The aim of the study was to prove the surgical and oncological safety of radical vaginal trachelectomy (RVT) and laparoscopic lymphadenectomy for patients with early-stage cervical cancer who are seeking parenthood.A database of 225 patients with early-stage cervical cancer and intention to treat by RVT after laparoscopic lymphadenectomy was prospectively maintained. A total of 212 patients were treated according to the protocol. The procedure was preformed in a standardized manner, and life table analysis was applied.In the cohort of patients treated according to protocol, 8 recurrences occurred and 4 patients died from recurrence. The median follow-up time was 37 months (range, 0-171 months). The 5-year recurrence-free and overall survival was 94.4% and 97.4%, respectively. Perioperative and short-term postoperative complications were rare (2.8% and 7.5%, respectively). No severe long-term complications occurred.Radical vaginal trachelectomy combined with laparoscopic lymphadenectomy is a safe method for treatment of patients with early-stage cervical cancer who are seeking parenthood.
The aim of our study was to evaluate the outcome of alternative sequences of sunitinib followed by sorafenib versus sorafenib followed by sunitinib therapies in patients with metastatic renal cell carcinoma (mRCC).This single-center study analyzed patients with mRCC on systemic therapy between January 2005 and August 2011. Patients were treated with the recommended first-line therapy (sunitinib, sorafenib, pazopanib, or immunotherapy) until progression or intolerable toxicity and afterward switched to another guideline-recommended systemic therapy. Only patients starting first-line therapy on either sorafenib or sunitinib and switching to the other of these drugs were included in this analysis.Out of 266 patients (females: 85, males: 181) with a median age of 57.1 years (30 - 76 years), 57 patients with a sequence of sunitinib and sorafenib were identified. First-line sorafenib therapy was followed by sunitinib (So-Su) in 32 patients; sunitinib was followed by sorafenib (Su-So) in 25 patients. Progression-free survival (PFS) for patients with first-line sorafenib was 11.6 months and was 8.7 months for sunitinib. Overall survival (OS) rates for Su-So was 118.8 months and 83.3 months with So-Su (p = 0.82). No new safety signals were detected.None of the therapeutic first-line approaches was superior to the other. Sequencing tyrosine kinase inhibitor (TKI) therapy seems to be effective in mRCC and superior to single-line therapy. Further studies should focus on the efficacy of single treatment lines rather than treatment sequences to estimate more potent drugs based on PFS rather than overall survival (OS).
Objective: To assess whether salvage radical prostatectomy (rPx) after external beam radiotherapy (EBRT), brachytherapy (BT) or high intensity focused ultrasound (HIFU) is a valuable therapeutic option and efficacious in tumor control.Material and methods: 36 patients with local recurrence of prostate cancer (PC) after primary curative EBRT, BT or HIFU underwent open salvage rPx.Preoperative imaging was done by choline PET or PSMA PET-CT to check for a possible systemic disease as cause of biochemical recurrence (BCR) in all patients.We evaluated peri and post-operative complications and compared these to open rPx as primary treatment of PC as well as we did for functional and oncologic outcomes.BCR after salvage rPx was defined as a PSA-increase above ≥0.2ng/ml. Results:Primary treatment was EBRT in 21 patients (58%), BT in 7 (19%), a combination of both in 1 (3%) and HIFU in 7 pts (19%).Median age was 69 years (range 58-78) and median preoperative PSA was 5.7 ng/ml (range 0-197).No major intra-or postoperative complications were observed.Median intra-operative blood loss was 200 ml (50-1000), no transfusion was needed and median operating time was 75 min (46-169 min) -comparable to the data of primary treatment with open rPx of 4,837 pts from 2004-2015 with no statistically significant difference.Median follow-up (FU) was 48 m (range 3-131).Patho-histological tumor stage was ypT3 in 58% (21/36), ypT2 in 28% (10/36) and other (ypT0, ypTx) in 14% (5/36).Positive lymph nodes were found in 33% (12/36), distant metastases in 6% (2/36).Follow-up data were available from 34/36 patients.35% (12/34) had to undergo resection of the anastomosis because of a postsurgical stricture.After 12 and 36 months post-surgery, 33% and 50% needed ≥3 pads per day in contrast to 6% and 5% in the control group.84% and 85% of patients treated with salvage rPx had an IIEF-Score of 0 -compared to 33% and 36%, respectively.Median disease-free interval was 42 months; 56% (19/34) showed BCR during the FU-interval.Eight patients died of PC during the FU. Conclusion:Salvage rPx after EBRT, BT or HIFU is a feasible and valuable option for a well-informed individual patient and can lead to a significant BCR-free survival.However, the patient must be well informed about the burden of a salvage procedure.Regarding the poor results of cancer control, we have to realize that failure after EBRT and BT is obviously detected too late and is associated with a mostly poor differentiated prostate cancer.As a consequence, we should consider to escalate the follow up diagnostic after radiotherapy, e.g.multi-parametric magnetic resonance imaging (mpMRI) or biopsy after 12 months in cases of an insufficient PSA level.
To identify risk factors for anastomotic strictures in patients after radical prostatectomy.In all, 140 prostate cancer patients with one or more postoperative anastomotic strictures after radical prostatectomy were included. All patients underwent transurethral anastomotic resection at the University Hospital of Munich between January 2009 and May 2016. Clinical data and follow-up information were retrieved from patients' records. Statistical analysis was done using Kaplan-Meier curves and log rank-test with time to first transurethral anastomotic resection as endpoint, Chi-square-test, and Mann-Whitney-U test.In all, 140 patients with a median age of 67 years (IQR: 61-71 years) underwent radical prostatectomy. Median age at time of transurethral anastomotic resection was 68 years (IQR: 62-72). Patients needed 2 surgical interventions in median (range: 1-15). Median time from radical prostatectomy to transurethral anastomotic resection was 6 months (IQR: 3.9-17.4). Median duration of catheterization after radical prostatectomy was 10 days (IQR: 8-13). In all, 26% (36/140) received additional radiotherapy. Regarding time to first transurethral anastomotic resection, age and longer duration of catheterization after radical prostatectomy with a cutoff of 7 days showed no statistically significant differences (p = 0.392 and p = 0.141, respectively). Tumor stage was no predictor for development of anastomotic strictures (p = 0.892), and neither was prior adjuvant radiation (p = 0.162). Potential risk factors were compared between patients with up to 2 strictures (low-risk) and patients developing > 2 strictures (high-risk): high-risk patients had more often injection of cortisone during surgery (14% vs 0%, p < 0.001) and more frequently advanced tumor stage pT > 2 (54% vs 38%, p = 0.055), respectively. Other risk factors did not show any significant difference compared to number of prior transurethral anastomotic strictures.We could not identify a reliable risk factor to predict development of anastomotic strictures following radical prostatectomy.
