , Cheung Patrick , Vesprini Danny , Liu Stanley K. , Chu William , Korol Renee , Chung Hans T. , Mamedov Alexandre , Zhang Liying , Loblaw Andrew
Published: March 2017

60

Background: ASCENDE-RT has provided level 1 evidence supporting the use of androgen deprivation therapy (ADT), external beam radiotherapy and brachytherapy boost in intermediate- and high-risk prostate cancer. The objectives of this study are to report early toxicity and quality of life (QOL) outcomes in patients treated on a hybrid protocol using five-fraction pelvic stereotactic ablative radiotherapy (SABR) with a MRI dose painted HDR brachytherapy boost (HDR-BT). Methods: A phase I/II study was performed where intermediate (IR) and high-risk (HR) prostate cancer patients received HDR-BT 15Gy in single fraction to the prostate and up to 22.5Gy to the MRI nodule. Gantry-based 25Gy SABR was delivered to pelvis, seminal vesicles and prostate in 5 weekly fractions. ADT was used for 6-18 months. Common Terminology Criteria for Adverse Events version 3.0 was used to assess toxicities. QOL was captured using EPIC at every follow-up. A minimally clinically important change (MCIC) definition was triggered if the EPIC QOL score at each time point decreases > 0.5 SD, where SD is the standard deviation of baseline scores. Results: Thirty-three patients (NCCN 6.0% low IR, 45.5% high IR and 48.5% HR) completed this treatment with a median follow-up of 13.8 months (IQR 12.1, 18.8). The incidence of worst toxicities is shown in Table 1.The 3 grade 3 GU patients were due to temporary urinary catheterization in the acute period following HDR-BT. Mean (95% SD) EPIC urinary QOL scores were 82.5 (16.5), 83.2 (12.9) and 83.7 (16.3) at baseline, 3 months and 12 months and the bowel scores were 95.9 (3.8), 92.6 (8.2) and 90.5 (8.3), respectively. Proportion of patients experiencing MCIC at 3 months and 12 months were 20.8% and 14.3% for urinary domain, 47.8% and 53.9% for bowel domain; respectively (see Table). Conclusions: This novel treatment protocol incorporating MRI dose painted HDR brachytherapy boost and SABR pelvic radiation for intermediate- and high-risk prostate cancer in combination with ADT is feasible and well tolerated in the acute setting. Clinical trial information: REB 269-2014. [Table: see text]
A nomogram for testosterone recovery following combined androgen deprivation therapy and radiation therapy for prostate cancer.
Authors: Spiegel Daphna , Hong Julian C. , Lee W. Robert , Salama Joseph Kamel
Published: March 2017

67

Background: Combined androgen deprivation therapy (ADT) and radiation therapy (RT) is a frequently used localized prostate cancer (PC) treatment. Testosterone recovery (TR) after combined ADT-RT is not well-characterized. We studied TR in men who received RT and either short-term (ST) ADT or long-term (LT) ADT with LHRH agonists. Methods: We identified consecutive localized PC patients treated with ADT-RT at the Durham VA Medical Center (DVAMC) from 1/2011-10/2016. All patients had a documented baseline testosterone (T) level. Individual patient records were reviewed. TR was defined as time from last ADT injection to T normalization ( > 240 ng/dL). The Kaplan-Meier method was used to estimate time to TR. Cox proportional hazards models were generated to identify TR predictors with a nomogram built based on a parsimonious multivariate model. Results: 252 patients were identified. Median follow-up was 26.7 months. Median age was 65. Prior to treatment, 69% had a normal baseline T. 67% were treated with STADT, median duration 6 months. 33% were treated with LTADT, median duration 18 months. Median time for TR was 22.6 months for all patients (19.5 months for STADT and 25.6 months for LTADT). At 1 and 2 years post ADT, estimated TR was 13% and 53% (17% and 57% for STADT and 3% and 42% for LTADT). 2-year biochemical control was 99.2% and 97.6% for STADT and LTADT, respectively; 98.9% and 98.6% for those with and without TR, respectively. On multivariate analysis, higher pre-treatment T (HR = 1.004 95% CI 1.003-1.006, p < 0.001), use of STADT (HR = 2.48 95% CI 1.45-4.25, p = 0.001), and lower BMI (HR = 0.95 95% CI 0.91-0.98, p = 0.001) were associated with shorter time to TR. White race was a negative TR predictor (HR = 0.65 95% CI 0.43-0.9992, p = 0.049). Age, smoking, and Charlson Comorbidity Index were not significant independent TR predictors. A nomogram was generated to predict probability of TR at 1, 2, and 3 years. Conclusions: In this VA population of localized PC patients treated from 2011-2016, TR following the use of ADT-RT was variable. Using pre-treatment T levels, ADT duration, BMI, and race, a predictive nomogram can estimate the likelihood of TR.
Surgical center for ambulatory extended recovery: 30-day follow-up report of minimally invasive radical prostatectomy.
Authors: Sivaraman Arjun , Ehdaie Behfar , Eastham James Andrew , Coleman Jonathan , Touijer Karim A. , O'Shaughnessy Matthew , Stein Daniel , Durany Robert , Laudone Vincent Paul
Published: March 2017

83

Background: In January 2016, we opened a novel, multidisciplinary ambulatory surgical center dedicated to perform complex cancer surgeries on an Ambulatory Extended Recovery (AXR) pathway specifically aimed at a 1-night or less hospital stay. This is a standalone facility separate from the inpatient hospital. The aim of this study is to evaluate the 30-day post-operative follow-up of Minimally Invasive Radical Prostatectomy (MIRP) performed in an ambulatory care setting. Methods: Between January 2016 – September 2016, we performed 424 MIRP in the AXR dedicated surgical center. The baseline demographics, cancer characteristics, surgical information and follow-up data were prospectively collected. We evaluated the 30-day complications, rate of falling-off the AXR pathway, rate of transfer to our inpatient hospital, number urgent care visits and need for re-admission. Results: MIRP was performed as robot assisted (85%) and laparoscopic (15%) procedures. The median (range) overall length of hospital stay was 27.1 (11.4 – 35.2) hours with a total operative time of 4.8 (3.1 – 9.3) hours with an estimated blood loss of 175 (20 - 800) ml. Nine patients (2.1%) fell off the AXR pathway and were transferred to the main hospital for further care. In the 30-day post-surgery period, complications were noted in 6.4% patients (Grade 1 -38%, 2 - 34% 3 – 27%), while urgent care visits and re-admission rates were 10.7% and 2.6% respectively. The median (range) time from surgery to re-admission was 16 (2 - 43) days. Conclusions: A multidisciplinary ambulatory surgical center with a dedicated AXR pathway represents a significant advancement in MIRP surgical care, providing a 1-night hospital stay in an ambulatory setting with acceptably low rates of complications, urgency care visits and re-admissions.
Screening for aggressive prostate cancer: A single-center experience using the 4Kscore and multiparametric MRI for the detection of Gleason 7 or higher prostate cancer.
Authors: Venkatramani Vivek , Nahar Bruno , Koru-Sengul Tulay , Soodana-Prakash Nachiketh , Gonzalgo Mark L. , Ritch Chad , Parekh Dipen , Punnen Sanoj
Published: March 2017

84

Background: While non-invasive biomarkers and multi-parametric MRI (mpMRI) are routinely used for prostate cancer detection, few studies have assessed their performance together. We evaluated the performance of mpMRI and the 4Kscore for the detection of significant prostate cancer. Methods: We identified a consecutive series of men who underwent an mpMRI and 4Kscore for evaluation of prostate cancer at the University of Miami. We selected those who underwent a biopsy of the prostate. The primary outcome was the presence of Gleason 7 or higher cancer on biopsy. The 4Kscore was modeled as a continuous variable, but also categorized into low ( < 7.5%), intermediate (7.5-20%), and high ( > 20) risk scores. The mpMRI was categorized as being either negative or positive for a suspicion of cancer. We used logistic regression and Decision Curve Analysis to report the discrimination and clinical utility of using mpMRI and the 4Kscore for prostate cancer detection. Finally, we modeled the probability of harboring a Gleason 7 or higher prostate cancer based on various categories of the 4Kscore and mpMRI. Results: Among 235 men who underwent a 4Kscore and mpMRI, only 112 (52%) were referred for a biopsy, allowing a significant proportion of men to avoid a biopsy. Among those who had a biopsy, the AUC for using the 4Kscore and mpMRI together [0.81(0.72-0.90)] was superior to using the 4Kscore [0.71(0.61-0.81);p = 0.004] and mpMRI [0.74(0.65-0.83);p = 0.02] alone. Similarly, decision curve analysis revealed the highest net benefit for using both tests together, compared to either test alone. Finally, we found that having a positive mpMRI was a predictor of aggressive cancer in the higher two 4Kscores, but not in the lowest category, suggesting that men with a low 4Kscore may not benefit from getting an mpMRI, most likely due to the low likelihood of cancer and having a positive mpMRI. Conclusions: The 4Kscore and mpMRI provides independent, but complementary, information to enhance the prediction of aggressive prostate cancer. Prospective trials are required to confirm these findings.
Management of high-risk prostate cancer with 5-treatment stereotactic body radiotherapy: Long-term results.
Authors: Kang Josephine , Katz Alan J.
Published: March 2017

94

Background: Stereotactic Body Radiotherapy (SBRT) is an emerging treatment modality with excellent control rates for low- and intermediate-risk prostate cancer. The role of SBRT for high-risk disease, however, is less studied. The standard treatment (RT) for high-risk prostate cancer entails 8-9 weeks of daily RT with long-term androgen deprivation therapy (ADT). In comparison to this, SBRT is completed in 5 sessions, and offers convenience, low toxicity, and equivalent biochemical disease control rates as standard RT in the low- and intermediate-risk setting. We now present long-term results for SBRT in a cohort of patients with high-risk disease. Methods: We evaluated patients treated from 2006-2010 with SBRT alone (n = 52) to dose of 35-36.25 Gy in 5 fractions, or pelvic radiation to 45 Gy followed by SBRT boost of 19-21 Gy in 3 fractions (n = 46). Androgen deprivation therapy was administered to 55% of patients. Quality of life and bladder/bowel toxicity was assessed using the Expanded Prostate Index Composite (EPIC) and RTOG toxicity scale at regular time intervals. Results: Median followup was 84 months. 8-year biochemical disease-free survival (bDFS) was 61.3%. On univariate analyses,PSA was significant for bDFS (p = 0.001), whereas pelvic radiation (p = 0.97), T-stage (p = 0.79), ADT (p = 0.77), Gleason score (p = 0.78) were not. On multivariate analysis, only PSA remained significant (p = 0.003) for bDFS. Overall toxicity was mild, with 5.1% Grade 2 urinary, 3% Grade 3 urinary and 7.1% Grade 2 bowel toxicity. Use of pelvic radiotherapy was associated with significantly higher bowel toxicity (p = .001). EPIC bowel and bladder scores declined for the first six months and then returned towards baseline. Conclusions: Five-treatment SBRT appears to be a safe and effective treatment for high-risk prostate carcinoma now with median 84 month follow up. The addition of pelvic radiation or ADT does not confer any bDFS benefit with this modality. Our data suggests that SBRT alone may be the optimal approach. SBRT may be a good treatment alternative to discuss particularly for patients unable to undergo ADT or unwilling to receive standard 8-9 week RT. Prospective studies are required to corroborate our results.
New frontiers ahead focal therapy postoperative follow-up: What is the real role of MRI in this setting?
Authors: Nunes-Silva Igor , Barret Eric , Baghdadi Mohammed , Srougi Victor , Barreras Silvia Garcia , Carneiro Arie , Capogrosso Paolo , Rembeyo Gregory , Sanchez-Salas Rafael , Rozet François , Galiano Marc , Cathelineau Xavier
Published: March 2017

e539

Background: Magnetic resonance imaging (MRI) plays an important role as a treatment-monitoring tool along focal therapy (FT) follow-up. This is the first study to assess MRI ability to correctly predict prostate cancer (PCa) local T-stage in the FT postoperative scenario. We aimed to describe MRI effectiveness in predicting upstaging in two groups of men: 1) men who failure after primary FT and then underwent salvage robotic-assisted radical prostatectomy (S-RARP) and 2) men who underwent RARP as primary treatment (P-RARP). Methods: Prospective data of 2775 men underwent RARP for localized PCa from 2000 to 2016 were reviewed. Twenty-two men underwent S-RARP after FT failure (S-RARP group). Total 2750 underwent RARP as first treatment. Matched-pair 1:2 selection of 44 out of 2750 patients by age defined primary RARP group (P-RARP). All patients underwent MRI immediately before RARP. MRI findings were confronted with final surgical pathology. Primary endpoint: sensitivity, specificity, positive and negative predictive values; positive (+LR) and negative (-LR) likelihood ratio regarding upstaging analysis on S-RARP. Secondary endpoint: same effectiveness analysis on P-RARP. Results: Preoperative MRI failed in predicting upstaging in 80% versus 91.7% of patients (p = 0.515) that presented final pathological status ≥ pT3a on S-RARP and P-RARP groups, respectively. On the other hand, when final pathology described a localized disease T2a-T2c, MRI correctly predicted the final pathological status in 81.8% versus 95.2% of patients (p = 0.27) on S-RARP and P-RARP groups, respectively. Between-group analysis, showed sensitivity and specificity rates of 20% versus 8.33% and 81.8% versus 95.23%, respectively; Positive and negative predictive values of 33.33% versus 50% and 69.23% versus 64.51%, respectively; Positive (+LR) and negative (-LR) likelihood ratio of 1.1 versus 1.74 and 0.98 versus 0.96, respectively. Conclusions: MRI has shown to be a weak diagnostic tool for predicting extra-prostatic disease along FT follow-up. Urologists may be warned about the risk of underdiagnosis and undertreatment in patients presenting failure after FT.
A new technique of reporting prostate biopsy to predict prostatectomy outcome.
Authors: Olsson Carl A. , Shah Paras Hemant , Yaskiv Oksana , Kapoor Deepak A.
Published: March 2017

e544

Background: Presently, the highest Gleason Grade Group (GGG) is the metric used to gauge the clinical aggressiveness of tumor and dictate treatment. However, the urologist is limited by lack of consideration of the entire biopsy using that single parameter alone. Intuitively we presumed that the biopsy showing multiple cores of cancer would represent more aggressive disease. Herein, we propose the Weighted Gleason Grade Group (WGGG), a novel scoring system that synthesizes histopathologic data and cancer volume into a single numeric value representing the entire biopsy that provides the urologist with the ability to more accurately predict adverse pathologic outcomes of prostatectomy. Methods: We studied 212 men who underwent radical prostatectomy after standard multi-core prostate biopsy. The highest Gleason score of each biopsy was converted to its final GGG. The WGGG was calculated by summing the Gleason score of each positive core and normalized for a 12 core total. Radical prostatectomy pathology was studied to determine adverse pathological outcomes, specifically, extraprostatic extension (EPE), positive surgical margins (PSM), lymphovascular invasion (LVI), seminal vesical invasion (SVI) and pathological upgrading. Logistic regression analysis was used to compare the ability of conventional GGG versus WGGG to predict the risk of these adverse features. Results: The odds ratio (OR) for predicting EPE, SVI and LVI for increasing GGG versus WGGG (in 10-point incremental increases) were 1.16 (95% CI 1.1-1.2, p < 0.001) versus 1.81 (95% CI 1.42-2.32, p < 0.001), versus 2.05 (95% CI 1.45-2.90, p < 0.001) and versus 3.46 (95% CI 1.99-6.04, p < 0.001), respectively. WGGG, but not GGG was significantly associated with PSM 1.07 (95% CI 1.029-1.104, p = 0.004) and pathologic upgrading 1.621 (95% CI 1.461- 1.837, p = 0.002) of the prostatectomy specimen. Conclusions: The WGGG, by providing a measurable value reflecting the entirety of the prostate biopsy, is more informative than conventional single GGG alone in reliably predicting adverse pathologic outcomes on radical prostatectomy specimens.
Trends and clinico-sociodemographic determinants of stereotactic body radiotherapy use for localized prostate cancer: A National Cancer Database study.
Authors: Mahal Brandon Arvin Virgil , Chen Yu-Wei , Muralidhar Vinayak , Yang David , Mahal Amandeep R. , Yu James B. , Orio Peter F. , Nguyen Paul L.
Published: March 2017

e545

Background: Stereotactic body radiotherapy (SBRT) represents an emerging and cautiously guideline-approved definitive therapy option for prostate cancer, though long-term data on efficacy and toxicity is still pending. Herein, we sought to determine contemporary national SBRT trends and clinico-sociodemographic determinants associated with its use in prostate cancer. Methods: The National Cancer Data Base (NCDB) was queried to identify 181,544 patients diagnosed with localized prostate cancer from 2004-2012 who received external beam radiotherapy. Multivariable logistic regression adjusted for sociodemographic and clinical factors was used to identify independent determinants of SBRT use. Results: Rate of SBRT use for localized prostate cancer increased from 0.05% in 2004 to 4.87% in 2012 ( Ptrend< 0.001). SBRT was more likely to be delivered at academic centers, to patients with Medicare, and to patients who were white, younger, healthier, from wealthier and more educated zipcodes, and who had lower risk disease features (all P< 0.001). Relative to Whites, men from more affluent zipcodes, or men with low stage or grade prostate cancer, Blacks, Hispanics, and men from less affluent zipcodes and men with high stage or grade prostate cancer were less likely to receive SBRT after multivariable adjustment, with adjusted hazard ratios of 0.66, 0.35, 0.33, 0.07, and 0.21, respectively (all P< 0.001). Conclusions: The absolute national rate of SBRT use as definitive therapy for prostate cancer has increased nearly 100-fold over the last decade. Men who are White, younger, healthier, from more affluent zipcodes and with favorable disease characteristics are more likely to receive an emerging form of radiotherapy with unknown long-term efficacy and toxicity.
Utility of PCA3 and TMPRSS2: ERG urinary biomarkers to predict pathologic outcomes in African American men undergoing radical prostatectomy.
Authors: Feibus Allison H. , Sartor Oliver , Ledet Elisa M. , Shaw Eric , Moparty Krishnarao , Thomas Raju , Silberstein Jonathan L.
Published: March 2017

e547

Background: Tremendous disparity exists between preoperative characteristics and pathologic outcomes in men electing radical prostatectomy (RP) for localized prostate cancer (PCa). We sought to determine the performance characteristics of urinary PCA3 andTMPRSS2:ERG (T2:ERG) to predict pathologic outcomes in a racially diverse group of men undergoing RP. Methods: Following IRB approval, post digital rectal exam (DRE) urine was prospectively collected in consecutive patients with known PCa prior to RP. PCA3 and T2:ERG RNA copies were quantified and normalized to PSA mRNA copies using the Progensa assay (Hologic, San Diego, CA). Nonparametric Mann-Whitney U tests were performed to determine the ability of PCA3 and T2:ERG to predict higher risk PCa and notable disease features. Results: The cohort consisted of 214 men with PCa who underwent RP, and 89 men (42%) were African American (AA). The men in the cohort generally had higher risk disease, with 75% having AUA risk stratification of intermediate/high-risk PCa. PCA3 discriminated between biopsy low- and intermediate/high-grade Gleason Score (p = .005) and pathologic low- and intermediate/high-grade Gleason Score (p = 0.001). For men with low-risk PCa, PCA3 also predicted Gleason Score upgrading from biopsy to prostatectomy specimen (p = 0.003). PCA3 could not predict the presence of perineural invasion, lymph node positivity, seminal vesical invasion, positive surgical margins or extraprostatic extension. When stratified by race, within the AA cohort, T2:ERG did predict upgrading from Gleason 6 disease at the time of biopsy to higher grade pathology at RP (p = 0.016). However, T2:ERG was not predictive for the overall cohort, nor was it predictive for any of the disease features found to be significant with PCA3. Conclusions: In a racially-diverse group of men undergoing RP, PCA3 and T2:ERG urinary assays have limited ability to characterize aggressive pathologic features at the time of RP regardless of race.
Racial variations in upgraded gleason scores of active surveillance candidates.
Authors: Pandya Krishna , Feibus Allison H. , Sholl Andrew B. , Silberstein Jonathan L.
Published: March 2017

e548

Background: Currently, active surveillance is an appropriate option for patients who have low risk PCa as determined by the NCCN as Gleason Score (GS) ≤ 6 and a PSA <10. Methods: Following IRB approval, we determined that 141 men from our database had low risk PCa and were eligible for AS, but underwent radical prostatectomy (RP). We performed a retrospective review of these patients examining GS upon RP. Disease upgrading on RP was considered Gleason score ≥ 7. A two-tailed t-test was performed to examine whether African American (AA) patients had greater incidence of upgrading on RP than non-African American patients. Results: Of the 141 patients identified (36 AA, 105 non-AA) there were no significant differences in age at RP (59 AA, 59 non-AA), median PSA (5.5 ng/dL AA, 5.4 ng/dL non-AA), and number of positive cores (3 AA, 3 non-AA) at biopsy when stratified by race. A total of 85 patients (19 AA, 66 non-AA) were found to have an upgraded GS at the time of RP; again without significant difference with respect to age (60 AA, 61 non-AA), serum PSA (5.3 AA, 5.35 non-AA), total cores taken at biopsy (12 AA, 12 non-AA) and median positive cores (3.5 AA, 3 non-AA). Of the 85 patients upgraded, 66 (12 AA, 54 non-AA) were 3+4 and the remainder were ≥ 4+3. There was no significant racial variation for patients upgraded to Gleason 3+4 (p>0.05). Next we reviewed the presence of tertiary pattern 5 within these 3+4 patients and found it present in 1 patient who was AA. For the 19 patients with ≥ 4+3 upgrading, with respect to race (7 AA, 12 non-AA, p = .08) there were no significant differences in age, serum PSA, median positive and total cores taken at biopsy. However, when comparing these 19 upgraded ≥ 4+3 patients to the total cohort, they had a higher median serum PSA (6.16 ng/dLvs 5.4 ng/dL) and higher positive cores (4 vs 3) on biopsy. For these 19 patients, upgrading resulted in reclassification from low to high-grade (GS ≥ 8) PCa in 7 patients. Conclusions: African American patients with low risk PCa have do not have an increased risk of significant upgrading at RP when compared with other races, and further investigation is needed to identify factors that contribute to upgrading.
Does shared decision making for PSA screening empower patients?
Authors: Talcott James Austin , Bezuhly Maureen , Aharanoff Gina , Herzstein Jessica , Osborne Michael P. , Chadha Manjeet
Published: March 2017

e549

Background: Participant characteristics affect shared decision making. In a randomized trial of physician (MD) educational interventions to improve cancer screening guideline compliance, we studied patient (PT) and MD recall of discussions and how PT characteristics affected recall. Methods: In a cluster-randomized trial of educational supports for MDs, we are enrolling an age- (30-89 years) and sex-stratified sample of 216 PTs who underwent a physical examination at two urban hospitals, 18 for each of 12 primary care MDs. Screening guideline formatting (color-coding) and academic detailing were randomly assigned in a 2x2 design. Immediate post-encounter surveys recorded PT and MD recall of screening discussions. Results: Of the first 174 participants, 92 were men. PTs were diverse (69% white) and well educated (73% college degree). When MDs reported a prostate specific antigen (PSA) screening discussion, 32% of PTs did not, and 26% of MDs disagreed when PTs reported the discussion occurred. Further, when the MD reported recommending screening, 26% of PTs disagreed, and 33% of MDs disagreed when their patients reported a recommendation. Overall, agreement between all PTs and MDs on whether screening was recommended was fair (kappa = 0.29) but there was no agreement for PTs over 70 years (kappa = -0.03). PTs reported more elements of shared decision making than MDs (data not shown). When both PT and MD or the MD alone reported that all elements of shared medical decision making had occurred, agreement on whether screening was recommended improved (kappa = 0.54 and 0.45, respectively). When PTs disagreed with their MD, they more often reported recommending for screening not against (11 vs. 4). Conclusions: In a highly educated, diverse PT population, PTs and MDs surveyed immediately after their encounter often disagreed on whether PSA screening was discussed and recommended. Disagreement was worse with older PT age but improved when both PT and MD or the MD alone reported all shared decision making elements. Clinical trial information: NCT02430948.
Permanent prostate brachytherapy and short-term androgen deprivation for favorable and unfavorable intermediate risk: Clinical results for median 5 year follow-up.
Authors: Guerif Stephane Gilles , Molina Sarah , Hugues Guillaume , Boissonnade Odile , Debaene Bertrand , Fromont Gaelle , Berger Antoine
Published: March 2017

e554

Background: The option of prostate brachytherapy for intermediate risk is discuss. We present mature results of permanent prostate brachytherapy and short-term androgen deprivation for favourable and unfavourable intermediate risk. Methods: From 01/2006 through 12/2012, 707 patient were treated by real time iodine brachytherapy. 135 intermediate risk, 72% favourable and 28% unfavourable were include. Unfavourable was define as a gleason 7 (4+3) or > 50 % positive biopsy or 2 intermediate factors. Neoadjuvant with or without adjuvant androgen deprivation therapy was administered to 94% patients. 91 % of patients have a duration of hormone ≤ 6 mouths. 40% had vesicle seminal biopsy. 62 % had a lymph node dissection. 75 % had a bone scan. 95% had a MpMRI with tumour index in 72 %. All patients with DIL on MpMRI had a focused real time image guided brachytherapy. Tumour control was measure with phoenix definition and death with Kaplan-Meier method. The GU and GI toxicity were measure with IPSS and CTCAE V 3, IIEF-5. Results: The mean Number of seeds used was 63 ( SD, 13). Mean prostate volume was 27 cm3 (SD, 11) and 70cc maximum. Mean dose to 90% of the prostate was 188 Gy (SD, 9). Ud30 (mean, 189 Gy; SD, 10). RD2cc (mean, 105Gy; SD, 22). Mean duration of hormone was 5,6 mouths (SD,1,6). The biologic disease free survival at 5 and 8 years were 97,1 % and 94%. The global survival at 5 and 8 years were 98%. The urinary symptoms return to the baseline at 2 years with maximum toxicity at 1 month. 2 GU grade 3. GI grade 1 2 and 3 were 34%, 15% and 0%. 20% of patients with IIEF > 16 at baseline had sexual intercourse at Two years. Conclusions: Our single-institution study with a median 5-year follow-up showed that permanent prostate brachytherapy and short-term androgen deprivation risk was safe and effective for patients with favourable and unfavourable intermediate risk prostate cancer. However the association of hormone decrease the sexual function. The place of the hormone must be explore in selected intermediate risk treated by brachytherapy.
Three year results of a prospective study on focal salvage HDR prostate brachytherapy for local recurrence after external beam radiotherapy (XRT).
Authors: Chung Hans T. , D'alimonte Laura , Loblaw Andrew , Ravi Ananth , Davidson Melanie , Wronski Matthew , Haider Masoom A. , Morton Gerard
Published: March 2017

e558

Background: Salvage options for those with local recurrence after XRT include surgery, brachytherapy, cryotherapy or high-frequency ultrasound. However, the risk of significant complications (e.g. fistula, incontinence, bladder neck contracture), is not insignificant. The sensitivity of multiparametric MRI in detecting viable cancer within the prostate is now more than 70%. The objectives of this pilot study are to explore the toxicities, QOL and efficacy of focal salvage HDR brachytherapy in patients with MRI-visible biopsy-confirmed local recurrence. Methods: Eligible patients included: multiparametric 3T MRI-visible biopsy-confirmed local recurrence > 30 months after XRT, negative metastatic workup, IPSS < 15, post-XRT PSA < 10ng/mL, prostate volume ≤ 50cc. The ultrasound-based HDR brachytherapy prescription dose was 27Gy divided over two implants separated by 1 week to the target volume (TV) with dose constraints to the urethra and rectum. Follow-up PSA, IPSS, EPIC QOL and CTCAE v4.0 toxicities were collected. Results: 15 patients (mean age 73 years) were enrolled in the study. Median follow up was 30 months (12-42). At initial presentation, there were 5, 8 and 2 low-, intermediate- and high-risk disease, and initial XRT dose was 70-78Gy. The Gleason score of the local recurrence was 6, 7 and 8-10 in 1, 7 and 6, respectively, and not classified in 1 patient. The pre-HDR median PSA was 4.13 (1.30 – 9.29). The median size of the recurrence on MRI was 9mm (7-20), TV 6.1cc (2.2-16.1), TV V100 96.3%, TV D90 110.9%, urethral D10 64.5% and rectal D10 36.0%. No acute/late GU/GI grade 3-5 toxicities, nor urinary retention, were observed. The most common acute toxicity was frequency and nocturia. Median IPSS at baseline, 1-, 3-, 6-, 12-, 18-, 24-months was 4, 8, 5, 5, 8 and 5 (p = 0.72). Three year PSA failure free rate was 71%. There was no significant change in EPIC domains. Conclusions: Early toxicity, QOL and PSA failure-freedata suggests that focal salvage HDR brachytherapy is well tolerated and effective. Clinical trial information: NCT01583920.
Patients with metastatic castration-resistant prostate cancer (mCRPC) are primary resistant (PR) to the new agent (NA)-based second line: Clinical outcomes and prognostic factors of subsequent treatment with another NA.
Authors: Caffo Orazio , Bria Emilio , De Giorgi Ugo , Tucci Marcello , Biasco Elisa , Fratino Lucia , Rossetti Sabrina , Iacovelli Roberto , Morelli Franco , D'Angelo Alessandro , Campadelli Enrico , Verderame Francesco , Borsellino Nicolo , Sartori Donata , Guida Annalisa , Ricotta Riccardo , Barni Sandro , Maines Francesca , Sperduti Isabella , Zagonel Vittorina
Published: March 2017

e585

Background: Several NA [abiraterone acetate (AA), cabazitaxel (CABA), or enzalutamide (ENZ)] changed the prognosis of mCRPC pts being able to significantly prolong their overall survival (OS) after docetaxel failure. Unfortunately, a quote of pts experiences an early progression (within 3 mos) during the second line treatment and it is unclear if a clinical benefit may result from a subsequent treatment with another NA. The present study is aimed to assess the clinical outcomes and prognostic factors of subsequent NA treatment in those pts PR to the second line NA. Methods: We collected data of pts who received sequentially two NAs after DOC in 38 Italian hospitals. For each pt we recorded the clinical outcome of all treatments received after DOC. For the purpose of the present analysis we consider as PR pts who progressed within 3 months from the start of the NA second line. Cox regression analysis was used to assess the independent prognostic value of a series of third-line baseline covariates, in terms of progression free survival (PFS) and OS. Results: A consecutive series of 476 mCRPC pts with bone (86%), nodal (56%) or visceral (15%) mets, was collected. The NA-based second line consisted of AA (261 pts), CABA (151), and ENZ (64): we identified 55 PR pts (AA 24 – CABA 24 – ENZ 7). All pts received a subsequent NA-based third line: 22 received AA, 25 CABA, and 8 ENZ. Compared to no-PR pts, PR pts showed a lower biochemical response rate (12.2% vs 31.6%; p = 0.005), but no significant differences in terms of objective response rate (17.1% vs 15.2%), PFS (median 3.5 vs 4.7 mos), and OS (median 9.4 vs 12.9 mos). Considering the PR population, at the multivariate analysis , lactate dehydrogenase and PSA were independent prognostic factors for PFS in third line, while hemoglobin, PSA, administration of one NA in fourth line and lactate dehydrogenase were independent prognostic factors for OS. Conclusions: In our experience, NA-based third line is active also in mCRPC PR population and some factors may help in selecting patients with higher probability of achieving a disease control.
Is there an additional benefit of Tc-99m-PSMA-guided gamma probe use for salvage lymph node dissection in recurrent prostate cancer.
Authors: Pfister David , Schmidt Matthias , Haidl Friederike , Porres-Knoblauch Daniel , Drzezga Alexander , Heidenreich Axel
Published: March 2017

e591

Background: PSMA-PET/CT is the most sensitive diagnostic tool in biochemical recurrent prostate cancer to detect minimal metastatic disease. However, it may be difficult to localize small PSMA-positive lymph nodes intraoperatively. Therefore, it was the aim to investigate whether preoperative Tc-99m-PSMA targeting may improve intraoperative tumor localization by use of a gamma probe. Methods: In 13 Patients Ga-68-PSMA-PET/CT identified iliac lymph nodes in patients suitable for salvage lymph node dissection. On the day before operation a mean activity of 480 MBq Tc-99m-PSMA was injected and gamma camera scintigraphy + SPECT was performed 4-5 hours after tracer application. About 24 hours after tracer application a salvage lymph node dissection was performed on the side of initial suspicious lymph node metastases. Sensitivity, specifity, pos and neg. predictive values were calulated for PSMA-PET/CT and gamma probe use to analyse the additional use. Results: In 9 / 13 patients PSMA-positive metastatic lymph nodes were identified in Ga-68 PSMA-PET/CT. A total of 156 lymph nodes were removed with 14 lymph nodes in 9 patients being positive in histopathologic examination. Sensitivity, specifity, pos and neg. predictive values for PSMA PET/CT and gamma probe were 85% and 79%, 99% and 100%, 85% and 100% and 99% and 98% respectively. In one patient only gamma probe use identified a pathologic lymph node. Conclusions: Gamma probe guided salvage lymph node dissection in PSA recurrent prostate cancer is feasible and had a high concordance with PSMA-PET/CT. However, the additional diagnostic benefit is limited compared to PSMA-PET/CT because in only one patient (7%) a positive lymph node could be identified with the use of the gamma probe outside the standard operative area in salvage lymph node dissection.
Predictors for survival with cabazitaxel (CBZ) in metastatic, castration-resistant prostate cancer (mCRPC): Long term follow-up of the Spanish registry.
Authors: González-Maeso Iria , Lainez Nuria , Castellano Daniel , Garcia Carbonero Iciar , Borrega Pablo , Campos Balea Begona , Garcia Marrero Rosa , Esteban Emilio , Rodriguez Vida Alejo , Munarriz Javier , Garcia-Bueno Jose Maria , Villalobos Maria L. , Viciana Ruth , Rubio Gustavo , Perez-Valderrama Begoña , Garcia Sanchez Jose , Pelaez Lorenzo Beatriz , Cumplido Buron Jose David , Martin Almudena , Bellmunt Joaquim
Published: March 2017

e602

Background: The clinical experience with CBZ in mCRPC patients (pts) has enriched notably since its approval for clinical use, but there is still a lack of well-defined prognostic/predictive factors to better characterize the profile of pts that could achieve the best therapeutic benefit. Analysis of the final expanded cohort and mature long-term follow-up are presented. Methods: Medical records from mCRPC pts progressing during or after docetaxel and treated with CBZ at 21 centres in Spain were reviewed retrospectively. Baseline characteristics, overall survival (OS), radiographic progression-free survival (rPFS), and toxicity were collected. Univariate and multivariate analysis of a variety of factors predicting OS were conducted. Results: 187 consecutive pts (median age 69) with intermediate-poor prognostic baseline characteristics (Table 1) received a median of 6 cycles (range 2-59) of CBZ. Median OS from first CBZ cycle was 15.3 [CI: 11.7; 18.0] months (mo) and median clinical and/or rPFS was 7.9 mo [CI: 6.8; 10.3]. Gleason score (GS) < 8 (vs ≥ 8), time under first-line androgen deprivation therapy (ADT) ( > 16.1 (median) vs < 16.1 mo) and the number of chemotherapy lines before CBZ did not significantly influence OS. Median follow-up was 9.5 mo. Febrile neutropenia occurred in 4 pts and 1 pt had neutropenic infection. Main nonhematologic grade ≥ 3 toxicities were asthenia (2.7%) and diarrhea (1.6%). Alopecia, nails disorders and peripheral neuropathy were uncommon. Conclusions: CBZ administered in the daily clinical practice is associated with consistent OS, similar to that observed in pivotal clinical trials. GS, median time under first-line ADT and number of chemotherapy lines before CBZ did not influence clinical benefit. CBZ has an acceptable safety profile. Funding: Sanofi [Table: see text]
Recent advances in understanding Epstein-Barr virus
Authors: Stanfield Brent A. , Luftig Micah A.
Published: March 2017

Epstein-Barr virus (EBV) is a common human herpes virus known to infect the majority of the world population. Infection with EBV is often asymptomatic but can manifest in a range of pathologies from infectious mononucleosis to severe cancers of epithelial and lymphocytic origin. Indeed, in the past decade, EBV has been linked to nearly 10% of all gastric cancers. Furthermore, recent advances in high-throughput next-generation sequencing and the development of humanized mice, which effectively model EBV pathogenesis, have led to a wealth of knowledge pertaining to strain variation and host-pathogen interaction. This review highlights some recent advances in our understanding of EBV biology, focusing on new findings on the early events of infection, the role EBV plays in gastric cancer, new strain variation, and humanized mouse models of EBV infection.
INFLUENCE OF DENSITY AND LENGTH OF CUTTING OF BASALT FIBER ON PHYSICAL AND MECHANICAL INDICATORS OF COMPOSITE DISPERSION-REINFORCED ASPHALT-CONCRETE MIXTURE
Authors: Андронов Сергей , Andronov Sergey , Задирака Алексей , Zadiraka Aleksey
Published: March 2017

Experiments on the introduction of basalt fiber with various density and length of cutting into the composition of the dispersed-reinforced asphalt mixture were carried out, laboratory tests of asphalt concrete samples were carried out, the optimal density and length of cutting basalt fiber for introduction into asphalt concrete mixtures

In transport construction, asphalt concrete is widely used, which is prone to cracking, peeling, chipping, formation of stakes, waves and depressions. The way to increase the resistance of asphalt concrete to external loads is the introduction of fibers and threads into its composition. Introduction to the asphalt-concrete mixture of small (discrete) elements allows to achieve their uniform distribution (dispersion) in the mixture, and to obtain a "composite" material with higher physical and mechanical properties in the finished structural element
ABOUT THE NEW INTERSTATE STANDARD GOST 34028-2016 "STEEL FOR THE REINFORCEMENT FOR CONCRETE "
Authors: Саврасов Иван , Savrasov Ivan , Дьячков Вячеслав , D´yachkov Vyacheslav , Цыба Олег , Tsyba Oleg , Панченко Александр , Panchenko Aleksandr
Published: March 2017

Currently rebar for reinforced concrete structures is the most popular type of building purpose steel. Increase consumer properties of reinforcing bar is possible with close collaboration of metallurgists and builders. The results of paper of the reinforcing bar in weldability, endurance and stress relaxation in accordance with the requirements of the project of a new GOST 34028-2016 "Steel for the reinforcement for concrete."
DETERMINATION PATH OF MOVEMENT CENTER OF THE RING DURING CENTERLESS MACHINING
Authors: Дуганов Владимир , Duganov Vladimir , Сумской Александр , Sumskoy Aleksandr
Published: March 2017

In the given work, present the study of factors depending on elastic deformation of the products and the shift of its axis of rotation in the space, on the accuracy of centerless processing of large products. It allows increasing the quality of of support assemblies of large rotating devices, by enhancing machining precision of the functional surfaces. What becomes very important during mounting and of the repairs machine by portable modules in the mining and construction industries.
THE FEATURES OF ONLINE-CASHBOX
Authors: Брянцева Татьяна , Bryantseva Tatyana , Шевченко Мария , Shevchenko Mariya
Published: March 2017

The article discusses the features of the organization of the settlement system with the use of on-line сashboxs, imposed in connection with a change in federal law in 2017 and designed to simplify the implementation of tax control over the use of cash registers trade organizations, including in the construction industry.
INFLUENCE OF TRACES ADDITION OF TIN ON THE GROWTH AND ON THE COARSENING OF THE GUINIER-PRESTON ZONES IN Al-10% at.Ag ALLOY
Authors: Lourdjane Faiza , Kadi-Hanifi Mouhyddine , Abderrahmane Raho Azzeddine
Published: March 2017

The formation of the Guinier-Preston zones in aluminium alloys is closely linked with the excess vacancies. Traces of tin added to an Al-Ag alloy exert an influence on the Guinier-Preston zones precipitation. Due to their high binding energy with vacancies, tin atoms trap some of these available to promote the diffusion of silver atoms for the formation of the Guinier-Preston zones. At 125°C, tin microalloying slows down the reaction of the Guinier-Preston zones precipitation. The diffusion coefficient of the solute atoms in the Sn free alloy and in the Sn added alloy are determined during the coarsening regime which obeys to the Lifshitz, Slyosov and Wagner theory.
EFFECT OF SALT BATH NITRIDING ON SURFACE ROUGHNESS BEHAVIOUR OF AISI 4140 STEEL
Authors: Ghelloudj Elhadj , Hannachi Mohamed Tahar , Djebaili Hamid
Published: March 2017

In the present research, AISI 4140 steel was nitrided in salt bath to study and analyze the behaviour of the surface roughness. The structural surface characterization behaviour of the nitrided steel was compared to the behaviour of the same steel which was untreated. The nitriding process was implemented in the salt bath component at ten different times (from 1 h to 10 h) when the temperature was constant at (580ºC). The influence of nitriding treatment on structural properties of the material was studied by scanning electron microscopy (SEM), microhardness tester and surface profilometer. It was found that salt bath nitriding was effective in improving the surface properties behaviour of this steel. Experimental results showed that the nitrides ε-Fe2-3(N,C) and γ’-Fe4(N,C) present in the compound layer increase the microhardness (406–502 HV0.3), the initial surface roughness values of nitrided samples were higher than those of unnitrided specimens, it also observed that the increasing the nitriding time increases the surface roughness parameters (Ra, Rq and Rz).
COARSENING KINETICS IN Al ALLOY CAST THROUGH RAPID SLURRY FORMATION (RSF) PROCESS
Authors: Gupta Robin , Sharma Ashok , Pandel Upender , Ratke Lorenz
Published: March 2017

In the present investigation, the rate of coarsening kinetics was discussed on conventional diffusional Lifshitz, Slyozov and Wagner (LSW) theory, coarsening by convective mass flow and coalescence by stirring speed. The rate of coarsening kinetics was found to be faster than predicted by diffusional LSW theory, but slower than predicted by the convective mass flow. The effect of flow pattern with baffles in a crucible at different holding time was also examined. The results showed that use of baffles produced fine and more globular primary α-Al phase when compared to sample processed without baffles having the same holding time.
Rewievers, except the members of Editorial Boards, in year 2016
Authors: AMS Editorial
Published: March 2017

Dana BARICOVÁ, Faculty of Metallurgy, Technical University of Kosice, Slovakia

Jaroslav BRIANČIN, Slovak Academy of Sciences, Kosice, Slovak

Anh-Hoa BUI, School of Materials Sciecen and Engineering, Hanoi University of Technology, Viet Nam

Branislav BUĽKO, Faculty of Metallurgy, Technical University of Kosice, Slovakia

Martin ČERNÍK, US Steel, Kosice, Slovakia

Rakesh K. DHAKA, US Steel, Research and Technology Center, Pittsburg, USA

Ladislav FALAT, Institute of Materials Research, Slovak Academy of Sciences, Kosice, Slovakia

Martin FUJDA, Faculty of Metallurgy, Technical University of Kosice, Slovakia

Anna GUZANOVÁ, Faculty of Mechanical Engineering, Technical University of Kosice, Slovakia

Mária HAGAROVÁ, Faculty of Metallurgy, Technical University of Kosice, Slovakia

Mária HEŽELOVÁ, Faculty of Metallurgy, Technical University of Kosice, Slovakia

Pavol HVIZDOŠ, Institute of Materials Research, Slovak Academy of Sciences, Kosice, Slovakia

Ľuboš KAŠČÁK, Faculty of Mechanical Engineering, Technical University of Kosice, Slovakia

Ján KIZEK, Faculty of Metallurgy, Technical University of Kosice, Slovakia

Róbert KOČIŠKO, Faculty of Metallurgy, Technical University of Kosice, Slovakia

Andrea KOVAČOVÁ, Faculty of Metallurgy, Technical University of Kosice, Slovakia

Vladimir KOVAL, Institute of Materials Research, Slovak Academy of Sciences, Kosice, Slovakia

František LOFAJ, Institute of Materials Research, Slovak Academy of Sciences, Kosice, Slovakia

Pavol MAREK, Consultant, Kosice, Slovakia

Jan SAS, Institute for Technical Physics, Karlsruhe Institute of Technology, Germany

Andrzej TRYTEK, Politechnika Rzeszowska, Rzeszow, Poland
INFLUENCE OF HEAT TREATMENTS ON THE MICROSTRUCTURE OF WELDED API X70 PIPELINE STEEL
Authors: Digheche Kelthoum , Boumerzoug Zakaria , Diafi Malika , Saadi Khawla
Published: March 2017

Welding is one of the most important technological processes used in many branches of industry such us industrial engineering, shipbuilding, pipeline fabrication among others. Generally, welding is the preferred joining method and most common steel are weldable. This investigation is a contribution to some scientific works which have been done on welding of low carbon steel. This work, presents some heat treatments were used to alter the microstructure of base metal (BM), heat affected zone (HAZ) and weld metal (WM) in the welded pipe steel of grade API X70. It presents the microstructures obtained after three heat treatments at 200°C, 400°C and 600°C for 30 min. Scanning electron microscopy and X-ray diffraction have been used as characterization techniques to observe the WM microstructures, in addition the Vickers hardness test are also achieved. The results revealed that the isothermal heat treatment caused grain growth and coarsening reactions in the weld zone and the hardness of weld joints decreased were the main transformations after increasing the temperature of the heat treatment.