Rectal fistulae after salvage high-intensity focused ultrasound for recurrent prostate cancer after combined brachytherapy and external beam radiotherapy
Rectal fistulae after salvage high-intensity focused ultrasound for recurrent prostate cancer after combined brachytherapy and external beam radiotherapy
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DOI：
10.1111/j.1464-410x.2008.08026.x
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发表时间：
2009-02-01
影响因子：
4.5
通讯作者：
Emberton, Mark
中科院分区：
文献类型：
--
作者：
Ahmed, Hashim U.;Ishaq, Ayesha;Emberton, Mark
报告前列腺癌联合近距离放射治疗和外照射放射治疗（EBRT）失败后与补救性高强度聚焦超声（HIFU）相关的高直肠瘘发生率;当RT后局部复发时，我们回顾性地分析了2005年3月1日至2007年5月31日期间接受HIFU治疗的所有前列腺癌患者，并确定了5名在近距离放疗和EBRT失败后接受治疗的局限性前列腺癌患者，其中3名患者接受了碘粒子植入近距离放疗联合EBRT作为主要治疗，1名患者接受了高剂量率近距离放疗联合EBRT，1名患者接受了挽救性碘粒子近距离放疗治疗EBRT失败。5例患者中有3例在HIFU治疗后发生直肠-尿道瘘，这组患者直肠-尿道瘘的高发生率可能反映了血供受损或HIFU相关的直肠壁近场加热。无论采用何种挽救方法，组织活力和愈合均可能影响该组。仔细选择患者并避免直肠诊断性活检可能会将风险降至最低。新兴的消融疗法被认为比传统疗法侵入性更小，必须谨慎使用。
To report on the high rectal fistula rate associated with salvage high-intensity focused ultrasound (HIFU) after the failure of combined brachytherapy and external beam radiotherapy (EBRT) for prostate cancer; salvage ablative therapy for prostate cancer is indicated when there is local recurrence after RT, brachytherapy or their combination.We retrospectively reviewed all men with prostate cancer treated with HIFU between 1 March 2005 and 31 May 2007, and identified five men treated after the failure of both brachytherapy and EBRT for localized prostate cancer.Three of the five men had iodine-seed implantation brachytherapy combined with EBRT as primary treatment, one had high-dose rate brachytherapy combined with EBRT and one had salvage iodine-seed brachytherapy for failed EBRT. Three of the five patients developed a recto-urethral fistula after HIFU.The high rate of recto-urethral fistula formation in this group might reflect an impaired blood supply or HIFU-associated near-field heating of the rectal wall. Tissue viability and healing might affect this group regardless of the salvage method. Careful patient selection and avoidance of rectal diagnostic biopsies might minimize the risk. Emerging ablative therapies regarded as less invasive than traditional therapies must be used with caution.