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168 Abstracts

  • Introduction & Objectives

    For muscle-invasive bladder cancer, radical cystectomy has been a standard curative option with about 50% of 5-year local control rate and 20 – 40% or Overall Survival (OS) rates. However, for some patients inappropriate for radical surgery due to co-morbidities, old ages, or patient refusal, definitive radiotherapy is a proper therapeutic option. Recently, use of TURBT and RT with or without concurrent chemotherapy has been adopted for bladder conservation. Patients after bladder-preserving therapy are expected to have comparable survival outcomes correspond to previous radical cystectomy results, as well as better quality of life with intact bladder function. Therefore, we collected and analyzed clinical data from 7 institutions affiliated with Korean Radiation Oncology Group (KROG) to retrospectively review the current treatment status and to evaluate survival rates and prognostic factors related to treatment outcomes after bladder-preserving therapy including TURBT, RT, and chemotherapy.

    Material & Methods

    We conducted a multi-institutional retrospective study of 152 patients with stage Ⅱ to Ⅳ bladder cancer treated with curative radiotherapy from 2000 to 2010. The range of age was 37 to 94 years old (median 72). There were 72 patients in stage Ⅱ, 49 in Ⅲ, and 31 in Ⅳ. Ninety-seven patients were treated with Concurrent Chemoradiotherapy (CCRT) and 55 patients with RT alone. Radiation was delivered to the pelvis (31.2 – 70.2 Gy, median 63 Gy). Chemotherapeutic agents mainly administered with radiation were gemcitabine and cisplatin. The follow up periods ranged from 2 to 166 months (median 35.5 months).

    Results

    Sixty-nine patients (45.4%) showed complete response to radiotherapy and 46 (30.3%) did partial response. Five-year overall survival rate (OS) was 45.8% and 5-year disease specific survival rate (DSS) was 48.9%. On univariate analysis for prognostic factors, there were statistical significances on patient age, initial hemoglobin level, cT stage, cN stage, cTNM stage, and hydronephrosis in OS and DSS. On multivariate analysis, patient age (95% CI, 0.325 to 0.788; HR, 0.506; p=0.003 in OS, 95% CI, 0.264 to 0.689; HR, 0.426; pto be statistically significant for OS and DSS.

    Conclusions

    We thought our survival rates were comparable to those of other studies. Bladder cancer detection before getting older may influence the better survival outcomes. It is suggested that further randomized studies are needed to be elucidate the impact of radiotherapy in bladder cancer.

  • Introduction & Objectives

    More advanced imaging methods are needed to reliably distinguish benign Small Renal Masses (SRM) from Renal Cell Carcinoma (RCC) to prevent invasive biopsies or unnecessary surgery. Similarly, improved imaging methods are needed for unambiguous detection of lesions suspect for metastatic and relapse RCC during follow-up. Girentuximab is an antibody against Carbonic Anhydrase IX (CAIX), an antigen that is expressed on the cell surface of 95% of clear cell RCC(ccRCC). Zr-89-girentuximab PET/CT may be a valuable imaging technique in the diagnosis of patients with RCC. The aim of the present study is to show the impact of the Zr-89-girentuximab PET/CT on the clinical management of ccRCC patients. Here we present our first results with Zr-89-girentuximab PET/CT for diagnosing patients presenting with either SRM or with a history of ccRCC suspected for a recurrence.

    Material & Methods

    Patients suspected of or with a history of ccRCC in whom conventional imaging methods are inconclusive are eligible for the study. In these patients a PET/CT will be acquired 4-5 days after injection of 37 MBq Zr-89-girentuximab (5 mg).

    Results

    So far, 8 patients have been included in this clinical study. Three patients presented with a primary renal tumor. Two tumors (diameter 27 and 31 mm) showed clear uptake of Zr-89-girentuximab. A partial nephrectomy was performed and confirmed ccRCC in both patients. None of the 8 renal tumors in the third patient showed uptake of Zr-89-girentuximab and repeated biopsies showed the presence of oncocytomas. Therefore active surveillance was continued. Five patients with a history of ccRCC and a suspicion of recurrent disease were included. Clear uptake of Zr-89-girentuximab in multiple metastases was seen in three patients. Because of the positive PET/CT a biopsy could be avoided. Furthermore, treatment was changed from locoregional lymph node dissection to watchfull waiting in one patient, since PET/CT showed uptake of Zr-89-girentuximab in additional lesions compared to the CT scan. One patient had no uptake of Zr-89-girentuximab in a growing solitary lymph node, although histology showed a CAIX-expressing lymph node metastasis of a papillary growing ccRCC. In the last patient there was doubt about a 1-cm mass that was seen in the inferior caval vein on MRI. The PET/CT showed high uptake of Zr-89-girentuximab in the lesion and subsequent thrombectomy confirmed the presence of ccRCC. Overall, the PET/CT provided valuable information in 7 out of 8 patients.

    Conclusions

    These preliminary results suggest that Zr-89-girentuximab PET/CT can be a valuable aid in the management of patients suspected of (recurrent) ccRCC.

    Session: Poster session and Best Poster Award

    Location: Thursday 24 November 2016, 14:30 - 15:15, Amber 1

  • Introduction & Objectives

    Selective Internal Radiation Therapy (SIRT) is an interventional procedure used for unresectable liver tumours, and has properties that make it potentially useful for primary Renal Cell Carcinoma (RCC) that is unsuitable for nephrectomy. RESIRT is the first-in-human study to evaluate safety and feasibility of SIRT for primary RCC.

    Material & Methods

    Patients (pts) not amenable for or who declined conventional therapy were eligible. A single transfemoral microcatheter administration of Yttrium-90 (Y-90) resin microspheres (SIR-Spheres; Sirtex, Australia) was delivered super-selectively via the renal artery to the tumour at intended radiation doses of 75, 100, 150, 200, 300 Gray and a final cohort with a procedural endpoint of imminent stasis, in a dose-escalation design. Post-SIRT follow-up was 12 months. The primary endpoint was safety and toxicity 30 days post-SIRT. Secondary endpoints included tumour response (RECIST v1.1).

    Results

    The study enrolled 21 pts with RCC (33% left and 67% right kidney), mean age 75.0 years (SD: 9.3; range 48–86) and WHO performance status of 0 (81%) or 1 (19%); gender was 6 (29%) female and 15 (71%) male. Eight pts (38%) had metastatic RCC. Seven pts (33%) had previously undergone total nephrectomy of the contralateral kidney, 1 (5%) received prior chemotherapy and 1 (5%) progressed after cryotherapy to the target organ. Three patients were re-treated within the RESIRT study at a higher Y-90 dose, after at least a 12-month interval from their previous SIRT treatment. Median follow-up was 12.0 months (95% CI 11.9–12.1). Sum of longest diameters for the target lesion was median 45 mm (range 23‒123 mm). The intended Y-90 doses were delivered without any dose-limiting toxicity.  Imminent stasis was reached in 11 (52%) pts. 18 (86%) pts experienced 70 adverse events (AEs) at any time to 12 months, with 8 (38%) pts experiencing 18 SAEs; 4 (19%) pts experienced 5 SAEs within 30 days post-SIRT, all determined as not related to SIRT. Ten (48%) pts had 24 AEs grade ≥3 at any time point to 12 months and all were considered unrelated to SIRT; 9 pts (43%) had 16 AEs that were related to SIRT (all grade 1–2, no SAEs), of which 2 occurred pre SIRT. Treatment-related AEs were fatigue/tiredness/lethargy, pain, hypertension, lack of appetite, nausea, ‘heaviness’, bruised groin andhypomagnesemia. Best overall tumour responses were Partial Response [PR] 1/18 (6%), stable disease [SD] 16/18 (89%) and progressive disease 1/18 (6%), with SD in 2 further patients with on-going follow-up.

    Conclusions

    This pilot study demonstrates good tolerability of SIRT at all dose levels including imminent stasis in treating primary tumours in RCC pts otherwise unsuitable for conventional therapy.

    Session: Oral presentations of the 6 best abstracts

    Location: Saturday, 26 November 2016, 11:15 - 11:55, Auditorium

  • Introduction & Objectives

    Sunitinib (su) is a standard treatment (tx) for metastatic Renal Cell Carcinoma (mRCC). Octogenarian patients (pts) (aged ≥ 80) are often considered to be unfit for su tx, and recommendations for their tx is limited by the paucity of clinical trials data in this population. We aimed to study baseline characteristics and outcome of octogenarian versus (vs) young (aged ≤45) pts with mRCC treated with su.

    Material & Methods

    We performed an international multicenter retrospective study of pts with mRCC, who were treated with su in 8 centers across 2 different countries. We compared baseline characteristics and outcome of octogenarian versus young pts. The effect of very old age on Response Rate (RR), Progression Free Survival (PFS) and Overall Survival (OS), was tested with adjustment of other known confounding risk factors using a chi-square test and partial likelihood test from cox model. Furthermore, univariate and multivariate analyses of association between clinicopathologic factors and age, and outcome were performed using the entire pt cohort.

    Results

    Between 2004-2013, 36 octogenarian (group 1; median age 83) and 37 young (group 2; median age 42) mRCC were treated with su. The groups were balanced regarding the following baseline clinicopathologic characteristics: gender, HENG risk, past nephrectomy, mRCC histology, ≥ 2 metastatic sites, lung/liver/bone metastasis, prior targeted tx, smoking status, use of angiotensin system inhibitors (ASIs), pre-tx neutrophil to lymphocyte ratio (NLR) >3, and sunitinib induced hypertension (HTN). In group 1 vs 2, 53% vs 27% (p=0.006) had dose reduction/treatment interruption d/t side effects. Clinical benefit (partial response + stable disease) in group 1 vs 2 was 76% vs 84%, while 24% vs 16% had disease progression within the first 3 months of tx (p=0.09). Median PFS was 11 vs 8 months (p=0.1). Median OS was 22 vs 20 months (p=0.7). In multivariate analyses of the entire pt cohort (n=73), age was not significantly associated with PFS or OS.

    Conclusions

    Su is active in octogenarian mRCC pts. Vs young pts, a significantly higher proportion of octogenarian pts had dose reduction/treatment interruption d/t side effects.

  • Introduction & Objectives

    Traditional imaging modalities for advanced prostate cancer include PET/CT with choline-based tracers. Such modalities provide limited detection rates, particularly in patients with low-PSA levels during the early stages of biochemical recurrence. 68Ga PSMA-PET is an emerging imaging that provides the ability to selectively identify and localize metastatic prostate cancer. Current reports suggest improved detection rates in patients with low-levels of PSA in the setting of biochemical recurrence. We undertook a systematic review and meta-analysis of reported predictors of positive 68Ga PSMA-PET/CT in the setting of advanced prostate cancer.

    Material & Methods

    We performed critical reviews of MEDLINE, EMBASE, ScienceDirect, Cochrane Libraries and Web of Science databases in April 2016 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Quality assessment was performed using Quality Assessment if Diagnostic Accuracy Studies-2 tool. Meta-analysis and meta-regression of proportions were performed using a random-effects model with pre-PET PSA levels as the dependent variable.

    Results

    Seventeen articles including 1,841 patients were analysed. Overall percentage of positive 68Ga PSMA-PET was 44% (95% CI: 18-72%) for primary staging patients and 76% (95% CI: 66-85%) or biochemical recurrence (BCR) patients. Positive 68Ga PSMA-PET scans for BCR patients increased with higher pre-PET PSA. For PSA categories 0-0.2ng/ml, 0.2-1ng/ml, 1-2 ng/ml and > 2 ng/ml, the percentage positive were 30%, 53%, 78% and 96% respectively. Shorter PSA doubling time increased 68Ga PSMA-PET positivity.

    Conclusions

    In the setting of biochemically recurrent prostate cancer, pre-PET PSA predicts the risk of positive 68Ga PSMA-PET. Compared to traditional imaging modalities, 68Ga PSMA-PET appears to provide improved prostate cancer detection at lower PSA levels.

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