Munoz Fernando, Guarneri Alessia, Botticella Angela, Gabriele Pietro, Moretto Francesco, Panaia Rocco, Ruggieri Andrea, D'Urso Leonardo, Muto Giovanni, Filippi Andrea Riccardo, Ragona Riccardo, Ricardi Umberto
University of Torino, Department of Oncology, Radiation Oncology Unit, Turin, Italy.
Urol Int. 2013;90(3):288-93. doi: 10.1159/000345631. Epub 2013 Jan 30.
The main objective was to evaluate feasibility, toxicity and biochemical control rates of salvage external beam radiotherapy (EBRT) in recurrent localized prostate cancer after high-intensity focused ultrasound (HIFU) as primary therapy.
A total of 24 patients who underwent salvage EBRT after 1 or 2 HIFU sessions and with a minimum post-treatment follow-up of 24 months were retrospectively evaluated. Primary endpoints were toxicity and biochemical disease-free survival (bDFS, defined according to the ASTRO Phoenix definition).
Median follow-up was 40.3 months. Gastrointestinal toxicity was low. Acute genitourinary (GU) toxicity grade ≤II rate was 45.8%, with only few patients presenting grade III (8.3%) and grade IV (4.2%) toxicity. Late grade ≥III GU toxicity was registered in 16.7% of patients. The 3-year bDFS rate was 77.8%. Patients achieving a nadir prostate-specific antigen (nPSA) of ≤0.35 ng/ml after EBRT had significantly higher bDFS (3-year bDFS: 87.7 vs. 50%, respectively; p = 0.001). Achieving nPSA ≤0.35 ng/ml was the only factor independently associated to long-term bDFS both on univariate (p = 0.01) and multivariate analysis (HR 7.06, p = 0.039).
Salvage EBRT after HIFU failure is feasible and allows to obtain satisfactory biochemical control rates, especially in patients attaining a nPSA ≤0.35 ng/ml after EBRT.
主要目的是评估挽救性体外放射治疗（EBRT）用于高强度聚焦超声（HIFU）作为主要治疗手段后的复发性局限性前列腺癌的可行性、毒性和生化控制率。
对24例在接受1或2次HIFU治疗后接受挽救性EBRT且治疗后随访至少24个月的患者进行回顾性评估。主要终点为毒性和生化无病生存期（bDFS，根据ASTRO Phoenix定义）。
中位随访时间为40.3个月。胃肠道毒性较低。急性泌尿生殖系统（GU）毒性≤II级的发生率为45.8%，仅有少数患者出现III级（8.3%）和IV级（4.2%）毒性。16.7%的患者出现晚期≥III级GU毒性。3年bDFS率为77.8%。EBRT后前列腺特异性抗原最低点（nPSA）≤0.35 ng/ml的患者bDFS显著更高（3年bDFS分别为87.7%和50%；p = 0.001）。达到nPSA≤0.35 ng/ml是单因素（p = 0.01）和多因素分析（HR 7.06，p = 0.039）中与长期bDFS独立相关的唯一因素。
HIFU治疗失败后挽救性EBRT是可行的，并能获得满意的生化控制率，尤其是在EBRT后nPSA≤0.35 ng/ml的患者中。
