Evolution and outcomes of 3 MHz high intensity focused ultrasound therapy for localized prostate cancer during 15 years.
Evolution and outcomes of 3 MHz high intensity focused ultrasound therapy for localized prostate cancer during 15 years.
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15 年来 3 MHz 高强度聚焦超声治疗局限性前列腺癌的进展和结果。
DOI：
10.1016/j.juro.2013.02.010
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
C. Chaussy
中科院分区：
文献类型：
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作者：
S. Thüroff;C. Chaussy
我们描述了高强度聚焦超声与新辅助经尿道前列腺切除术的长期癌症控制和发病率，经尿道前列腺切除术诱导转移的风险，以及高强度聚焦超声应用和技术随时间的演变。（T1-2，N 0，M0，首次诊断时PSA小于50 ng/ml）和随访时间超过15个月。既往接受过长期雄激素剥夺治疗、局部晚期前列腺癌或任何影响前列腺特异性抗原的治疗的患者从研究中排除。所有患者均使用Ablatherm®高强度聚焦超声设备进行完全治疗。根据队列组、风险组（D 'Amico标准）、前列腺特异性抗原最低值和Gleason评分进行总体和分层评价。凤凰的定义是用于生化失败。统计分析采用Kaplan-Meier法，单变量和多变量分析采用考克斯model.ResultsOf 704研究患者78.5%有中度或高度危险的疾病。平均随访时间为5.3年（范围1.3 - 14年）。癌症特异性生存率为99%，无转移生存率为95%，10年无挽救治疗率在低风险患者中为98%，在中等风险患者中为72%，在高风险患者中为68%。前列腺特异性抗原最低值和Gleason评分预测生化失败，副作用为中度。自2005年以来，高强度聚焦超声治疗的再治疗率为15%。结论长期随访高强度聚焦超声治疗显示了高的癌症特异性生存率和低风险患者免于挽救治疗要求的异常高的比率。高强度聚焦超声技术和临床实践的进步以及新辅助经尿道前列腺切除术的使用允许在不诱导转移的情况下完全治疗任何大小的前列腺。
PurposeWe describe the long-term cancer control and morbidity of high intensity focused ultrasound with neoadjuvant transurethral resection of the prostate, the risk of metastatic induction by transurethral prostate resection, and the evolution of high intensity focused ultrasound application and technology with time.Materials and MethodsA prospective Harlaching high intensity focused ultrasound database was searched for patients with primary localized prostate cancer (T1–2, N0, M0, PSA at first diagnosis less than 50 ng/ml) and followup longer than 15 months. Those patients with previous long-term androgen deprivation therapy, locally advanced prostate cancer or any therapy influencing prostate specific antigen were excluded from study. All patients were treated completely with an Ablatherm® high intensity focused ultrasound device. Evaluation was performed in aggregate, and by stratification according to cohort group, risk group (D'Amico criteria), prostate specific antigen nadir and Gleason score. The Phoenix definition was used for biochemical failure. Statistical analysis was performed using the Kaplan-Meier method, and univariate and multivariate analysis was performed using a Cox model.ResultsOf 704 study patients 78.5% had intermediate or high risk disease. Mean followup was 5.3 years (range 1.3 to 14). Cancer specific survival was 99%, metastasis-free survival was 95%, and 10-year salvage treatment-free rates were 98% in low risk, 72% in intermediate risk and 68% in high risk patients. Prostate specific antigen nadir and Gleason score predicted biochemical failure, and side effects were moderate. The high intensity focused ultrasound re-treatment rate has been 15% since 2005.ConclusionsLong-term followup with high intensity focused ultrasound therapy demonstrated a high overall rate of cancer specific survival and an exceptionally high rate of freedom from salvage therapy requirements in low risk patients. Advances in high intensity focused ultrasound technology and clinical practice as well as the use of neoadjuvant transurethral prostate resection allow the complete treatment of any size prostate without inducing metastasis.
DOI：
10.1093/jnci/djn255
发表时间：
2008-08-20
期刊：
JOURNAL OF THE NATIONAL CANCER INSTITUTE
影响因子：
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作者：
Bill-Axelson, Anna;Holmberg, Lars;Johansson, Jan-Erik
通讯作者：
Johansson, Jan-Erik