Crouzet Sebastien, Blana Andreas, Murat Francois J, Pasticier Gilles, Brown Stephen C W, Conti Giario N, Ganzer Roman, Chapet Olivier, Gelet Albert, Chaussy Christian G, Robertson Cary N, Thuroff Stefan, Ward John F
Department of Urology, Edouard Herriot Hospital, Lyon, France.
Department of Urology, Fuerth Hospital, Fürth, Germany.
BJU Int. 2017 Jun;119(6):896-904. doi: 10.1111/bju.13766. Epub 2017 Mar 10.
To report the oncological outcome of salvage high-intensity focused ultrasound (S-HIFU) for locally recurrent prostate cancer after external beam radiotherapy (EBRT) from a multicentre database.
This retrospective study comprises patients from nine centres with local recurrent disease after EBRT treated with S-HIFU from 1995 to 2009. The biochemical failure-free survival (bFFS) rate was based on the 'Phoenix' definition (PSA nadir + 2 ng/mL). Secondary endpoints included progression to metastasis and cancer-specific death. Kaplan-Meier analysis was performed examining overall (OS), cancer-specific (CSS) and metastasis-free survival (MFS). Adverse events and quality of life status are reported.
In all, 418 patients with a mean (SD) follow-up of 3.5 (2.5) years were included. The mean (SD) age was 68.6 (5.8) years and the PSA level before S-HIFU was 6.8 (7.8) ng/mL. The median PSA nadir after S-HIFU was 0.19 ng/mL. The OS, CSS and MFS rates at 7 years were 72%, 82% and 81%, respectively. At 5 years the bFFS rate was 58%, 51% and 36% for pre-EBRT low-, intermediate- and high-risk patients, respectively. The 5-year bFFS rate was 67%, 42% and 22% for pre-S-HIFU PSA level ≤4, 4-10 and ≥10 ng/mL, respectively. Complication rates decreased after the introduction of specific post-RT parameters: incontinence (grade II or III) from 32% to 19% (P = 0.002); bladder outlet obstruction or stenosis from 30% to 15% (P = 0.003); recto-urethral fistula decreased from 9% to 0.6% (P < 0.001). Study limitations include being a retrospective analysis from a registry with no control group.
S-HIFU for locally recurrent prostate cancer after failed EBRT is associated with 7-year CSS and MFS rates of >80% at a price of significant morbidity. S-HIFU should be initiated early following EBRT failure.
通过一个多中心数据库报告挽救性高强度聚焦超声（S-HIFU）治疗外照射放疗（EBRT）后局部复发前列腺癌的肿瘤学结局。
这项回顾性研究纳入了1995年至2009年期间在9个中心接受S-HIFU治疗的EBRT后局部复发疾病患者。生化无进展生存率（bFFS）基于“凤凰城”定义（PSA最低点+2 ng/mL）。次要终点包括进展至转移和癌症特异性死亡。进行了Kaplan-Meier分析以检验总生存期（OS）、癌症特异性生存期（CSS）和无转移生存期（MFS）。报告了不良事件和生活质量状况。
共纳入418例患者，平均（标准差）随访3.5（2.5）年。平均（标准差）年龄为68.6（5.8）岁，S-HIFU治疗前的PSA水平为6.8（7.8）ng/mL。S-HIFU治疗后的PSA最低点中位数为0.19 ng/mL。7年时的OS、CSS和MFS率分别为72%、82%和81%。5年时，EBRT治疗前低、中、高危患者的bFFS率分别为58%、51%和36%。S-HIFU治疗前PSA水平≤4、4-10和≥10 ng/mL的患者5年bFFS率分别为67%、42%和22%。引入特定的放疗后参数后并发症发生率降低：尿失禁（II级或III级）从32%降至19%（P = 0.002）；膀胱出口梗阻或狭窄从30%降至15%（P = 0.003）；直肠尿道瘘从9%降至0.6%（P < 0.001）。研究局限性包括为来自登记处的回顾性分析且无对照组。
EBRT失败后局部复发前列腺癌的S-HIFU治疗与7年CSS和MFS率>80%相关，但代价是有显著的发病率。EBRT失败后应尽早开始S-HIFU治疗。
