Ripert Thomas, Bayoud Younes, Messaoudi Rabah, Ménard Johann, Azémar Marie-Dominique, Duval François, Nguyen Tan Dat, Staerman Frédéric
Department of Urology-Andrology, Reims Academic Hospital, Reims, France;
Can Urol Assoc J. 2012 Oct;6(5):E179-83. doi: 10.5489/cuaj.10137. Epub 2011 May 1.
The objective of this study is to evaluate the feasibility, tolerance and efficacy of salvage external beam radiotherapy (EBRT) in persistent or recurrent prostate cancer after failed high intensity focused ultrasound (HIFU) therapy.
We reviewed data on tolerance and oncologic outcomes for all patients with biopsy-proven locally recurrent or persistent prostate cancer who underwent salvage EBRT in our department between April 2004 and June 2008. Minimum follow-up for inclusion was 2 years. Failure with EBRT was defined as biochemical relapse (Phoenix definition) or introduction of androgen deprivation therapy (ADT). Gastrointestinal and urinary toxicity and urinary stress incontinence were scored at 12 and 24 months (Radiation Therapy Oncology Group and Ingelman Sundberg rating, respectively).
The mean age of the patients was 68.8 years (range: 60-79). Mean prostate-specific antigen (PSA) before EBRT was 5.57 ng/mL (range: 2.5-14.8). Median follow-up was 36.5 ± 10.9 months (range: 24-54). No patient received adjunctive ADT. The EBRT course was well-tolerated and completed by all patients. The mean PSA nadir was 0.62 ng/mL (range: 0.03-2.4) and occurred after a median of 22 months (range: 12-36). One patient experienced biochemical failure and was prescribed ADT 30 months after EBRT. The disease-free survival rate was 83.3% at 36.5 months. There was no major EBRT-related toxicity at 12 or 24 months.
Our early clinical results confirm the feasibility and good tolerance of salvage radiotherapy after HIFU failure. Oncological outcomes were promising. A prospective study with longer follow-up is needed to identify factors predictive of success for salvage EBRT therapy after HIFU failure.
本研究的目的是评估挽救性外照射放疗（EBRT）用于高强度聚焦超声（HIFU）治疗失败后的持续性或复发性前列腺癌的可行性、耐受性和疗效。
我们回顾了2004年4月至2008年6月间在我院接受挽救性EBRT的所有经活检证实为局部复发或持续性前列腺癌患者的耐受性和肿瘤学结局数据。纳入研究的患者的最短随访时间为2年。EBRT失败定义为生化复发（凤凰城定义）或开始雄激素剥夺治疗（ADT）。在12个月和24个月时分别对胃肠道和泌尿系统毒性以及尿失禁进行评分（分别采用放射治疗肿瘤学组和英格曼·桑德伯格分级）。
患者的平均年龄为68.8岁（范围：60 - 79岁）。EBRT前的平均前列腺特异性抗原（PSA）为5.57 ng/mL（范围：2.5 - 14.8）。中位随访时间为36.5 ± 10.9个月（范围：24 - 54个月）。没有患者接受辅助ADT。所有患者均能很好地耐受EBRT疗程并完成治疗。PSA最低点的平均值为0.62 ng/mL（范围：0.03 - 2.4），中位出现时间为22个月（范围：12 - 36个月）。1例患者出现生化失败，并在EBRT后30个月开始接受ADT治疗。36.5个月时的无病生存率为83.3%。在12个月或24个月时未出现与EBRT相关的严重毒性反应。
我们的早期临床结果证实了HIFU治疗失败后挽救性放疗的可行性和良好耐受性。肿瘤学结局令人满意。需要进行一项随访时间更长的前瞻性研究，以确定预测HIFU治疗失败后挽救性EBRT治疗成功的因素。
