Current opinion in urology
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Radiotherapy has the potential to augment the host's immune response to cancer. Urological malignancies are highly immunogenic and the combination of radiotherapy and immunotherapy shows promise. In this review, we discuss the effects of radiotherapy on the cancer immune system and highlight the rationale for using the combined approach in prostate, urothelial and renal cancers. Current clinical studies are summarized emphasising the synergistic effects of the combination and the possibility of improved clinical outcomes. ⋯ Although our knowledge of immunomodulation by radiotherapy has improved significantly in recent times, there remain several unanswered questions regarding how to best use the combination in clinical practice. Ongoing trials will provide further insight into complex mechanisms governing radiotherapy-immunotherapy interactions, with potential to improve clinical outcomes.
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Over the past decade, three-dimensional printing for the medical field has been expanding rapidly throughout all of medicine. This manuscript reviews the current and potential applications for three-dimensional printing, including education, presurgical planning, surgical simulation, bioprinting, and printed surgical equipment. ⋯ Three-dimensional printing in the field of medicine is growing quickly, and will soon be incorporated into the way residents are taught and patients are educated. For surgical simulation in a variety of disease processes, this will be particularly useful for urologic surgery.
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The geriatric population is the fastest growing segment of the population, and geriatric trauma patients are increasingly common. Caring for this population has unique challenges. The goal of the review is to identify factors that may help in the care of geriatric patients suffering from genitourinary trauma. ⋯ Interventions for geriatric patients differ from younger populations. Direct changes in overall management of the geriatric population lead to improved outcomes. The treatment of geriatric trauma patients with genitourinary injuries is similar to a younger cohort. The lack of recent studies in clinical outcomes in this population has been identified as a gap in knowledge that will require future research to answer.
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The advent of checkpoint inhibitors has fostered great expectations for long-term outcome in cancer patients. Inhibitors of programmed death -1, programmed death ligand-1 and cytotoxic T-lymphocyte associated protein 4 are targets of contemporary cancer immunotherapy. Current phase III studies are ongoing and may define a novel treatment paradigm in metastatic renal cell carcinoma (mRCC). This review focuses on current clinical data in mRCC. ⋯ Immunotherapies have fostered great expectations on long-term overall survival in mRCC. As seen with previous cytokine treatment, long-term response is a key clinical outcome. Phase III data for previously treated patients are expected later this year and may define a novel standard for treatment. Combinational therapies have generated promising response data, indicating a potential role in treatment intensification in mRCC. Combination treatment is associated with ample toxicity, which might restrict this approach to selected patients. The major task for the future is to tailor immunotherapy for individual patients.