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Urological Cancer: Imaging Diagnosis and Radiotherapy
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Urological Cancer: Imaging Diagnosis and Radiotherapy

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nephrology & Urology".

Deadline for manuscript submissions: closed (15 October 2023) | Viewed by 5867

Special Issue Editors

Dr. Luca Nicosia

E-Mail Website
Guest Editor
Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034 Verona, Negrar, Italy
Interests: radiotherapy; prostate cancer; oligometastatic disease; MR-guided radiotherapy
Dr. Constantinos Zamboglou

E-Mail Website
Guest Editor
Department of Radiotherapy, University Hospital Freiburg, Freiburg, Germany; German Oncology Center, European University, Limassol, Cyprus
Interests: oncology; radiotherapy

Special Issue Information

Dear Colleagues,

The introduction of modern diagnostic imaging methods such as metabolic tracers for positron emission tomography (PET) and multiparametric magnetic resonance (MR) is changing the landscape in the management of urological malignancies. The current indication of radiotherapy is based on the location and extent of the disease; consequently, the role of adequate imaging is crucial for the diagnostic assessment of the real tumor burden, especially in the era of the sub-stratification of the disease (localized, oligometastatic, and polymetastatic disease).

Assuming the cancer disease history as an iceberg wherein we can see only the tip, several scientific experiences have been reported to introduce advanced imaging methods to show a deeper portion of this iceberg. In this view, radiotherapy is directly linked to imaging techniques including recent technologies such as MR-linacs. Furthermore, artificial intelligence allows for quantitative imaging evaluation, which might play a predictive or prognostic role alongside radiotherapy in the treatment of urological cancers.

This Special Issue provides highlights on the role of modern diagnostic imaging in guiding and improving radiotherapy indications and clinical outcomes in urological malignancies. Other topics of interest for this Special Issue could be PET-imaging, MR imaging, prostate cancer, bladder cancer, MR-guided radiotherapy, radiomics, and oligometastatic disease.

Dr. Luca Nicosia
Dr. Constantinos Zamboglou
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • metabolic imaging
  • radiotherapy
  • urological cancer
  • MR-guided radiotherapy
  • radiomics
  • oligometastatic disease

Published Papers (4 papers)

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Research

11 pages, 1329 KiB  
Article
SBRT in Lymph-Nodal Oligometastases from Prostate Cancer: Different Outcomes between Pelvic and Para-Aortic Disease
by Edoardo Pastorello, Luca Nicosia, Luca Triggiani, Francesco Frassine, Paola Vitali, Emiliano Salah El Din Tantawy, Valeria Santoro, Michele Rigo, Simona Gaito, Renzo Mazzarotto, Michela Buglione di Monale e Bastia and Filippo Alongi
J. Clin. Med. 2024, 13(11), 3291; https://doi.org/10.3390/jcm13113291 - 3 Jun 2024
Viewed by 355
Abstract
Background: Lymph-nodal prostate cancer oligometastases are differently treated according to their site: pelvic are locoregional lymph nodes; instead, para-aortic lymph nodes are considered as distant metastases. The aim of the study was a comparison between para-aortic and pelvic oligometastases treated with stereotactic [...] Read more.
Background: Lymph-nodal prostate cancer oligometastases are differently treated according to their site: pelvic are locoregional lymph nodes; instead, para-aortic lymph nodes are considered as distant metastases. The aim of the study was a comparison between para-aortic and pelvic oligometastases treated with stereotactic body radiation therapy (SBRT). Methods: This is a retrospective analysis. De novo metastatic or extra-nodal disease were excluded. Univariate and multivariate analyses were performed; the pattern of recurrence was also evaluated. A propensity score matching (PSM) was applied to create comparable cohorts. The primary end-point was the progression-free survival (PFS). The secondary end-points were biochemical relapse-free survival (BRFS), ADT-free survival (ADTFS), polymetastases-free survival (PMFS), local progression-free survival (LPFS), and pattern of relapse. Results: In total, 240 lymph-nodal oligometastases in 164 patients (127 pelvic and 37 para-aortic) were treated. The median PFS was 20 and 11 months in pelvic and para-aortic patients, respectively (p = 0.042). The difference was not confirmed in the multivariate analysis (p = 0.06). The median BRFS was 16 and 9 months, respectively, in the pelvic and para-aortic group (p = 0.07). No statistically significant differences for ADTFS or PMFS were detected. The cumulative 5-year LPFS was 90.5%. In PSM, no statistically significant differences for all the study end-points were detected. Conclusions: Patients affected by para-aortic disease might have a PFS comparable to pelvic disease; local control is high in both cohorts. Our results also support the use of SBRT for para-aortic metastases. Full article
(This article belongs to the Special Issue Urological Cancer: Imaging Diagnosis and Radiotherapy)
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19 pages, 3600 KiB  
Article
Radiogenomics Reveals Correlation between Quantitative Texture Radiomic Features of Biparametric MRI and Hypoxia-Related Gene Expression in Men with Localised Prostate Cancer
by Chidozie N. Ogbonnaya, Basim S. O. Alsaedi, Abeer J. Alhussaini, Robert Hislop, Norman Pratt and Ghulam Nabi
J. Clin. Med. 2023, 12(7), 2605; https://doi.org/10.3390/jcm12072605 - 30 Mar 2023
Cited by 1 | Viewed by 1897
Abstract
Objectives: To perform multiscale correlation analysis between quantitative texture feature phenotypes of pre-biopsy biparametric MRI (bpMRI) and targeted sequence-based RNA expression for hypoxia-related genes. Materials and Methods: Images from pre-biopsy 3T bpMRI scans in clinically localised PCa patients of various risk categories (n [...] Read more.
Objectives: To perform multiscale correlation analysis between quantitative texture feature phenotypes of pre-biopsy biparametric MRI (bpMRI) and targeted sequence-based RNA expression for hypoxia-related genes. Materials and Methods: Images from pre-biopsy 3T bpMRI scans in clinically localised PCa patients of various risk categories (n = 15) were used to extract textural features. The genomic landscape of hypoxia-related gene expression was obtained using post-radical prostatectomy tissue for targeted RNA expression profiling using the TempO-sequence method. The nonparametric Games Howell test was used to correlate the differential expression of the important hypoxia-related genes with 28 radiomic texture features. Then, cBioportal was accessed, and a gene-specific query was executed to extract the Oncoprint genomic output graph of the selected hypoxia-related genes from The Cancer Genome Atlas (TCGA). Based on each selected gene profile, correlation analysis using Pearson’s coefficients and survival analysis using Kaplan–Meier estimators were performed. Results: The quantitative bpMR imaging textural features, including the histogram and grey level co-occurrence matrix (GLCM), correlated with three hypoxia-related genes (ANGPTL4, VEGFA, and P4HA1) based on RNA sequencing using the TempO-Seq method. Further radiogenomic analysis, including data accessed from the cBioportal genomic database, confirmed that overexpressed hypoxia-related genes significantly correlated with a poor survival outcomes, with a median survival ratio of 81.11:133.00 months in those with and without alterations in genes, respectively. Conclusion: This study found that there is a correlation between the radiomic texture features extracted from bpMRI in localised prostate cancer and the hypoxia-related genes that are differentially expressed. The analysis of expression data based on cBioportal revealed that these hypoxia-related genes, which were the focus of the study, are linked to an unfavourable survival outcomes in prostate cancer patients. Full article
(This article belongs to the Special Issue Urological Cancer: Imaging Diagnosis and Radiotherapy)
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11 pages, 292 KiB  
Article
Prostate Cancer Treatment-Related Toxicity: Comparison between 3D-Conformal Radiation Therapy (3D-CRT) and Volumetric Modulated Arc Therapy (VMAT) Techniques
by Fabrizio Tonetto, Alessandro Magli, Eugenia Moretti, Andrea Emanuele Guerini, Annarita Tullio, Chiara Reverberi, Tino Ceschia, Luigi Spiazzi, Francesca Titone, Agnese Prisco, Marco Andrea Signor, Michela Buglione, Gioacchino De Giorgi, Marco Trovò and Luca Triggiani
J. Clin. Med. 2022, 11(23), 6913; https://doi.org/10.3390/jcm11236913 - 23 Nov 2022
Cited by 1 | Viewed by 1781
Abstract
Objective: This paper illustrates the results of a mono-institutional registry trial, aimed to test whether gastrointestinal (GI) and genitourinary (GU) toxicity rates were lower in localized prostate cancer patients treated with image-guided volumetric modulated arc therapy (IG-VMAT) compared to those treated with IG-3D [...] Read more.
Objective: This paper illustrates the results of a mono-institutional registry trial, aimed to test whether gastrointestinal (GI) and genitourinary (GU) toxicity rates were lower in localized prostate cancer patients treated with image-guided volumetric modulated arc therapy (IG-VMAT) compared to those treated with IG-3D conformal radiation therapy (IG-3DCRT). Materials and Methods: Histologically proven prostate cancer patients with organ-confined disease, treated between October 2008 and September 2014 with moderately hypofractionated radiotherapy, were reviewed. Fiducial markers were placed in the prostate gland by transrectal ultrasound guide. The prescribed total dose was 70 Gy in 28 fractions. The mean and median dose volume constraints for bladder and rectum as well as total volume of treatment were analyzed as potentially prognostic factors influencing toxicity. The Kaplan–Meier method was applied to calculate survival. Results: Overall, 83 consecutive patients were included. Forty-two (50.6%) patients were treated with 3D-CRT and 41 (49.4%) with the VMAT technique. The median follow-up for toxicity was 77.26 months for the whole cohort. The VMAT allowed for a dose reduction to the rectum and bladder for the large majority of the considered parameters; nonetheless, the only parameter correlated with a clinical outcome was a rectal dose limit V66 > 8.5% for late GI toxicity G ≥ 2 (p = 0.045). Rates of G ≥ 2 toxicities were low among the whole cohort of these patients treated with IGRT. The analysis for rectum dose volume histograms (DVHs) showed that a severe (grade ≥ 2) late GI toxicity was related with the rectal dose limit V66 > 8.5% (p = 0.045). Conclusions: This study shows that moderate hypofractionation is feasible and safe in patients with intermediate and high-risk prostate cancer. Daily IGRT may decrease acute and late toxicity to organs at risk and improve clinical benefit and disease control rate, cutting down the risk of PTV geographical missing. The adoption of VMAT allows for promising results in terms of OAR sparing and a reduction in toxicity that, also given the small sample, did not reach statistical significance. Full article
(This article belongs to the Special Issue Urological Cancer: Imaging Diagnosis and Radiotherapy)
13 pages, 568 KiB  
Article
Hypofractionated Radiotherapy in Intermediate-Risk Prostate Cancer Patients: Long-Term Results
by Maurizio Valeriani, Mario Di Staso, Giuseppe Facondo, Gianluca Vullo, Vitaliana De Sanctis, Giovanni Luca Gravina, Milena di Genesio Pagliuca, Mattia Falchetto Osti and Pierluigi Bonfili
J. Clin. Med. 2022, 11(16), 4783; https://doi.org/10.3390/jcm11164783 - 16 Aug 2022
Cited by 1 | Viewed by 1182
Abstract
Background: To evaluate outcomes in terms of survival and toxicity in a series of intermediate-risk prostate cancer (PCa) patients treated with hypofractionated radiotherapy (HyRT) + hormonal therapy (HT) with or without image guidance (IGRT) and to investigate the impact of different variables. Methods: [...] Read more.
Background: To evaluate outcomes in terms of survival and toxicity in a series of intermediate-risk prostate cancer (PCa) patients treated with hypofractionated radiotherapy (HyRT) + hormonal therapy (HT) with or without image guidance (IGRT) and to investigate the impact of different variables. Methods: This is a multi-centric study. From January 2005 to December 2019, we treated 313 intermediate-risk PCa patients (T2b–T2c, Gleason score 7, or pre-treatment PSA 10 to 20 ng/mL) with HyRT. Patients received 54.75 Gy in 15 fractions in 5 weeks plus 9 months of neo-adjuvant, concomitant, and adjuvant HT with or without IGRT. Results: Median follow-up was 91.6 months (range 5.1–167.8 months). Median OS was not reached, and the 8- and 10-year OS was 81.9% and 72.4%, respectively. Median CSS was not reached, and the 8- and 10-year CSS was 97.9% and 94.5%, respectively. PSA at first follow-up <0.8 ng/mL was significantly related to better oncological outcomes (CSS, bRFS, LRFS, cPFS, and MFS) in both univariate and multivariate analysis. After Propensity Score matching, grade 2–3 acute and cumulative late GU (p = 0.153 and p = 0.581, respectively) and GI (p = 0.196 and p = 0.925, respectively) toxicity were not statistically different in patients treated with or without IGRT. Conclusions: HyRT is effective and safe regardless of the use of IGRT. PSA at first follow-up is an easily accessible prognostic factor that may help the clinicians to identify patients who require a treatment intensification. Full article
(This article belongs to the Special Issue Urological Cancer: Imaging Diagnosis and Radiotherapy)
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