Salvage high-intensity focused ultrasound ablation for prostate cancer local recurrence after external-beam radiation therapy: Prognostic value of prostate MRI
Salvage high-intensity focused ultrasound ablation for prostate cancer local recurrence after external-beam radiation therapy: Prognostic value of prostate MRI
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DOI：
10.1016/j.crad.2012.12.010
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发表时间：
2013-07-01
影响因子：
2.6
通讯作者：
Chapelon, J. -Y.
中科院分区：
文献类型：
--
作者：
Rouviere, O.;Sbihi, L.;Chapelon, J. -Y.
目的：探讨高强度聚焦超声(HIFU)挽救外照射(EBRT)后局部复发前列腺癌的预后价值。材料与方法：对46例经HIFU挽救治疗后局部复发的前列腺癌患者进行回顾性研究。HIFU失败定义为前列腺特异性抗原(PSA)值+2 ng/ml(菲尼克斯标准)或随访活检阳性或开始任何其他挽救治疗。评估了以下预后参数：新辅助激素治疗、临床分期和复发的Gleason评分、高强度聚焦超声治疗时的PSA水平和速度，以及6个磁共振成像参数(前列腺体积、肿瘤体积、包膜外扩展、精囊侵犯、肿瘤扩展到尖端或尿路前)。结果：两个因素是挽救高强度聚焦超声失败的显著独立预测因素：高强度聚焦超声治疗时的PSA水平(p<；0.012；肿瘤向尿路前方扩散的危险性比为1.15，95%可信区间为1.03~1.29(p=0.046，95%可信区间为2.51，95%可信区间为1.02~6.16)。结论：肿瘤复发部位在尿路前方是局部复发前列腺癌放疗失败的独立预测因素。因此，在EBRT后补救HIFU消融前，MRI可能有助于患者的选择。(C)2013年皇家放射科医生学会。爱思唯尔有限公司出版。保留所有权利。
AIM: To assess the prognostic value of magnetic resonance imaging (MRI) before salvage high-intensity focused ultrasound (HIFU) for locally recurrent prostate cancer after external-beam radiotherapy (EBRT).MATERIALS AND METHODS: Forty-six patients who underwent prostate MRI before salvage HIFU for locally recurrent prostate cancer after EBRT were retrospectively studied. HIFU failure was defined as a prostate-specific antigen (PSA) value >nadir + 2 ng/ml (Phoenix criteria) or positive follow-up biopsy or initiation of any other salvage therapy. The following prognostic parameters were assessed: neoadjuvant hormone therapy, clinical stage and Gleason score of recurrence, PSA level and velocity at HIFU treatment, and six MRI-derived parameters (prostate volume, tumour volume, extracapsular extension, seminal vesicle invasion, tumour extension into the apex or anterior to the urethra).RESULTS: Two factors were significant independent predictors of salvage HIFU failure: the PSA level at HIFU treatment (p < 0.012; risk ratio: 1.15, 95% CI: 1.03-1.29) and the tumour extension anterior to the urethra, as assessed by MRI (p = 0.046, risk ratio: 2.51, 95% CI: 1.02-6.16).CONCLUSION: The location of cancer recurrence anterior to the urethra on MRI is an independent significant predictor of salvage HIFU failure for locally recurrent prostate cancer after EBRT. Therefore, MRI may be useful for patient selection before post-EBRT salvage HIFU ablation. (c) 2013 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.