Factors determining the efficacy of radiotherapy for prostate cancer

Background. Prostate cancer (PC) ranks first in the structure of oncological pathology in men, being the second leading cause of cancer death and having 30 % as the five-year survival rate. Radiation therapy (RT) for prostate cancer has great potential for enhancement. Purpose – to evaluate the efficacy of RT in patients with prostate cancer and highlight the clinical and laboratory factors determining it. Materials and methods. The study enrolled 195 men with prostate cancer aged 52 to 82 years. The duration from the moment of diagnosis of the disease averaged 3 years. The Gleason score parameters were 6 points on average, the ratio of peripheral to central tumor form was 3:1, adenocarcinoma was diagnosed in 94 % of cases, giant cell carcinoma – in 6 %. Results. On average, recurring neoplasm is observed in 40 % of the patients with prostate cancer 2.5 years after radical prostatectomy combined with different methods of radiation therapy, which is associated with the initial indicators of the Gleason score, shape, localization and expansion of the tumor process, the presence of comorbid papillary carcinoma of the urinary bladder, metastases in the lymph nodes, distant viscera and the skeleton, while the power and direction of radiation exposure influence such radiotherapy complications as dermatitis, polyneuropathy, acute vascular insufficiency and tubulointerstitial nephritis. Conclusions. Developing the medical technology for RT in patients with prostate cancer to reduce the effect of prognostically unfavorable treatment factors is essential.

Pleomorphic Giant Cell Carcinoma of Urinary Bladder with Brain Metastases Despite Initial Response to Cisplatin and Gemcitabine: A Case Report

A 59-year-old male presented with haematuria and was diagnosed with pleomorphic giant cell carcinoma of the urinary bladder, a very rare variant of urothelial carcinoma. The tumour was staged at pT2N3M1 and the primary tumour was removed by transurethral resection, and nodal metastases were treated with the standard systemic cisplatin and gemcitabine for urothelial cell carcinoma of the bladder. This treatment rendered the tumour clinically undetectable. Despite this treatment the patient developed brain metastases which were not found until the patient presented with neurological symptoms. This is the first recorded case of brain metastases from pleomorphic giant cell carcinoma of the urinary bladder recorded in the literature. CT imaging of the brain should be considered in the follow-up in patients with this tumour.

Osteoclast-like giant cell tumors of the pancreas: Clinical characteristics, genetic testing, and treatment modalities.

e16752 Background: Undifferentiated osteoclast-like giant cell carcinoma of the pancreas is an aggressive malignancy only described by a few case reports in the literature. In this study, we sought to better characterize this entity by examining patients seen at Mayo Clinic. Methods: This study identified patients with osteoclast-like giant cell carcinoma of the pancreas using Mayo Clinic databases (MN, AZ, FL) from the year 2000 to present. Patient demographics, genetic data, and treatment modalities were reviewed. Kaplan-Meier analysis was used to evaluate median overall survival (mOS) for the cohort as well as mOS and mPFS for treatment subgroups. Results: 15 patients were identified (9 female, 6 male). Median age at diagnosis was 59 years and mOS for all patients was 11.0 mos (95% CI 6.2-15.7 mos). 3 patients (20%) had metastatic disease at diagnosis with the liver being the most common site (n = 3). Metastatic disease was associated with significantly shorter OS (3.5 vs. 14.1 mos, p = 0.005; HR 7.98 [95% CI 1.43-44.4]) compared to locoregional disease (LRD). 4 patients underwent genetic testing. The most common mutation was CDKN2A (n = 3), followed by TP53 (n = 2) and KRAS (n = 2). 13/15 patients had detailed follow-up information. 6/7 patients undergoing chemotherapy received a gemcitabine-based regimen as first line: with capecitabine (n = 2), with nab-paclitaxel (n = 2), or as monotherapy (n = 2). 1 patient received FOLFIRINOX. In patients with LRD and adequate follow-up (n = 11), 8/11 underwent surgical resection and had longer OS compared to those without resection (17.0 vs. 8.4 mos, p = 0.09). No surgical patients received neoadjuvant chemotherapy. 5/8 received adjuvant chemotherapy, 2 did not undergo chemotherapy, and 1 was lost to follow-up after surgery. PFS from time of surgery was 15.3mos (95% CI 5.0-25.6mos). 6 patients (40%) were alive at time of analysis; all 6 underwent surgical resection. Conclusions: Osteoclast-like giant cell carcinoma of the pancreas is a rare malignancy with a poor prognosis, even when diagnosed at an early stage. OS for patients of all stages in this study was less than 1 year suggesting prognosis may be even worse than that of pancreatic adenocarcinoma. The optimal therapy remains unknown but most patients received similar chemotherapy as in adenocarcinoma. Patients with LRD amenable to surgical resection experienced a PFS over 1 year from surgery, possibly associated with OS benefit, however overall prognosis is poor. Further study is warranted on a larger scale to better understand disease course and treatment options.