Lindner U, Weersink R A, Haider M A, Gertner M R, Davidson S R H, Atri M, Wilson B C, Fenster A, Trachtenberg J
Surgical Oncology, Urology Division, University Health Network, University of Toronto, Toronto, Ontario, Canada.
J Urol. 2009 Oct;182(4):1371-7. doi: 10.1016/j.juro.2009.06.035. Epub 2009 Aug 14.
We ascertained the feasibility and safety of image guided targeted photothermal focal therapy for localized prostate cancer.
Twelve patients with biopsy proven low risk prostate cancer underwent interstitial photothermal ablation of the cancer. The area of interest was confirmed and targeted using magnetic resonance imaging. Three-dimensional ultrasound was used to guide a laser to the magnetic resonance to ultrasound fused area of interest. Target ablation was monitored using thermal sensors and real-time Definity contrast enhanced ultrasound. Followup was performed with a combination of magnetic resonance imaging and prostate biopsy. Validated quality of life questionnaires were used to assess the effect on voiding symptoms and erectile function, and adverse events were solicited and recorded.
Interstitial photothermal focal therapy was technically feasible to perform. Of the patients 75% were discharged home free from catheter the same day with the remainder discharged home the following day. The treatment created an identifiable hypovascular defect which coincided with the targeted prostatic lesion. There were no perioperative complications and minimal morbidity. All patients who were potent before the procedure maintained potency after the procedure. Continence levels were not compromised. Based on multicore total prostate biopsy at 6 months 67% of patients were free of tumor in the targeted area and 50% were free of disease.
Image guided focal photothermal ablation of low risk and low volume prostate cancer is feasible. Early clinical, histological and magnetic resonance imaging responses suggest that the targeted region can be ablated with minimal adverse effects. It may represent an alternate treatment approach to observation or delayed standard therapy in carefully selected patients. Further trials are required to demonstrate the effectiveness of this treatment concept.
我们确定了影像引导下针对局限性前列腺癌的靶向光热聚焦治疗的可行性和安全性。
12例经活检证实为低风险前列腺癌的患者接受了癌灶的间质光热消融治疗。利用磁共振成像确认并靶向感兴趣区域。使用三维超声将激光引导至磁共振与超声融合的感兴趣区域。使用热传感器和实时Definity对比增强超声监测靶向消融。通过磁共振成像和前列腺活检相结合的方式进行随访。使用经过验证的生活质量问卷评估对排尿症状和勃起功能的影响，并收集和记录不良事件。
间质光热聚焦治疗在技术上可行。75%的患者在同一天无导尿管出院，其余患者在第二天出院。治疗产生了一个可识别的低血运缺损，与靶向前列腺病变相符。无围手术期并发症，发病率极低。所有术前有性功能的患者术后仍保持性功能。控尿水平未受影响。基于6个月时的多芯全前列腺活检，67%的患者靶向区域无肿瘤，50%的患者无疾病。
影像引导下对低风险、小体积前列腺癌进行聚焦光热消融是可行的。早期临床、组织学和磁共振成像反应表明，靶向区域可以在不良反应最小的情况下被消融。对于精心挑选的患者，它可能代表了一种替代观察或延迟标准治疗的方法。需要进一步的试验来证明这种治疗理念的有效性。
