High-intensity focused ultrasound as salvage therapy for patients with recurrent prostate cancer after external beam radiation, brachytherapy or proton therapy
High-intensity focused ultrasound as salvage therapy for patients with recurrent prostate cancer after external beam radiation, brachytherapy or proton therapy
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DOI：
10.1111/j.1464-410x.2010.09518.x
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发表时间：
2011-02-01
影响因子：
4.5
通讯作者：
Nagata, Yoshihiro
中科院分区：
文献类型：
--
作者：
Uchida, Toyoaki;Shoji, Sunao;Nagata, Yoshihiro
关于这个问题有什么进展？这项研究增加了什么？补救性HIFU是放射治疗后局部复发的一种有前途的治疗选择，与其他形式的挽救治疗的发病率相媲美。这项研究显示了长期随访的补救性高强度聚焦超声（HIFU）在男性复发的局限性前列腺癌后，不仅外照射放射治疗，但近距离放射治疗或质子治疗。作为局部前列腺癌复发患者的补救治疗后，外部束辐射（EBRT），近距离放射治疗，或质子therapy.Patients和METHODS我们回顾性审查了所有患者的图表谁经历了挽救HIFU活检证实的前列腺癌后，初步放射治疗。对22例中位（范围）随访24（5-80）个月的患者的随访记录进行了回顾。患者是患有假定器官局限性疾病的男性，在EBRT（14例患者）、近距离放射治疗（5例患者：4例使用In 192进行高剂量近距离放射治疗; 1例使用Au 98进行低剂量近距离放射治疗）或质子治疗（3例患者）后复发疾病后接受了补救性HIFU治疗。补救性HIFU治疗时的中位（范围）年龄为65（52-80）岁，放疗前的中位（范围）前列腺特异性抗原（PSA）水平为14.3（5.7-118）ng/mL，HIFU治疗前的中位（范围）PSA水平为4.0（1.2-30.1）ng/mL。放疗后至HIFU治疗的中位（范围）时间为36（4-96）个月。所有患者5年的生化无病生存率（bDFS）为52%。低、中和高风险组的bDFS率分别为100%、86%和14%。12例接受HIFU后前列腺活检的患者中有1例显示恶性肿瘤。副作用包括尿道狭窄4例，I级尿失禁4例，直肠尿道瘘和附睾炎在每个patient.CONCLUSIONSalvage高强度聚焦超声是一个有前途的治疗选择放射治疗后局部复发，与其他形式的挽救治疗的发病率相当。
What's known on the subject? and What does the study add?Salvage HIFU is a promising treatment option for local recurrence after radiation therapy, with morbidity comparable with other forms of salvage treatment.This study showed a long-term follow up of salvage HIFU in men with recurrence of localized prostate cancer following not only external beam radiation therapy but also brachytherapy or proton therapy.OBJECTIVETo investigate the use of high-intensity focused ultrasound (HIFU) as a salvage therapy in patients with recurrence of localized prostate cancer after external beam radiation (EBRT), brachytherapy, or proton therapy.PATIENTS AND METHODSWe retrospectively reviewed the charts of all patients who had undergone salvage HIFU for biopsy-proven prostate cancer after primary radiation therapy. Patient characteristics and oncological outcomes were assessed.RESULTSRecords of 22 patients with a median (range) follow-up of 24 (5-80) months were reviewed. Patients were men with presumed organ-confined disease who had been treated with salvage HIFU following recurrent disease after EBRT (fourteen patients), brachytherapy (five patients: four with high-dose brachytherapy using In192; and one with low-dose brachytherapy using Au98) or proton therapy (three patients). The median (range) age at salvage HIFU was 65 (52-80) years, with a median (range) prostate-specific antigen (PSA) level before radiation therapy of 14.3 (5.7-118) ng/mL and a median (range) PSA level of 4.0 (1.2-30.1) ng/mL before HIFU. The median (range) period to HIFU after radiation therapy was 36 (4-96) months. The biochemical disease-free survival (bDFS) rate in all patients at 5 years was 52%. Rates of bDFS in low-, intermediate- and high-risk groups were 100%, 86%, and 14%, respectively. One of the twelve patients who received post-HIFU prostate biopsy showed malignancy. Side effects included urethral stricture in four patients, grade I urinary incontinence in four patients, rectourethral fistula and epididymitis in one of each patient.CONCLUSIONSalvage HIFU is a promising treatment option for local recurrence after radiation therapy, with morbidity comparable with other forms of salvage treatment.