Postema A W, De Reijke T M, Ukimura O, Van den Bos W, Azzouzi A R, Barret E, Baumunk D, Blana A, Bossi A, Brausi M, Coleman J A, Crouzet S, Dominguez-Escrig J, Eggener S, Ganzer R, Ghai S, Gill I S, Gupta R T, Henkel T O, Hohenfellner M, Jones J S, Kahmann F, Kastner C, Köhrmann K U, Kovacs G, Miano R, van Moorselaar R J, Mottet N, Osorio L, Pieters B R, Polascik T J, Rastinehad A R, Salomon G, Sanchez-Salas R, Schostak M, Sentker L, Tay K J, Varkarakis I M, Villers A, Walz J, De la Rosette J J
Departments of Urology, AMC University Hospital, Amsterdam, The Netherlands.
USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
World J Urol. 2016 Oct;34(10):1373-82. doi: 10.1007/s00345-016-1782-x. Epub 2016 Feb 18.
To reach standardized terminology in focal therapy (FT) for prostate cancer (PCa).
A four-stage modified Delphi consensus project was undertaken among a panel of international experts in the field of FT for PCa. Data on terminology in FT was collected from the panel by three rounds of online questionnaires. During a face-to-face meeting on June 21, 2015, attended by 38 experts, all data from the online rounds were reviewed and recommendations for definitions were formulated.
Consensus was attained on 23 of 27 topics; Targeted FT was defined as a lesion-based treatment strategy, treating all identified significant cancer foci; FT was generically defined as an anatomy-based (zonal) treatment strategy. Treatment failure due to the ablative energy inadequately destroying treated tissue is defined as ablation failure. In targeting failure the energy is not adequately applied to the tumor spatially and selection failure occurs when a patient was wrongfully selected for FT. No definition of biochemical recurrence can be recommended based on the current data. Important definitions for outcome measures are potency (minimum IIEF-5 score of 21), incontinence (new need for pads or leakage) and deterioration in urinary function (increase in IPSS >5 points). No agreement on the best quality of life tool was established, but UCLA-EPIC and EORTC-QLQ-30 were most commonly supported by the experts. A complete overview of statements is presented in the text.
Focal therapy is an emerging field of PCa therapeutics. Standardization of definitions helps to create comparable research results and facilitate clear communication in clinical practice.
达成前列腺癌（PCa）聚焦治疗（FT）的标准化术语。
在PCa聚焦治疗领域的国际专家小组中开展了一个四阶段的改良德尔菲共识项目。通过三轮在线问卷从专家小组收集聚焦治疗术语的数据。在2015年6月21日由38位专家参加的面对面会议上，对在线轮次的所有数据进行了审查，并制定了定义建议。
27个主题中的23个达成了共识；靶向聚焦治疗被定义为一种基于病灶的治疗策略，治疗所有已识别的显著癌灶；聚焦治疗一般被定义为一种基于解剖结构（分区）的治疗策略。由于消融能量未充分破坏治疗组织而导致的治疗失败被定义为消融失败。在靶向失败中，能量在空间上未充分施加于肿瘤，而当患者被错误地选择进行聚焦治疗时则发生选择失败。基于当前数据，无法推荐生化复发的定义。结局指标的重要定义包括性功能（国际勃起功能指数-5最小评分21分）、尿失禁（新出现使用尿垫或漏尿情况）和尿功能恶化（国际前列腺症状评分增加>5分）。对于最佳生活质量工具未达成一致意见，但加州大学洛杉矶分校前列腺癌指数综合问卷（UCLA-EPIC）和欧洲癌症研究与治疗组织核心生活质量问卷（EORTC-QLQ-30）最常得到专家支持。文中给出了声明的完整概述。
聚焦治疗是PCa治疗学的一个新兴领域。定义的标准化有助于产生可比的研究结果，并促进临床实践中的清晰沟通。
