Kvorning Ternov Klara, Krag Jakobsen Ane, Bratt Ola, Ahlgren Göran
Medical School, Faculty of Health and Medical Science, University of Copenhagen , Denmark.
Scand J Urol. 2015 Apr;49(2):115-9. doi: 10.3109/21681805.2014.968869. Epub 2014 Nov 27.
The aim of this study was to present the outcome of patients treated with salvage cryotherapy after radiotherapy for prostate cancer at one institution.
Consecutive patients treated between 2007 and 2013 with transperineal cryotherapy for biopsy-verified local recurrence after radiotherapy were investigated. An external reviewer retrieved outcome data retrospectively from medical records. Complications were graded according to the Clavien classification. One patient with less than 1 year of follow-up was excluded from the analysis of side-effects.
Thirty patients were included, 29 of whom had a follow-up of at least 1 year. The median follow-up was 2.7 years (range 1-6.5 years). Eleven of the 23 patients without hormonal treatment at the time of cryotherapy reached a prostate-specific antigen (PSA) nadir of less than 0.5 ng/ml. At the end of follow-up five of these 23 patients still had a PSA below 0.5 ng/ml and 10 were free from recurrence according to the Phoenix definition. Clinical recurrence (verified with imaging or biopsies) was detected in 13 patients, six of which were local. One patient died from prostate cancer. Eleven patients had urinary incontinence grade 1-2 and three had grade 3-4, seven had pelvic pain, three had severe but transitory tissue sloughing, three developed a urethral stricture or had prolonged urinary retention, and one developed a urinary fistula 4.5 years after cryotherapy.
Salvage cryotherapy should be considered as an alternative to hormonal treatment and surgery for local recurrence after radiotherapy for prostate cancer. The results compare well to those reported from centres with longer experience.
本研究旨在介绍在一家机构接受前列腺癌放疗后挽救性冷冻治疗的患者的治疗结果。
对2007年至2013年间因活检证实放疗后局部复发而接受经会阴冷冻治疗的连续患者进行调查。一名外部审查员从医疗记录中回顾性检索结果数据。并发症根据Clavien分类进行分级。一名随访时间少于1年的患者被排除在副作用分析之外。
纳入30例患者，其中29例随访至少1年。中位随访时间为2.7年（范围1 - 6.5年）。在冷冻治疗时未接受激素治疗的23例患者中，11例前列腺特异性抗原（PSA）最低点低于0.5 ng/ml。随访结束时，这23例患者中有5例PSA仍低于0.5 ng/ml，根据Phoenix定义，10例无复发。13例患者检测到临床复发（经影像学或活检证实），其中6例为局部复发。1例患者死于前列腺癌。11例患者有1 - 2级尿失禁，3例有3 - 4级尿失禁，7例有盆腔疼痛，3例有严重但短暂的组织脱落，3例发生尿道狭窄或尿潴留延长，1例在冷冻治疗4.5年后发生尿瘘。
挽救性冷冻治疗应被视为前列腺癌放疗后局部复发的激素治疗和手术的替代方案。结果与经验更丰富的中心报告的结果相当。
