Department of Urology, Mayo Clinic, Rochester, MN, USA.
Department of Radiology, Mayo Clinic, Rochester, MN, USA.
Abdom Radiol (NY). 2020 Apr;45(4):1155-1161. doi: 10.1007/s00261-019-02147-4.
To describe safety, efficacy, and added oncologic margin of saline displacement of the rectal wall during MRI-guided cryoablation of primary and recurrent prostate cancer.
A retrospective review was conducted for patients who underwent MRI-guided cryoablation with saline displacement of the rectal wall for treatment of primary and recurrent prostate cancer over a 2-year period. Saline displacement was used when the distance from the edge of the ablation area to the rectal wall was insufficient to provide at least a 5-mm treatment margin. Pre- and post-ablation rectal wall displacement distances as well as ablative zone margins were assessed with MRI. Saline displacement distance was measured from the rectal wall to the edge of the lesion for focal lesion ablation and from the edge of the prostate for hemi-gland ablation. Immediate and intermediate-term complications were assessed.
Saline displacement was used in 25 patients undergoing MRI-guided cryoablation. Twenty-one patients underwent salvage cryoablation, while four patients had it as primary treatment for prostate cancer. Median pre- and post- saline displacement rectal wall displacement distances were 6.0 and 11.2 mm, respectively (P < 0.0001). Median-added oncologic margin achieved by saline displacement was 4.6 mm (range 0.6-26.5). Median follow-up was 14 months (range 5-29). There were no intra-procedural complications and 3 patients experienced minor (Clavien-Dindo grade I) complications. One rectal complication occurred in a patient undergoing salvage cryotherapy with a history of extensive pelvic surgery and radiation.
Saline infusion at the time of MRI- guided cryoablation for prostate cancer resulted in increased distances between the target lesion and rectum. This is a useful technique in providing an added oncologic margin when treating lesions close to the rectal wall.
描述 MRI 引导下冷冻消融治疗原发性和复发性前列腺癌时，直肠壁盐水置换的安全性、疗效和附加肿瘤边缘。
对 2 年内接受 MRI 引导下冷冻消融治疗原发性和复发性前列腺癌且直肠壁进行盐水置换的患者进行回顾性分析。当消融区域边缘到直肠壁的距离不足以提供至少 5mm 的治疗边缘时，使用盐水置换。通过 MRI 评估消融前和消融后直肠壁移位距离以及消融区域边缘。对于局灶性病变消融，从直肠壁到病变边缘测量盐水置换距离；对于半腺体消融，从前列腺边缘测量盐水置换距离。评估即刻和中期并发症。
25 例患者在 MRI 引导下冷冻消融时使用了盐水置换。21 例患者接受了挽救性冷冻消融，4 例患者将其作为前列腺癌的初始治疗方法。中位盐水置换前和置换后直肠壁移位距离分别为 6.0 和 11.2mm（P<0.0001）。盐水置换获得的中位附加肿瘤边缘为 4.6mm（范围 0.6-26.5mm）。中位随访时间为 14 个月（范围 5-29 个月）。无术中并发症，3 例患者发生轻微并发症（Clavien-Dindo 分级 I 级）。1 例接受挽救性冷冻治疗且有广泛盆腔手术和放疗史的患者发生直肠并发症。
MRI 引导下冷冻消融治疗前列腺癌时，直肠内注入盐水可增加目标病变与直肠之间的距离。对于治疗靠近直肠壁的病变，这是一种提供附加肿瘤边缘的有用技术。
