Department of Urology and Transplantation Surgery, Edouard Herriot Hospital, Lyon, France.
Department of Urology, Université de Lyon, Lyon, France.
BJU Int. 2019 Nov;124(5):746-757. doi: 10.1111/bju.14838. Epub 2019 Jul 2.
To evaluate the oncological and functional outcomes of salvage high-intensity focused ultrasound (S-HIFU) for locally recurrent prostate cancer after low-dose-rate (LDR) brachytherapy.
Clinical phase II studies (2003-2015) included 50 consecutive patients with post-brachytherapy local recurrence treated by S-HIFU. S-HIFU was performed with post-external beam radiotherapy (EBRT) parameters and, since 2008, with specific post-brachytherapy parameters. Treatments were whole-gland ablation and, since 2009, hemi-ablation in cases of unilateral prostate cancer. The primary objective was to assess oncological outcomes: treatment failure-free survival, progression-free survival (PFS), overall survival (OS), cancer-specific survival (CSS), and metastasis-free survival (MFS) rates. The secondary objective was to evaluate adverse events, continence, and erectile function. Kaplan-Meier analysis estimated oncological outcomes.
In all, 13 patients were treated with post-EBRT parameters, 37 with post-brachytherapy parameters, 35 with whole-gland treatment, and 15 with hemi-ablation. The median follow-up was 4.6 years. After S-HIFU, the median prostate-specific antigen level was 0.3 ng/mL. At 6 years, treatment failure-free survival, PFS, OS, CSS, and MFS rates were 41%, 45%, 93%, 98%, and 80%, respectively. Post-brachytherapy compared with post-EBRT parameters reduced Grade 2-3 incontinence (34% vs 62%, P = 0.015). Incontinence, bladder outlet obstruction and Grade ≥III complications were significantly reduced with hemi-ablation compared with whole-gland treatment (14% vs 54%, P < 0.001; 13% vs 46%, P = 0.03; 13% vs 63%, P = 0.001; respectively). Before S-HIFU, 25 patients had a five-item version of the International Index of Erectile Function score of ≥17, which was maintained in 48% at 12 months.
S-HIFU for locally recurrent prostate cancer after LDR brachytherapy is associated with favourable survival rates at a price of significant morbidity. Dedicated post-brachytherapy parameters and hemi-ablation improve the safety of the treatment.
评估低剂量率（LDR）近距离放射治疗后高强度聚焦超声（HIFU）治疗局部复发性前列腺癌的肿瘤学和功能结果。
临床 II 期研究（2003-2015 年）纳入了 50 例接受 LDR 近距离放射治疗后局部复发的患者，采用 S-HIFU 治疗。S-HIFU 采用外照射放射治疗（EBRT）后参数，自 2008 年以来，采用特定的近距离放射治疗后参数。治疗为全腺体消融，自 2009 年以来，在单侧前列腺癌的情况下采用半腺体消融。主要目的是评估肿瘤学结果：治疗失败无进展生存率、无进展生存率（PFS）、总生存率（OS）、癌症特异性生存率（CSS）和无转移生存率（MFS）。次要目的是评估不良反应、尿控和勃起功能。Kaplan-Meier 分析估计了肿瘤学结果。
共有 13 例患者采用 EBRT 后参数治疗，37 例采用近距离放射治疗后参数治疗，35 例采用全腺体治疗，15 例采用半腺体消融。中位随访时间为 4.6 年。S-HIFU 后，前列腺特异性抗原中位水平为 0.3ng/mL。6 年后，治疗失败无进展生存率、PFS、OS、CSS 和 MFS 分别为 41%、45%、93%、98%和 80%。与 EBRT 后参数相比，近距离放射治疗后参数降低了 2-3 级尿失禁（34% vs 62%，P=0.015）。与全腺体治疗相比，半腺体消融显著降低了 2-3 级尿控（14% vs 54%，P<0.001）、膀胱出口梗阻（13% vs 46%，P=0.03）和≥III 级并发症（13% vs 63%，P=0.001）。S-HIFU 前，25 例患者的国际勃起功能指数（International Index of Erectile Function）五分量表评分为≥17，12 个月时保持在 48%。
LDR 近距离放射治疗后局部复发性前列腺癌的 S-HIFU 治疗具有良好的生存率，但发病率较高。专门的近距离放射治疗后参数和半腺体消融提高了治疗的安全性。
