Ting F, Tran M, Böhm M, Siriwardana A, Van Leeuwen P J, Haynes A M, Delprado W, Shnier R, Stricker P D
St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia.
Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia.
Prostate Cancer Prostatic Dis. 2016 Mar;19(1):46-52. doi: 10.1038/pcan.2015.47. Epub 2015 Oct 13.
Current data on the use of irreversible electroporation (IRE) in the treatment of prostate cancer (PCa) is limited. We aim to evaluate the safety, short-term functional and oncological outcomes of focal IRE in low-intermediate risk PCa.
Between February 2013 and May 2014, 32 consecutive men underwent IRE at a single centre. Patients with low-intermediate risk PCa who had not received previous PCa treatment were included for analysis. The tumour was ablated using 3-6 electrodes, ensuring a minimum 5-mm safety margin around the visible magnetic resonance imaging (MRI) lesion. Follow-up included recording Clavien complications, Expanded Prostate Cancer Index Composite (EPIC) questionnaires (baseline, 1.5, 3, 6 months), 6-month multi-parametric MRI (mp-MRI) and 7-month biopsy. Findings on mp-MRI and biopsy were sub-divided into infield, adjacent or outfield of the treatment zone.
Twenty-five men were included for final analysis. Safety follow-up revealed one Clavien Grade 3 complication and five Grade 1 complications. Functional follow-up confirmed no significant change in American Urological Association urinary symptom score, sexual or bowel function. Infield, there were no suspicious findings on mp-MRI (n=24) or biopsy (n=21) in all patients. Adjacent to the treatment zone, five (21%) had suspicious findings on mp-MRI with four (19%) proving to be significant on biopsy. Outfield, there were two (8%) with suspicious findings on mp-MRI and one (5%) significant finding on biopsy. For the five patients with significant findings on follow-up biopsy, one is awaiting repeat IRE, one had radical prostatectomy and three remained on active surveillance.
In selected patients with low-intermediate risk PCa, focal IRE appears to be safe with minimal morbidity. There were no infield recurrences and 76% of patients were histologically free of significant cancer at 8 months. Almost all recurrences were adjacent to the treatment zone, and this was addressed by widening the treatment margins.
目前关于不可逆电穿孔（IRE）用于治疗前列腺癌（PCa）的数据有限。我们旨在评估局灶性IRE治疗低中危PCa的安全性、短期功能及肿瘤学结局。
2013年2月至2014年5月期间，32名男性在单一中心接受了IRE治疗。纳入未接受过PCa治疗的低中危PCa患者进行分析。使用3 - 6根电极对肿瘤进行消融，确保在可见磁共振成像（MRI）病变周围有至少5毫米的安全边缘。随访包括记录Clavien并发症、扩展前列腺癌指数综合问卷（EPIC）（基线、1.5、3、6个月）、6个月的多参数MRI（mp - MRI）及7个月的活检。mp - MRI和活检结果分为治疗区域内、相邻或外区域。
25名男性纳入最终分析。安全性随访显示1例Clavien 3级并发症和5例1级并发症。功能随访证实美国泌尿外科学会尿症状评分、性功能或肠道功能无显著变化。在治疗区域内，所有患者的mp - MRI（n = 24）或活检（n = 21）均未发现可疑结果。在治疗区域相邻处，5例（21%）mp - MRI有可疑结果，4例（19%）活检证实有显著病变。在治疗区域外，2例（8%）mp - MRI有可疑结果，1例（5%）活检有显著结果。对于5例随访活检有显著结果的患者，1例正在等待重复IRE，1例接受了根治性前列腺切除术，3例仍在进行积极监测。
在选定的低中危PCa患者中，局灶性IRE似乎安全，发病率极低。治疗区域内无复发，8个月时76%的患者组织学上无显著癌症。几乎所有复发均在治疗区域相邻处，可通过扩大治疗边缘来解决。
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