Department of Urology, University of California-Los Angeles, Los Angeles, California; Department of Bioengineering, University of California-Los Angeles, Los Angeles, California; Center for Advanced Surgical and Interventional Technology, University of California-Los Angeles, Los Angeles, California.
Department of Urology, University of California-Los Angeles, Los Angeles, California.
J Urol. 2017 Oct;198(4):839-847. doi: 10.1016/j.juro.2017.04.017. Epub 2017 Apr 8.
Focal laser ablation is a potential treatment in some men with prostate cancer. Currently focal laser ablation is performed by radiologists in a magnetic resonance imaging unit (in bore). We evaluated the safety and feasibility of performing focal laser ablation in a urology clinic (out of bore) using magnetic resonance imaging-ultrasound fusion for guidance.
A total of 11 men with intermediate risk prostate cancer were enrolled in this prospective, institutional review board approved pilot study. Magnetic resonance imaging-ultrasound fusion was used to guide laser fibers transrectally into regions of interest harboring intermediate risk prostate cancer. Thermal probes were inserted for real-time monitoring of intraprostatic temperatures during laser activation. Multiparametric magnetic resonance imaging (3 Tesla) was done immediately after treatment and at 6 months along with comprehensive fusion biopsy.
Ten of 11 patients were successfully treated while under local anesthesia. Mean procedure time was 95 minutes (range 71 to 105). Posttreatment magnetic resonance imaging revealed a confined zone of nonperfusion in all 10 men. Mean zone volume was 4.3 cc (range 2.1 to 6.0). No CTCAE grade 3 or greater adverse events developed and no changes were observed in urinary or sexual function. At 6 months magnetic resonance imaging-ultrasound fusion biopsy of the treatment site showed no cancer in 3 patients, microfocal Gleason 3 + 3 in another 3 and persistent intermediate risk prostate cancer in 4.
Focal laser ablation of prostate cancer appears safe and feasible with the patient under local anesthesia in a urology clinic using magnetic resonance imaging-ultrasound fusion for guidance and thermal probes for monitoring. Further development is necessary to refine out of bore focal laser ablation and additional studies are needed to determine appropriate treatment margins and oncologic efficacy.
在某些前列腺癌患者中，局灶性激光消融是一种潜在的治疗方法。目前，局灶性激光消融由磁共振成像单元（在磁体孔内）中的放射科医生进行。我们评估了在泌尿科诊室（磁体孔外）使用磁共振成像-超声融合引导进行局灶性激光消融的安全性和可行性。
本前瞻性、机构审查委员会批准的试点研究共纳入 11 例中危前列腺癌患者。使用磁共振成像-超声融合引导将激光纤维经直肠插入包含中危前列腺癌的靶区。激光激活时插入热探针以实时监测前列腺内温度。治疗后即刻及 6 个月行 3 特斯拉多参数磁共振成像检查，并进行综合融合活检。
11 例患者中有 10 例在局部麻醉下成功治疗。平均手术时间为 95 分钟（71 至 105 分钟）。治疗后磁共振成像显示 10 例患者的所有靶区均存在无灌注区。平均靶区体积为 4.3cc（2.1 至 6.0cc）。无 CTCAE 3 级或更高级别的不良事件发生，且尿功能和性功能无变化。6 个月时，治疗部位的磁共振成像-超声融合活检显示 3 例患者无肿瘤，3 例患者为微灶性 Gleason 评分 3+3，4 例患者为持续中危前列腺癌。
在泌尿科诊室中，使用磁共振成像-超声融合引导和热探针进行监测，对前列腺癌患者进行局部麻醉下的局灶性激光消融术是安全且可行的。需要进一步开发来完善孔外局灶性激光消融术，需要进一步研究以确定适当的治疗边界和肿瘤学疗效。
