前列腺肿胀和高强度聚焦超声治疗中的移位：对靶向焦点治疗的影响。

Prostate swelling and shift during high intensity focused ultrasound: implication for targeted focal therapy.

机构信息

University of Southern California Institute of Urology, Hillard and Roclyn Herzog Center for Prostate Cancer Focal Therapy, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Urology, Tokai University Hachioji Hospital, Hachioji, Japan.

出版信息

J Urol. 2013 Oct;190(4):1224-32. doi: 10.1016/j.juro.2013.03.116. Epub 2013 Apr 9.

DOI:10.1016/j.juro.2013.03.116

PMID:23583532

Abstract

PURPOSE

We quantified prostate swelling and the intraprostatic point shift during high intensity focused ultrasound using real-time ultrasound.

MATERIALS AND METHODS

The institutional review board approved this retrospective study. Whole gland high intensity focused ultrasound was done in 44 patients with clinically localized prostate cancer. Three high intensity focused ultrasound sessions were required to cover the entire prostate, including the anterior zone (session 1), middle zone (session 2) and posterior zone (session 3). Computer assisted 3-dimensional reconstructions based on 3 mm step-section images of intraoperative transrectal ultrasound were compared before and after each session.

RESULTS

Most prostate swelling and intraprostatic point shifts occurred during session 1. The median percent volume increase was 18% for the transition zone, 9% for the peripheral zone and 13% for the entire prostate. The volume percent increase in the transition zone (p <0.001), peripheral zone (p = 0.001) and entire prostate (p = 0.001) statistically depended on the volume of each area measured preoperatively. The median 3-dimensional intraprostatic shift was 3.7 mm (range 0.9 to 13) in the transition zone and 5.5 mm (range 0.2 to 14) in the peripheral zone. A significant negative linear correlation was found between the preoperative presumed circle area ratio, and the percent increase in prostate volume (p = 0.001) and shift (p = 0.01) during high intensity focused ultrasound.

CONCLUSIONS

We quantified significant prostate swelling and shift during high intensity focused ultrasound. Smaller prostates and a smaller preoperative presumed circle area ratio were associated with greater prostate swelling and intraprostatic shifts. Real-time intraoperative adjustment of the treatment plan impacts the achievement of precise targeting during high intensity focused ultrasound, especially in prostates with a smaller volume and/or a smaller preoperative presumed circle area ratio.

摘要

目的

我们使用实时超声量化高强度聚焦超声治疗过程中前列腺肿胀和前列腺内点位移。

材料与方法

本研究经机构审查委员会批准。对 44 例临床局限性前列腺癌患者进行全腺体高强度聚焦超声治疗。为了覆盖整个前列腺，包括前区（第 1 个疗程）、中区（第 2 个疗程）和后区（第 3 个疗程），需要进行 3 个高强度聚焦超声疗程。基于术中经直肠超声的 3mm 层厚图像，使用计算机辅助三维重建，对每个疗程前后的图像进行比较。

结果

大多数前列腺肿胀和前列腺内点位移发生在第 1 个疗程期间。移行区的体积百分比增加中位数为 18%，外周区为 9%，整个前列腺为 13%。移行区（p<0.001）、外周区（p=0.001）和整个前列腺（p=0.001）的体积百分比增加与术前每个区域的体积均呈统计学相关。移行区的中位三维前列腺内位移为 3.7mm（范围 0.9 至 13），外周区为 5.5mm（范围 0.2 至 14）。术前假定的圆形区域比率与高强度聚焦超声治疗过程中前列腺体积的增加百分比（p=0.001）和位移（p=0.01）之间存在显著的负线性相关。