挽救性高强度聚焦超声治疗低剂量率近距离治疗后局部复发性前列腺癌：肿瘤学和功能学结果。

Salvage high-intensity focused ultrasound for locally recurrent prostate cancer after low-dose-rate brachytherapy: oncological and functional outcomes.

机构信息

Department of Urology and Transplantation Surgery, Edouard Herriot Hospital, Lyon, France.

Department of Urology, Université de Lyon, Lyon, France.

出版信息

BJU Int. 2019 Nov;124(5):746-757. doi: 10.1111/bju.14838. Epub 2019 Jul 2.

DOI:10.1111/bju.14838

PMID:31148367

Abstract

OBJECTIVES

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.

PATIENTS AND METHODS

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.

RESULTS

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.

CONCLUSION

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.

摘要

目的

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。

患者和方法

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。

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%。