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Neto A.S.,Urologic | Tobias-Machado M.,Urologic | Tobias-Machado M.,Research Institute Albert Einstein Jewish Hospital IEP HIAE | Ficarra V.,University of Padua | And 5 more authors.
Annals of Surgical Oncology | Year: 2011

Background. Dynamic sentinel node biopsy (DSNB) is used to evaluate the nodal status of patients with clinically node-negative penile carcinoma. Its use is not widespread, and the majority of patients with clinically node-negative disease undergo an elective inguinal lymph node dissection (ILND). However, a prophylactic bilateral ILND is a procedure with approximately 50% of morbidity. The purpose of this review is to evaluate the accuracy of DSNB in penile cancer. Methods. This is a systematic review and cumulative analysis of studies published between 1966 and 2010. The Medline, Embase, Cancerlit, and American Society of Clinical Oncology abstract databases were searched for published studies on penile cancer and DSNB. The outcomes assessed were: sensitivity, specificity, likelihood ratios, and summary receiver operating characteristics (ROC) curves. Results. Ten articles covering 519 participants were included in the cumulative analysis. The pooled sensitivities and specificities for sentinel node biopsy for detection of metastasis were 77.1 and 100% versus ILND and 87.9 and 100% versus wait and see program. The false-negative rate founded was 3.1% in the ILND group and 3.5% in the wait and see group. Conclusions. The use of dynamic sentinel lymph node biopsy to detect lymph node metastasis in specialized centers appears to be justified. Addiction of other techniques to DSNB to reduce false-negative results is awaited and must be confirmed by future studies. © Society of Surgical Oncology 2011. Source


Serpa Neto A.,Urologic | Tobias-Machado M.,Urologic | Tobias-Machado M.,Research Institute Albert Einstein Jewish Hospital IEP HIAE | Esteves M.A.P.,Urologic | And 8 more authors.
Prostate Cancer and Prostatic Diseases | Year: 2012

The objective of this study was to clarify the role of bisphosphonates in the treatment of osteoporosis in patients with prostate adenocarcinoma under androgen deprivation therapy (ADT). The Medline, EMBASE, Cancerlit and the American Society of Clinical Oncology abstract databases were searched for published randomized, placebo-controlled trials evaluating the usage of bisphosphonates in patients with prostate cancer (PC) under ADT. The outcomes assessed were fracture, osteoporosis, incidence of adverse events and changes in bone mineral density (BMD) during treatment. A total of 15 articles (2634 participants) were included in the meta-analysis. Treatment with bisphosphonates showed a substantial effect in preventing fractures (risk ratio (RR), 0.80; P=0.005) and osteoporosis (RR, 0.39; P < 0.00001). Zoledronic acid showed the best number needed to treat (NTT), compared with placebo, in relation to fractures and osteoporosis (NNT=14.9 and NNT=2.68, respectively). The between-group difference (bisphosphonates vs placebo) in the lumbar spine and femoral neck BMD were 5.18±3.38% and 2.35±1.16%, respectively. This benefit of bone loss prevention could be reached without major side effects (cardiovascular or gastrointestinal events). Bisphosphonates are effective in preventing bone loss in patients with PC who are under ADT. © 2012 Macmillan Publishers Limited All rights reserved. Source

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