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Background We investigated the first-line activity of vinflunine in patients with penis cancer. Cisplatin-based combinations are commonly used, but survival is not prolonged; many patients are unfit for such treatment or experience toxicity that outweighs clinical benefit. Methods Twenty-five patients with inoperable squamous carcinoma of the penis were recruited to a single-arm, Fleming–A’Hern exact phase II trial. Treatment comprised 4 cycles of vinflunine 320 mg/m2, given every 21 days. Primary endpoint was clinical benefit rate (CBR: objective responses plus stable disease) assessed after 4 cycles. Seven or more objective responses or disease stabilisations observed in 22 evaluable participants would exclude a CBR of 40% being probable. Results Twenty-two participants were evaluable. Ten objective responses or disease stabilisations were confirmed. CBR was 45.5%, meeting the primary endpoint; partial response rate was 27.3%. Seven patients received >4 cycles of vinflunine. Dose reduction or treatment delay was required for 20% of cycles. In all, 68% of patients experienced at least one grade 3 adverse event. Two deaths on treatment were not caused by disease progression. Conclusions Pre-specified clinical activity threshold was exceeded. Toxicity was in keeping with experience in other tumours. Vinflunine merits further study in this disease. Trial registration NCT02057913.

PURPOSE The European Organisation for Research and Treatment of Cancer (EORTC) trial 22991 ( NCT00021450 ) showed that 6 months of concomitant and adjuvant androgen suppression (AS) improves event- (EFS, Phoenix) and clinical disease-free survival (DFS) of intermediate- and high-risk localized prostatic carcinoma, treated by external-beam radiotherapy (EBRT) at 70-78 Gy. We report the long-term results in intermediate-risk patients treated with 74 or 78 Gy EBRT, as per current guidelines. PATIENT AND METHODS Of 819 patients randomly assigned between EBRT or EBRT plus AS started on day 1 of EBRT, 481 entered with intermediate risk (International Union Against Cancer TNM 1997 cT1b-c or T2a with prostate-specific antigen (PSA) ≥ 10 ng/mL or Gleason ≤ 7 and PSA ≤ 20 ng/mL, N0M0) and had EBRT planned at 74 (342 patients, 71.1%) or 78 Gy (139 patients, 28.9%). We report the trial primary end point EFS, DFS, distant metastasis–free survival (DMFS), and overall survival (OS) by intention-to-treat stratified by EBRT dose at two-sided α = 5%. RESULTS At a median follow-up of 12.2 years, 92 of 245 patients and 132 of 236 had EFS events in the EBRT plus AS and EBRT arm, respectively, mostly PSA relapse (48.7%) or death (45.1%). EBRT plus AS improved EFS and DFS (hazard ratio [HR] = 0.53; CI, 0.41 to 0.70; P < .001 and HR = 0.67; CI, 0.49 to 0.90; P = .008). At 10 years, DMFS was 79.3% (CI, 73.4 to 84.0) with EBRT plus AS and 72.7% (CI, 66.2 to 78.2) with EBRT (HR = 0.74; CI, 0.53 to 1.02; P = .065). With 140 deaths (EBRT plus AS: 64; EBRT: 76), 10-year OS was 80.0% (CI, 74.1 to 84.7) with EBRT plus AS and 74.3% (CI, 67.8 to 79.7) with EBRT, but not statistically significantly different (HR = 0.74; CI, 0.53 to 1.04; P = .082). CONCLUSION Six months of concomitant and adjuvant AS statistically significantly improves EFS and DFS in intermediate-risk prostatic carcinoma, treated by irradiation at 74 or 78 Gy. The effects on OS and DMFS did not reach statistical significance.

Introduction Neoadjuvant cisplatin-based combination chemotherapy improves survival in muscle-invasive bladder cancer. However, response rates and survival remain suboptimal. We evaluated the efficacy, safety, and tolerability of cisplatin plus cabazitaxel. Methods A phase II single-arm trial was designed to recruit at least 26 evaluable patients. This would give 80% power to detect the primary endpoint, an objective response rate defined as a pathologic complete response plus partial response (pathologic downstaging), measured by pathologic staging at cystectomy (p0 = 0.35 and p1 = 0.60, α = 0.05). Results Objective response was seen in 15 of 26 evaluable patients (57.7%) and more than one- third of patients achieved a pathologic complete response (9/26; 34.6%). Seventy-eight percent of the patients (21/27) completed all cycles of treatment, with only 6.7% of the reported adverse events being graded 3 or 4. There were 6 treatment-related serious adverse event reported, but no suspected unexpected serious adverse reactions. In the patients who achieved an objective response, the median progression-free survival and overall survival were not reached (median follow-up of 41.5 months). In contrast, the median progression-free survival (7.2 months) and overall survival (16.9 months) were significantly worse (P = .001, log-rank) in patients who did not achieve an objective response. Conclusion Cabazitaxel plus cisplatin for neoadjuvant treatment of muscle-invasive bladder cancer can be considered a well-tolerated and effective regimen before definitive therapy with higher rates (57.7%) of objective response, comparing favorably to that with of cisplatin/gemcitabine (23%–26%). These results warrant further evaluation in a phase III study.

Background: Short peripheral intravenous catheters (PIVCs) fail prior to completion of therapy in up to 63% of hospitalizations. This unacceptably high rate of failure has become the norm for the most common invasive procedure in all of medicine. Securement strategies may improve PIVC survival. Methods: We conducted a prospective, single-site, parallel, two-arm randomized controlled investigation with a primary outcome of catheter failure comparing securement with standard semi-permeable dressing and clear tape (SPD) to standard semipermeable dressing and clear tape with cyanoacrylate glue (SPD + CG). Adult emergency department patients with a short PIVC and anticipated hospital duration ⩾ 48 h were enrolled and followed until IV failure or completion of therapy for up to 7 days. Secondary outcomes included complications and cost comparisons between groups. Primary outcome was assessed by intention to treat and per protocol analyses. Findings: 350 patients were enrolled between November 2019 and October 2020. PIVC survival for SPD + CG was similar to SPD group with the absolute risk difference of IV failure in the intention-to-treat (−5.8%, p = 0.065) population and improved in the per protocol (−8.1%, p = 0.04) population, respectively. Kaplan-Meier survival analysis indicated there was a significant benefit of the SPD + CG at greater than 2 days of hospitalization ( p = 0.04). Prior to 48 h, there was no survival enhancement to either group ( p = 0.98) in the intention to treat population. In a multivariable analysis with piecewise Cox regression, when the IV was functional greater than 48 h, the risk of IV failure in the SPD + CG was 43% less than the SPD group (adjusted hazard ratio [HR] 0.57, 95% confidence interval [CI] 0.34 to 0.97; p = 0.04). Cumulative cost related to IV during hospitalization was similar between groups with a lower incremental rescue cost in the SPD + CG group. Interpretation: SPD combined with cyanoacrylate glue provides similar benefit to patients compared to SPD alone and potentially improves short PIVC survival when the IV was inserted >48 h. As this strategy is cost neutral, it could be considered in admitted patients, particularly those with longer anticipated hospital durations.

Objective: Thrombophlebitis associated with peripheral intravenous catheters (PIVCs) is a poorly described complication in the literature. Given limited accuracy of current assessment tools and poor documentation in the medical record, the true incidence and relevance of this complication is misrepresented. We aimed to identify risk factors in the development of thrombophlebitis using an objective methodology coupling serial diagnostic ultrasound and clinical assessment. Methods: We conducted a single-site, prospective observational cohort study. Adult patients presenting to the emergency department that underwent traditionally placed PIVC insertion and were being hospitalized with an anticipated length of stay greater than two days were eligible participants. Using serial, daily ultrasound evaluations and clinical assessments via the phlebitis scale, we identified patients with asymptomatic and symptomatic thrombosis. The primary goal was to identify demographic, clinical, and IV related risk factors associated with thrombophlebitis. Univariate and multivariate analyses were employed to identify risk factors for thrombophlebitis. Results: 62 PIVCs were included between July and August 2020. 54 (87.10%) developed catheter-related thrombosis with 22 (40.74%) of the thrombosed catheters were characterized as symptomatic. Multivariate cox regression demonstrated that catheter diameter relative to vein diameter greater than one-third [AHR 5.41 (1.91, 15.4) P = 0.0015] and angle of distal tip of catheter against vein wall ≥ 5 degrees [AHR 4.39 (1.39, 13.8) P = 0.0116] were associated with increased likelihood of thrombophlebitis. Conclusions: Our study found that the increased proportion of catheter relative to vein size and steeper catheter tip angle increased the risk of thrombophlebitis. Catheter size relative to vein size is a modifiable factor that should be considered when inserting PIVCs. Additional larger prospective investigations using objective methodologies are needed to further characterize complications in PIVCs. Funding Statement: There is no funding source for this study. Declaration of Interests: All authors (AB, SJ, PK, NM) have nothing to disclose. There are no relevant conflict of interest disclosures relevant to the research, authorship, and/or publication of this article. Ethics Approval Statement: The Institutional Review Board (IRB) at our institution approved this study.

Background: Real-world data on characteristics, outcomes, and toxicity in patients with early breast cancer (EBC) receiving neo-adjuvant chemotherapy (NACT) is lacking. This study characterises experience of NACT in a single UK NHS specialist oncology centre. Methods: Retrospective case note review of sequential patients with EBC treated with NACT between April 2013 and Sept 2019. Treatment regimens, toxicity data, pathological response (PathCR, defined as no residual invasive tumour in the breast and lymph nodes), recurrence-free survival (RFS) and overall survival (OS) were compared between groups according to baseline characteristics and tumour subtype, defined by oestrogen receptor (ER) and HER2 status. Results: 405 patients (median age 52 years (IQR 45–61)) were included with a median follow up of 36.4 months. At diagnosis most (253 (62%)) were symptomatic, 368 (91%) had invasive ductal carcinoma, 19 (5%) invasive lobular carcinoma and 18 (4%) inflammatory, spindle or mixed histology. Most were pre-NACT stage 2 or above (Stage 1 - 12 (3%), Stage 2a - 129 (32%), Stage 2b 148 (37%), Stage 3a - 73 (18%), Stage 3b – 25 (6%), Stage 3c -14 (3%)) with no clear trend in stage by year of diagnosis or disease subtype and overall 244 (60%) were node positive pre-NACT. 99% had grade 2 or grade 3 cancer; 320 patients (79%) had Ki-67 >15% and 72 patients (18%) had Ki-67 61 years (Odds Ratio (OR) v patients Conclusions: Real-world outcomes from NACT at a single UK centre are consistent with published randomised data for pathCR rates by tumour subtype. Despite 96.8% of patients receiving GCSF almost half had at least one dose reduction, potentially compromising dose intensity. Whilst this retrospective analysis must be interpreted with caution, as expected there was a trend toward improved response with the addition of platinum in ER-/HER2- disease but an interesting lack of further pathCR when adding pertuzumab in HER2 positive disease. Further analyses will be presented including site of recurrence, type of surgery by response, radiotherapy treatment given and multi-variate analysis. Citation Format: Catherine McDonald, Rebecca Squires, Mark Gormley, Ryan Langdon, Ann Archer, Jessica Ball, Georgina Gullick, Chloe Caws, John Boardman, Vivek Mohan, Amit Bahl, Jessica Jenkins, Charles Comins, Lara Gibbs, Jeremy Braybrooke, Timothy Robinson. Real-world outcomes in patients receiving neo-adjuvant chemotherapy for early-stage breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS13-40.

To find if an association could be established between Human Papilloma Virus (HPV) infection and oropharyngeal cancers (OPCs) in a group of patients known to be regular users of tobacco, and to determine the impact of HPV status on clinical outcomes.Case records of 212 patients with AJCC-7 (The American Joint Committee on Cancer 7th edition) stages II–IVB non metastatic squamous cell carcinoma of the oropharynx treated using radical radiotherapy with or without chemotherapy during the years 2015–2018 were retrieved. Formalin-fixed, paraffin-embedded blocks from oropharyngeal biopsies were available for 177 patients and were evaluated for p16 expression by immunohistochemical (IHC) staining. More than 50% nuclear staining with or without cytoplasmic staining was considered HPV+ . The association between tobacco use and HPV, as well as the influence of HPV status on survival outcomes were assessed. p16 expression was found to be positive in 23(13%) patients. Significant association was found between chewable tobacco usage and HPV positivity (p = 0.051). The median follow up was 20.5 months (range: 3–80). 5-year Overall Survival was 43.4% and 29.8% (p = 0.044) in HPV+ and HPV− patients, respectively. Local control was significantly better in HPV+ patients (38.6% vs. 25.3%, p = 0.049). There was also a trend towards improved Disease-free Survival in HPV+ patients (31 months vs. 15 months, p = 0.078). Though less in prevalence among the Indian population, improved outcomes in HPV+ OPC patients and widely available IHC HPV assays signifies the routine implementation of p16 testing in day-to-day clinical practice.

PURPOSE Capivasertib is a pan-AKT inhibitor. Preclinical data indicate activity in metastatic castration-resistant prostate cancer (mCRPC) and synergism with docetaxel. PATIENTS AND METHODS ProCAID was a placebo controlled randomized phase II trial in mCRPC. Patients received up to ten 21-day cycles of docetaxel (75 mg/m2 intravenous, day 1) and prednisolone (5 mg twice daily, oral, day 1-21) and were randomly assigned (1:1) to oral capivasertib (320 mg twice daily, 4 days on/3 days off, from day 2 each cycle), or placebo, until disease progression. Treatment allocation used minimization factors: bone metastases; visceral metastases; investigational site; and prior abiraterone or enzalutamide. The primary objective, by intention to treat, determined if the addition of capivasertib prolonged a composite progression-free survival (cPFS) end point that included prostate-specific antigen progression events. cPFS and overall survival (OS) were also assessed by composite biomarker subgroup for PI3K/AKT/PTEN pathway activation status. RESULTS One hundred and fifty patients were enrolled. Median cPFS was 7.03 (95% CI, 6.28 to 8.25) and 6.70 months (95% CI, 5.52 to 7.36) with capivasertib and placebo respectively (hazard ratio [HR], 0.92; 80% CI, 0.73 to 1.16; one-sided P = .32). Median OS was 31.15 (95% CI, 20.07 to not reached) and 20.27 months (95% CI, 17.51 to 24.18), respectively (HR, 0.54; 95% CI, 0.34 to 0.88; two-sided P = .01). cPFS and OS results were consistent irrespective of PI3K/AKT/PTEN pathway activation status. Grade III-IV adverse events were equivalent between arms (62.2%). The most common adverse events of any grade deemed related to capivasertib were diarrhea, fatigue, nausea, and rash. CONCLUSION The addition of capivasertib to chemotherapy did not extend cPFS in mCRPC irrespective of PI3K/AKT/PTEN pathway activation status. The observed OS result (a secondary end point) will require prospective validation in future studies to address potential for bias.

Bone is a common site of metastases in advanced cancers. The main symptom is pain, which increases morbidity and reduces quality of life. The treatment of bone metastases needs a multidisciplinary approach, with the main aim of relieving pain and improving quality of life. Apart from systemic anticancer therapy (hormonal therapy, chemotherapy or immunotherapy), there are several therapeutic options available to achieve palliation, including analgesics, surgery, local radiotherapy, bone-seeking radioisotopes and bone-modifying agents. Long-term use of non-steroidal analgesics and opiates is associated with significant side-effects, and tachyphylaxis. Radiotherapy is effective mainly in localised disease sites. Bone-targeting radionuclides are useful in patients with multiple metastatic lesions. Bone-modifying agents are beneficial in reducing skeletal-related events. This overview focuses on the role of surgery, including minimally invasive treatments, conventional radiotherapy in spinal and non-spinal bone metastases, bone-targeting radionuclides and bone-modifying agents in achieving palliation. We present the clinical data and their associated toxicity. Recent advances are also discussed.

Coronavirus disease (COVID-19) has aggressively spread across the United States with numerous fatalities. Risk factors for mortality are poorly described. This was a multicentered cohort study identifying patient characteristics and diagnostic markers present on initial evaluation associated with mortality in hospitalized COVID-19 patients. Epidemiological, demographic, clinical, and laboratory characteristics of survivors and non-survivors were obtained from electronic medical records and a multivariable survival regression analysis was conducted to identify risk factors of in-hospital death. Of 1629 consecutive hospitalized adult patients with confirmed COVID-19 from March 1st thru March 31, 2020, 1461 patients were included in final analysis. 327 patients died during hospitalization and 1134 survived to discharge. Median age was 62 years (IQR 50.0, 74.0) with 56% of hospitalized patients under the age of 65. 47% were female and 63% identified as African American. Most patients (55%) had either no or one comorbidity. In multivariable analysis, older age, admission respiratory status including elevated respiratory rate and oxygen saturation ≤ 88%, and initial laboratory derangements of creatinine > 1.33 mg/dL, alanine aminotransferase > 40 U/L, procalcitonin > 0.5 ng/mL, and lactic acid ≥ 2 mmol/L increased risk of in-hospital death. This study is one of the largest analyses in an epicenter for the COVID-19 pandemic. Older age, low oxygen saturation and elevated respiratory rate on admission, and initial lab derangements including renal and hepatic dysfunction and elevated procalcitonin and lactic acid are risk factors for in-hospital death. These factors can help clinicians prognosticate and should be considered in management strategies.

Summary Background BIG 3-07/TROG 07.01 is an international, multicentre, randomised, controlled, phase 3 trial evaluating tumour bed boost and hypofractionation in patients with non-low-risk ductal carcinoma in situ following breast-conserving surgery and whole breast radiotherapy. Here, we report the effects of diagnosis and treatment on health-related quality of life (HRQOL) at 2 years. Methods The BIG 3-07/TROG 07.01 trial is ongoing at 118 hospitals in 11 countries. Women aged 18 years or older with completely excised non-low-risk ductal carcinoma in situ were randomly assigned, by use of a minimisation algorithm, to tumour bed boost or no tumour bed boost, following conventional whole breast radiotherapy or hypofractionated whole breast radiotherapy using one of three randomisation categories. Category A was a 4-arm randomisation of tumour bed boost versus no boost following conventional whole breast radiotherapy (50 Gy in 25 fractions over 5 weeks) versus hypofractionated whole breast radiotherapy (42·5 Gy in 16 fractions over 3·5 weeks). Category B was a 2-arm randomisation between tumour bed boost versus no boost following conventional whole breast radiotherapy, and category C was a 2-arm randomisation between tumour bed boost versus no boost following hypofractionated whole breast radiotherapy. Stratification factors were age at diagnosis, planned endocrine therapy, and treating centre. The primary endpoint, time to local recurrence, will be reported when participants have completed 5 years of follow-up. The HRQOL statistical analysis plan prespecified eight aspects of HRQOL, assessed by four questionnaires at baseline, end of treatment, and at 6, 12, and 24 months after radiotherapy: fatigue and physical functioning (EORTC QLQ-C30); cosmetic status, breast-specific symptoms, arm and shoulder functional status (Breast Cancer Treatment Outcome Scale); body image and sexuality (Body Image Scale); and perceived risk of invasive breast cancer (Cancer Worry Scale and a study-specific question). For each of these measures, tumour bed boost was compared with no boost, and conventional whole breast radiotherapy compared with hypofractionated whole breast radiotherapy, by use of generalised estimating equation models. Analyses were by intention to treat, with Hochberg adjustment for multiple testing. This trial is registered with ClinicalTrials.gov , NCT00470236 . Findings Between June 1, 2007, and Aug 14, 2013, 1208 women were enrolled and randomly assigned to receive no tumour bed boost (n=605) or tumour bed boost (n=603). 396 of 1208 women were assigned to category A: conventional whole breast radiotherapy with tumour bed boost (n=100) or no boost (n=98), or to hypofractionated whole breast radiotherapy with tumour bed boost (n=98) or no boost (n=100). 447 were assigned to category B: conventional whole breast radiotherapy with tumour bed boost (n=223) or no boost (n=224). 365 were assigned to category C: hypofractionated whole breast radiotherapy with tumour bed boost (n=182) or no boost (n=183). All patients were followed up at 2 years for the HRQOL analysis. 1098 (91%) of 1208 patients received their allocated treatment, and most completed their scheduled HRQOL assessments (1147 [95%] of 1208 at baseline; 988 [87%] of 1141 at 2 years). Cosmetic status was worse with tumour bed boost than with no boost across all timepoints (difference 0·10 [95% CI 0·05–0·15], global p=0·00014, Hochberg-adjusted p=0·0016); at the end of treatment, the estimated difference between tumour bed boost and no boost was 0·13 (95% CI 0·06–0·20; p=0·00021), persisting at 24 months (0·13 [0·06–0·20]; p=0·00021). Arm and shoulder function was also adversely affected by tumour bed boost across all timepoints (0·08 [95% CI 0·03–0·13], global p=0·0033, Hochberg adjusted p=0·045); the difference between tumour bed boost and no boost at the end of treatment was 0·08 (0·01 to 0·15, p=0·021), and did not persist at 24 months (0·04 [–0·03 to 0·11], p=0·29). None of the other six prespecified aspects of HRQOL differed significantly after adjustment for multiple testing. Conventional whole breast radiotherapy was associated with worse body image than hypofractionated whole breast radiotherapy at the end of treatment (difference –1·10 [95% CI –1·79 to –0·42], p=0·0016). No significant differences were reported in the other PROs between conventional whole breast radiotherapy compared with hypofractionated whole breast radiotherapy. Interpretation Tumour bed boost was associated with persistent adverse effects on cosmetic status and arm and shoulder functional status, which might inform shared decision making while local recurrence analysis is pending. Funding National Health and Medical Research Council, Susan G Komen for the Cure, Breast Cancer Now, OncoSuisse, Dutch Cancer Society.

The cumulative effect of radiation and the extent of related morbidities on oral tissues are enormous and increase over time. The numerous radiation-related side effects have a strong, negative influence on the oral functions and are responsible for a drastic reduction in the oral-health-related quality of life of the cancer survivors. In a significant deviation to the earlier approach of advising extraction of all remaining teeth before RT, the concept of preserving a maximum number of teeth in a state of health and for better oral functions postcancer cure has been globally accepted and is adhered to. The effects of radiation and their impact on the general well-being of the patients underscore the relevance of understanding the sequelae of radiation therapy on healthy oral tissues, preexisting oral diseases and their progression, impact on oral treatment needs, limitations in performing the indicated treatment, and shortcoming in treatment outcomes. It is vital for the professionals involved in head and neck cancer care to follow a well-devised referral system for oral care before and after RT and educate patients for a life-long follow-up.

Background HDR brachytherapy alone is effective for the treatment of localised prostate cancer when given in 2–4 or more fractions. Single dose treatment has been explored in small cohort studies to date. This paper reports a large patient population with localised prostate cancer treated with single dose HDR brachytherapy delivering 19 Gy providing early outcome data from this approach. Patients and methods Seven centres across the UK collaborated in this national protocol to deliver 19 Gy to the PTV defined by the prostate capsule and a 3 mm expansion with clearly defined planning constraints for the urethra and rectum. Entry criteria allowed all risk groups provided PSA ≤40 µg/L and staging investigations were negative for metastases. The primary end point was biochemical relapse free survival (bRFS) defined using the Phoenix definition. Toxicity was measured using CTCAE v4.0. Results A total of 441 patients were entered with median follow up 26 months (range 2–56). Median age was 73 (range 54–84) and 10% were low risk, 65% intermediate risk and 25% high risk. ADT was received by 37.6% overall and 90% of high risk patients for a median period of 6 months. Three year bRFS was overall 88%: this was 100% in low risk, 86% in intermediate risk and 75% in high risk. Only Gleason score was an independent predictor of bRFS. Relapse in 25 patients was assessed radiologically and occurred in the prostate in 15 of these, 11 of whom had localised prostate relapse only. Acute toxicity was low with no grade 3 or 4 events; there were two cases of late urinary stricture and two grade 3 late rectal events. Conclusion This is the largest cohort of single dose HDR brachytherapy patients treated with a single dose published to date. It shows that with 19 Gy there is 100% bRFS at 3 years in low risk patients but results in intermediate and high risk groups are less encouraging falling to 86% and 75% at 3 years with relapse predominantly in the prostate. Limited by the short follow up period of this study, the long-term outcomes of this single dose HDR approach remains uncertain. It is important to have close ongoing surveillance of this cohort as the data matures.

ImportanceWhile recent literature has shown the efficacy of the COVID-19 vaccine in preventing infection, its impact on need for emergency care/hospitalization in breakthrough infections remain unclear, particularly in regions with a high rate of variant viral strains.ObjectiveWe aimed to determine if vaccination reduces hospital visits and severe disease in breakthrough COVID-19 infections.DesignMulticenter observational cohort analysisSettingEight-hospital acute care regional health system in Michigan, USAParticipantsConsecutive adult patients with COVID-19 requiring emergency care (EC)/hospitalization were eligible participants. Between December 15, 2020 and April 30, 2021, 11,834 EC encounters with COVID-19 infection were included.ExposuresCOVID-19 vaccinationMain Outcomes and MeasuresPrimary endpoint was rate of COVID-19 emergency care/hospitalization encounters comparing unvaccinated (UV), partially vaccinated (PV), and fully vaccinated (FV) cases. Secondary outcome was severe disease represented as a composite outcome (ICU admission, mechanical ventilation, or in-hospital death).Demographic and clinical variables were obtained from the electronic record. Vaccination data was obtained from the Michigan Care Improvement Registry and the Centers for Disease Control vaccine tracker.Results10,880 (91.9%) UV, 825 (7%) PV, and 129 (1.1%) FV were included. Average age was 53.0 ± 18.2 and 52.8% were female. Accounting for the COVID-19 vaccination population groups in Michigan, the ED encounters/hospitalizations rate relevant to COVID-19 infection was 96% lower in FV versus UV (eβ:0.04,95% CI 0.03 to 0.06, p ConclusionsThe need for emergency care and/or hospitalization due to breakthrough COVID-19 is an exceedingly rare event in fully vaccinated patients. As vaccination has increased within our region, emergency visits amongst fully vaccinated individuals have remained low and occur much less frequently when compared to unvaccinated individuals. In cases of breakthrough COVID-19, if hospital-based treatment is required, elderly patients with significant comorbidities remain at high risk for severe outcomes regardless of vaccination status.

Electrocardiographic (ECG) tip confirmation is a validated technique to place the distal tip of a peripherally inserted central catheter (PICC) in the distal superior vena cava at or near the cavoatrial junction during point-of-care insertions. This case report discusses an inadvertent arterial PICC placement despite navigation technology demonstrating similar confirmatory ECG changes seen in standard venous insertions. The findings demonstrate that ECG navigation technology should not be used to rule out arterial PICC placement.

Objective Peripheral intravenous catheter (PIVC) failure occurs frequently, but the underlying mechanisms of failure are poorly understood. We aim to identify ultrasonographic factors that predict impending PIVC failure prior to clinical exam. Methods We conducted a single site prospective observational investigation at an academic tertiary care center. Adult emergency department (ED) patients who underwent traditional PIVC placement in the ED and required admission with an anticipated hospital length of stay greater than 48 hours were included. Ongoing daily PIVC assessments included clinical and ultrasonographic evaluations. The primary objective was to identify ultrasonographic PIVC site findings associated with an increased risk of PIVC failure. The secondary outcome was to determine if ultrasonographic indicators of PIVC failure occurred earlier than clinical recognition of PIVC failure. Results In July and August of 2020, 62 PIVCs were enrolled. PIVC failure occurred in 24 (38.71%) participants. Multivariate logistic regression demonstrated that the presence of ultrasonographic subcutaneous edema [AOR 7.37 (1.91, 27.6) p = 0.0030] was associated with an increased likelihood of premature PIVC failure. Overall, 6 (9.67%) patients had subcutaneous edema present on clinical exam, while 35 (56.45%) had subcutaneous edema identified on ultrasound. Among patients with PIVC failure, average time to edema detectable on ultrasound was 46 hours and average time to clinical recognition of failure was 67 hours (P = < 0.0001). Conclusions Presence of subcutaneous edema on ultrasound is a strong predictor of PIVC failure. Subclinical subcutaneous edema occurs early and often in the course of the PIVC lifecycle with a predictive impact on PIVC failure that is inadequately captured on clinical examination of the PIVC site. The early timing of this ultrasonographic finding provides the clinician with key information to better anticipate the patient’s vascular access needs. Further research investigating interventions to enhance PIVC survival once sonographic subcutaneous edema is present is needed.

Objectives To assess the efficacy and tolerability of cabazitaxel in relapsed penile cancer. Methods This Phase II single-arm trial was designed to recruit 17 patients with relapsed penile cancer. The primary endpoint was objective (complete + partial) response rate (ORR; Response Evaluation Criteria in Solid Tumours [RECIST] v1.1). Treatment comprised six 21-day cycles of cabazitaxel with restaging after cycles 2 and 4. The planned interim analysis was based upon the premise that if none of the first nine patients achieved ORR, trial would be stopped (α = 0.05, Simon’s 2-stage design). Results Nine patients were recruited from four UK centres between December 2014 and August 2016. The median age was 61 (range, 27–73.6) years, and seven patients had metastases. Patients received a median of two chemotherapy cycles (range, 2–5). None of the nine patients achieved ORR and the trial was stopped. Cabazitaxel was well tolerated with no dose reductions or delays. Three patients had grade 3/4 adverse events (anaemia, vomiting, or neutropenic sepsis). The median progression-free and overall survival were 1.3 and 5.6 months, respectively. Conclusions The trial did not reach the threshold for further continuation of single-agent cabazitaxel. However, the observed tolerability profile supports its further investigation in combination with other agents to improve patient outcomes.

Author(s): Price, Jacob; Xiao, Jane; Tausch, Katie; Hang, Bophal; Bahl, Amit | Abstract: Introduction: Peripheral, ultrasound-guided intravenous (IV) access occurs frequently in the emergency department, but certain populations present unique challenges for successfully completing this procedure. Prior research has demonstrated decreased compressibility under double tourniquet technique (DT) compared with single tourniquet (ST). We hypothesized that catheters inserted under DT method would have a higher first-stick success rate compared with those inserted under ST method.Methods: We randomized 100 patients with a history of difficult IV access, as defined by past ultrasound IV, prior emergency visit with two or more attempts required for vascular access, history of IV drug abuse, history of end stage renal disease on hemodialysis or obesity, to ultrasound-guided IV placement under either DT or ST method. We measured the vein characteristics measured under ultrasound, and recorded the number of attempts and location of attempts at vascular access.Results: Of an initial 100 patients enrolled, we analyzed a total of 99 with 48 placed under ST and 51 placed under DT. Attending physicians inserted 41.7% of ST and 41.2% of DT, with non-attending inserters (including residents, nurses, and technicians) inserted the remainder. First-stick success rate was observed at 64.3% in ST and 66.7% in DT (p=0.93). Attendings had an overall higher first-stick success rate (95.1%) compared to non-attending inserters (65.5%) (p=l0.001). The average vein depth measured in ST was 0.73 centimeters (cm) compared with 0.87 cm in DT (p=0.02).Conclusion: DT technique did not produce a measureable increase in first-stick success rate compared to ST, including after adjusting for level of training of inserter. However, a significant difference in average vein depth between the study arms may have limited the reliability of our overall results. Future studies controlling for this variable may be required to more accurately compare these two techniques.

Introduction Establishing peripheral intravenous (IV) access is a vital step in providing emergency care. Ten to 30% of Emergency Department (ED) patients have difficult vascular access (DVA). Even after cannulation, early failure of US-guided IV catheters is a common complication. The primary goal of this study was to compare survival of a standard long IV catheter to a longer extended dwell catheter. Methods This study was a prospective, randomized comparative evaluation of catheter longevity. Two catheters were used in the comparison: [1] a standard long IV catheter, the 4.78 cm 20 gauge Becton Dickinson (BD); and [2] a 6 cm 3 French (19.5 gauge) Access Scientific POWERWAND™ extended dwell catheter (EDC). Adult DVA patients in the ED with vein depths of 1.20 cm–1.60 cm and expected hospital admissions of at least 24 h were recruited. Results 120 patients were enrolled. Ultimately, 70 patients were included in the survival analysis, with 33 patients in the EDC group and 37 patients in the standard long IV group. EDC catheters had lower rates of failure (p = 0.0016). Time to median catheter survival was 4.04 days for EDC catheters versus 1.25 days for the standard long IV catheter. Multivariate survival analysis also showed a significant survival benefit for the EDC catheter (p = 0.0360). Conclusion A longer extended dwell catheter represents a viable and favorable alternative to the standard longer IVs used for US-guided cannulation of veins >1.20 cm in depth. These catheters have significantly improved survival rates with similar insertion success characteristics.

Aim: The aim of the present study was to access the need of daily cone-beam computed tomography (CBCT) and the requirement of in-house protocols of image acquisition frequency to reduce unnecessary exposure to the patients undergoing radiotherapy treatment. Materials and Methods: The dose delivered during CBCT procedure (On-Board Imager, Trilogy, Varian medical system, Inc., Palo Alto, California) was assessed for pelvic and head and neck region. For dose estimation, cylindrical polymethyl methacrylate phantoms of 15 cm length, 16 cm, and 32 cm diameter were used to simulate the patient's head and neck and pelvic region thickness, respectively. More than 10 cm scatterer was added on either end of this phantom. Calibrated Ionization chamber DCT10 LEMO SN 1685 iba, dosimetry, Germany (10 cm active length) was used to measure the dose Index. The doses known as cone-beam dose index (CBDI100) were estimated for all the scanning protocols (kV and mAs setting) available on the machine. In this study, image acquisition frequency to correct the setup error was optimized. In-house protocol for image acquisition frequency during treatment has been suggested to reduce the dose. It was based on the principle of as low as reasonable achievable. Results: Optimized dose protocol observed was the “standard dose head” for which the CBDI100 was 2.43 mGy. Whereas for pelvic imaging, single protocol of 125 kV, 80 mA was available by which a dose of 7.61 mGy is likely to be received by the patient during scan. Maximum shift of 6 mm in lateral direction was observed to the patient of Pelvis region and 5 mm was observed in the longitudinal direction for the H and N patients. Angular shift measured in patient position was 3.8° and 3.1° for H and N and pelvic region, respectively. Conclusion: Three consecutive-day CBCT-imaging at the beginning of the treatment followed by once weekly CBCT and two-dimensional (2D) imaging in remaining days of treatment can be an optimized way of imaging for the patient having malignancy in the region of pelvic and abdomen. For H and N, once in a week, CBCT with standard dose head protocol, followed by 2D-imaging in remaining days can be an optimized way of imaging.

Aim To understand the awareness and use of rectal spacers for prostate cancer patients undergoing radical radiotherapy in the United Kingdom. Methods An expert-devised online questionnaire was completed by members of the British Uro-oncology Group (BUG). Results Sixty-three specialists completed the survey (50% of BUG members at that point in time). Only 37% had used rectal spacers, mostly for private patients or those with pre-existing bowel conditions. However, many (68%) would like to use these devices in future. More than 70% of the uro-oncologists felt that bowel toxicity was underreported, but 60% believed that the use of radiotherapy without bowel toxicity was achievable with the use of rectal spacers. Conclusions The current use of rectal spacers by UK uro-oncologists for patients with localised or locally advanced prostate cancer receiving radiotherapy is low and largely restricted by resourcing issues.

Background Although there is some support for visual estimation (VE) as an accurate method to estimate left ventricular ejection fraction (LVEF), it is also scrutinized for its subjectivity. Therefore, more objective assessments, such as fractional shortening (FS) or e-point septal separation (EPSS), may be useful in estimating LVEF among patients in the emergency department (ED). Objective Our aim was to compare the real-world accuracy of VE, FS, and EPSS using a sample of point-of-care cardiac ultrasound transthoracic echocardiography (POC-TTE) images acquired by emergency physicians (EPs) with the gold standard of Simpson's method of discs, as measured by comprehensive cardiology-performed echocardiography. Methods We conducted a single-site prospective observational study comparing VE, FS, and EPSS to assess LVEF. Adult patients in the ED receiving both POC-TTE and comprehensive cardiology TTE were included. EPs acquired POC-TTE images and videos that were then interpreted by 2 blinded EPs who were fellowship-trained in emergency ultrasound. EPs estimated LVEF using VE, FS, and EPSS. The primary outcome was accuracy. Results Between April and May 2018, 125 patients were enrolled and 113 were included in the final analysis. EP1 and EP2 had a κ of 0.94 (95% confidence interval [CI] 0.87–1.00) and 0.97 (95% CI 0.91–1.00), respectively, for VE compared with gold standard, a κ of 0.40 (95% CI 0.23–0.57) and 0.38 (95% CI 0.18–0.57), respectively, for EPSS compared with gold standard, and a κ of 0.70 (95% CI 0.54–0.85) and 0.66 (95% CI 0.50–0.81), respectively, for FS compared with gold standard. Sensitivity of severe dysfunction was moderate to high in VE (EP1 85% and EP2 93%), poor to moderate in FS (EP1 73% and EP2 50%), and poor in EPSS (EP1 11% and EP2 18%). Conclusions Using a real-world sample of POC-TTE images, the quantitative measurements of EPSS and FS demonstrated poor accuracy in estimating LVEF, even among experienced sonographers. These methods should not be used to determine cardiac function in the ED. VE by experienced physicians demonstrated reliable accuracy for estimating LVEF compared with the gold standard of cardiology-performed TTE.

Objective:Peripheral intravenous catheter (PIVC) failure occurs frequently, but the underlying mechanisms of failure are poorly understood. We aim to identify factors that predict premature PIVC failure.Methods:We conducted a single site prospective observational investigation at an academic tertiary care center. Adult emergency department (ED) patients who underwent traditional PIVC placement in the ED and required admission with an anticipated hospital length of stay greater than 48 hours were included. Ongoing daily PIVC assessments included clinical and ultrasonographic evaluations. The primary goal was to identify demographic, clinical, and PIVC related variables that predicted PIVC failure. Univariate and multivariate analyses were employed to identify risk factors for PIVC failure.Results:In July and August of 2020, 62 PIVCs were enrolled. PIVC failure occurred in 24 (38.71%) participants. Multivariate logistic regression demonstrated that the presence of subcutaneous edema [AOR 8.29 (1.50, 45.8) p = 0.0153], an above average neutrophil to lymphocyte (N:L) ratio [AOR 4.63 (1.06, 20.3) p = 0.0422], and the administration of an irritant/vesicant [10.3 (1.46, 72.6) p = 0.0.192] were associated with increased likelihood of premature PIVC failure. Conclusions:PIVC failure is related to clinical and ultrasonographic variables associated with inflammation: elevated N:L ratio, use of caustic medications, and presence of subcutaneous edema on ultrasound. Reducing inflammation of the vein may lead to better PIVC survival outcomes. Further large-scale randomized controlled trials are needed to validate and build upon the concepts in this study.

OBJECTIVE To evaluate the association between SpaceOAR and radiation dosing, toxicity and quality-of-life vs no spacer across all radiotherapy modalities for prostate cancer. METHODS A systematic search of the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase was performed from database inception through May 2020. Two reviewers independently screened titles/abstracts and full papers. Data extraction was performed, and quality assessed by 1 reviewer and checked by a second, using a third reviewer as required. The synthesis was narrative. RESULTS 19 studies (3,622 patients) were included (only 1 randomized controlled trial, in image-guided intensity-modulated radiotherapy (IG-IMRT), 18 comparatives non-randomized controlled trials in external-beam radiotherapy (EBRT), brachytherapy, and combinations thereof). No hypofractionation studies were found. Regardless of radiotherapy type, SpaceOAR significantly reduced rectal radiation dose (eg, V40 average difference -6.1% in high dose-rate brachytherapy plus IG-IMRT to -9.1% in IG-IMRT) and reduced gastrointestinal and genitourinary toxicities (eg, late gastrointestinal toxicity 1% vs 6% (P = .01), late genitourinary toxicity of 15% vs 32% (P < .001) in stereotactic body radiotherapy). Improvements were observed in most Expanded Prostate Cancer Index Composite quality-of-life domains (eg, bowel function score decrease at 3 and 6 months: Average change of zero vs -6.25 and -3.57 respectively in low dose-rate brachytherapy plus EBRT). CONCLUSION The randomized controlled trial in IG-IMRT demonstrated that SpaceOAR reduces rectal radiation dose and late gastrointestinal and genitourinary toxicities, with urinary, bowel, and sexual quality-of-life improvement. These advantages were verified in observational studies in various radiotherapy types. Further research is required in hypofractionation.

Aim To explore the practice and views of uro-oncologists in the United Kingdom regarding their use of chemotherapy and androgen receptor-targeted agents (ARTAs) in patients with newly diagnosed metastatic hormone-sensitive prostate cancer (mHSPC). Methods An expert-devised paper or online questionnaire was completed by members of the British Uro-oncology Group. Results All respondents stated that they would offer patients with newly diagnosed mHSPC docetaxel and androgen deprivation therapy (ADT) if they were sufficiently fit to receive chemotherapy (this was the only option available at the time of the survey); 64% would strongly recommend docetaxel for those with high-volume metastatic disease and 31% for those with low-volume disease. Hypothetically, if both docetaxel and ARTAs were available in the United Kingdom for mHSPC, almost 65% of respondents would recommend an ARTA with ADT to these patients in at least one-half of all cases, with the strongest recommendations to patients with high-risk disease. Imaging for the response was conducted according to suspicion of disease progression, regardless of treatment, with the minority of clinicians recommending routine imaging. If a choice of therapy was available, docetaxel would be more likely to be offered to patients with liver or lung metastases, and ARTAs to patients with bone or lymph node only metastases. Almost all respondents would offer local radiotherapy to the primary tumour in patients with low-volume disease. Conclusion All the UK uro-oncologists surveyed stated that they would offer docetaxel in combination with ADT to all newly diagnosed patients with mHSPC if fit enough for chemotherapy. ARTAs would be offered to many patients if available, especially those with high-risk disease or those unfit to receive chemotherapy. Scanning was typically conducted following treatment only at the suspicion of disease progression.

Radical cystectomy with urinary diversion is one of the most complex urologic procedures. Despite improvements in surgical technique, anaesthesia and perioperative care, radical cystectomy is still associated with significant morbidity and prolonged in-patient stay after surgery [1]. Fast-track principles are standard procedure in radical cystectomy, to minimise complications. Robotic surgery has been performed in an effort to reduce surgical stress and decrease perioperative morbidity [2]. Despite the degree of dissection, it remains the gold standard for muscle invasive bladder cancer. The magnitude of the surgical insult is associated with the degree of stress response, particularly in ageing patients with multiple comorbidities. However, there has been a growing trend towards enhanced recovery protocols (ERP).

A systematic review relating to muscle invasive bladder cancer and was conducted. This was to identify the molecular basis of muscle invasive disease. The search strategy aimed to identify all references related to bladder cancer AND muscle invasive disease AND molecular basis. Search terms used were as follows: (Bladder cancer) AND (muscle invasive disease) AND (Molecular Basis). The following databases were screened from 1989 to June 2020. The Molecular Basis of Bladder Cancer—Precision Diagnostics and Treatment, PIK3CA Mutations in Muscle Invasive Bladder Cancer, Epidermal Growth Factor in Muscle Invasive Bladder Cancer, P53, pRB and RAS in Muscle Invasive Bladder Cancer, Transcriptome Profiling in Muscle Invasive Bladder Cancer, Methylation Status in Bladder Cancer, The Cancer Genome Project and the Molecular Basis of Bladder Cancer.

A systematic review relating to literature on urinary diversion for muscle invasive bladder cancer was conducted. This was to identify which gave better outcomes. This chapter covers Incidence of ileal conduit vs. orthotopic neobladder, health related quality of life, morbidity and mortality, AKI, modified S pouch outcomes, conversion factors, factors influencing selection of urinary diversion, types of diversion outcomes.

There are a number of issues as no difference in outcomes between open and robotic cystectomies that have been noted. A complete minimally invasive approach shows consistent advantages compared with open radical cystectomy. The lower complications rates, and shorter length of stay all contribute towards better functional and oncological outcomes. This chapter is an introduction to robotic intracorporeal neobladder formation.

A systematic review relating to bladder cancer and obesity was conducted. The search strategy aimed to identify all references related to bladder cancer AND obesity. Search terms used were as follows: (Bladder cancer) AND (obesity). The following databases were screened from 1989 to June 2020

A systematic review relating locally advanced and metastatic bladder and immunotherapy was conducted. This was to identify the bladder cancer, immunotherapy outcomes in locally advanced and metastatic disease. The search strategy aimed to identify all references related to bladder cancer, ureteric strictures AND urinary diversion. Search terms used were as follows: (Bladder cancer) AND (immunotherapy) AND (locally advanced) OR (metastatic). The following databases were screened from 1989 to June 2020

A systematic review relating to muscle invasive bladder cancer and neoadjuvant chemotherapy prior to radical cystectomy was conducted. This was to identify whether neoadjuvant chemotherapy has a role in this cohort. This chapter covers outcomes of neoadjuvant chemotherapy vs. radical cystectomy.

A systematic review relating to muscle invasive bladder cancer and bladder preservation was conducted. This was to identify the role of bladder preservation. This chapter covers tetramodal bladder preservation therapy, radical cystectomy vs. bladder preservation in the elderly, bladder perseveration with brachytherapy and external beam radiotherapy, survival outcomes in bladder preservation therapy for MIBC, patterns of bladder preservation therapy, bladder preservation rate, paclitaxel, trasuzumab with irradiation after transurethral surgery, second TURBT in bladder preservation for MIBC, trimodal chemotherapy with cisplatin in bladder preservation.

A systematic review relating to muscle invasive bladder cancer and radical cystectomy in the elderly was conducted. This chapter covers prognostic factors in elderly patients, mortality rate in elderly undergoing cystectomy, type of reconstruction in the elderly, open radical cystectomy, national trends in cystectomy figures for the elderly, robotic vs. open radical cystectomy in elderly, extraperitoneal vs. transperitoneal laparoscopic approaches, younger vs. older patients for radical cystectomy, risks and benefits of pelvic lymphadenectomy in the elderly, outcomes in elderly patients, pathology of elderly patients undergoing radical cystectomy, pathology of elderly patients undergoing radical cystectomy, post-operative outcomes in younger and older patients.

TMT consists of a maximal resection of the bladder, followed by a concurrent radiotherapy and chemotherapy, limiting salvage radical cystectomy to non-responder tumours or muscle-invasive recurrence (Mathieu et al., Curr Opin Urol 25:476–482, 2015). This chapter is an introduction to trimodal therapy in bladder cancer.

The micropapillary variant of urothelial carcinoma (MPUC) is a rare but well-recognized tumour (Chatterjee et al., Indian J Pathol Microbiol 58:2–6, 2015). This chapter covers histopathology, clinical presentation, risk stratification, survival outcomes, neoadjuvant chemotherapy, trimodal therapy, surgical outcomes, adjuvant therapy.

Urothelial tumours represent a spectrum of diseases with a range of prognoses (Scher et al., Oncology (Williston Park) 12:225–271, 1998). Within each category of disease, more refined methods to determine prognosis and guide management, based on molecular staging, are under development (Scher et al., Oncology (Williston Park) 12:225–271, 1998). This chapter covers risk stratification in bladder cancer.

Bladder cancer (BC) has an incidence of 100,000 men and women each year in the European Union (EU) (Klaile et al., Transl Androl Urol 5(5):692–701, 2016). Variant histology account for up to 25%. There is evidence that additional variant histology results in impaired prognosis (Klaile et al., Transl Androl Urol 5(5):692–701, 2016). This chapter covers survival outcomes, CEA, CA 19-9 in diagnostics, muscle invasive adenocarcinoma, partial cystectomy and radiotherapy, neoadjuvant chemotherapy in bladder cancer, adjuvant therapy in adenocarcinoma of the bladder, novel chemotherapeutic agents.

Early detection greatly improves the chances of survival from bladder cancer. More recently ICG use has been reported in robotic surgery, which review in the context of bladder cancer. This chapter is an introduction to sentinel node mapping in bladder cancer.

Filipas et al. (Eur Urol 32:23–29, 1997) compared the quality of life and health in incontinent and continent urinary diversions (Filipas et al., Eur Urol 32:23–29, 1997). Patients with non-tumour disease, a continent reservoir and employment tended to have the highest level of quality of life (Filipas et al., Eur Urol 32:23–29, 1997). This chapter covers quality of life with urinary diversion.

A systematic review relating to bladder cancer epidemiology, risk factors and occupational hazards was conducted. This chapter covers urinary metabolites in bladder cancer, CellDetect, NMP 22, 5 Aminolevulinic Acid, BTA stat test, Bladder EpiCheck, Microsatellite analysis, urinary cytology and urotel.

A systematic review relating to trials in locally advanced and metastatic bladder cancer was conducted. Search terms used were as follows: (Bladder cancer) AND (Trials) AND (Locally Advanced) OR (Metastatic). The following databases were screened from 1989 to June 2020

The current ‘gold standard’ for radical cystectomy remains open radical cystectomy (Collins and Wiklund BJU Int 2014;114(3):326–333, 2014). RARC has lagged behind robot-assisted prostatectomy in terms of adoption and perceived patient benefit, but there are indications that this is now changing (Collins and Wiklund BJU Int 2014;114(3):326–333, 2014). This chapter covers radical cystectomy outcomes.

A systematic review relating to muscle invasive bladder cancer, robotic cystectomy and Urinary Diversion was conducted. This chapter covers T-Pouch neobladder vs. studer pouch, studer pouch vs. I pouch, the Studer neobladder, ileal conduit vs. neobladder.

A systematic review relating to staging, imaging and bladder cancer was conducted. The search strategy aimed to identify all references related to the Staging conundrum and Bladder Cancer. This chapter covers variation in imaging, MRI in detection of MIBC, MRI in low grade vs. high grade MIBC, role of high resolution US in bladder cancer, MRI vs. CT Urogram, FDG PET in bladder cancer staging.

A systematic review relating to muscle invasive bladder cancer and laparoscopic vs. open vs. robotic surgery was conducted. This was to identify the outcomes. This chapter covers Complication Rate Robotic vs. Open Cystectomy, Laparoscopic vs. Open Radical Cystectomy with prior Abdominal Surgery, Laparoscopic vs. Open Cystectomy Outcomes, Robotic Cystectomy vs. Laparoscopic Cystectomy Outcomes, Recurrence after Open and Robotic Radical Cystectomy, Robotic vs. Laparoscopic Radical Cystectomy in Elderly Patients, Robotic vs. Laparoscopic High Extended Pelvic Lymph Node Dissection, Open vs. Laparoscopic vs. Robotic Cystectomy.

There have been a number of articles recently on secondary pelvic malignancies. With the advent of robotic surgery, and new platforms, many changes have come into place. However, what can be done differently to allow improved outcomes? This chapter covers secondary pelvic malignancies and bladder cancer.

A systematic review relating locally advanced and metastatic bladder and immunotherapy was conducted. This was to identify the bladder cancer, immunotherapy outcomes in locally advanced and metastatic disease. The search strategy aimed to identify all references related to bladder cancer, ureteric strictures AND urinary diversion. Search terms used were as follows: (Bladder cancer) AND (Chemotherapy) AND (locally advanced) OR (metastatic). The following databases were screened from 1989 to June 2020