Pisters L L, von Eschenbach A C, Scott S M, Swanson D A, Dinney C P, Pettaway C A, Babaian R J
Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
J Urol. 1997 Mar;157(3):921-5.
A phase I/II study was done to evaluate the efficacy and complications of salvage cryotherapy as a treatment for locally recurrent prostate cancer following full dose radiation therapy and/or systemic therapy. The efficacy of single and double freeze-thaw cycles was compared using posttreatment prostate specific antigen (PSA) levels and prostate biopsies as end points.
A total of 150 patients with locally recurrent prostate cancer following radiation, hormonal therapy and/or systemic chemotherapy underwent salvage cryotherapy using a single (71 men, mean followup 17.3 months) or double (79 men, mean followup 10.0 months) freeze-thaw cycle. PSA was measured approximately every 3 months postoperatively and sextant biopsies were repeated 6 months postoperatively. Complications were assessed by retrospective chart review and a mailed quality of life survey.
Overall, 45 patients (31%) had persistently undetectable PSA. Patients with a history of radiation therapy only who underwent a double freeze-thaw cycle had a higher negative biopsy rate (93 versus 71%, p < 0.02) and lower biochemical failure rate (defined as an increase in serum PSA of 0.2 ng./ml. above the nadir value, 44 versus 65%, p < 0.03) than those who underwent a single freeze-thaw cycle. The main complications of salvage cryotherapy were urinary incontinence (73% of the patients), obstructive symptoms (67%), impotence (72%) and severe perineal pain (8%).
Salvage cryotherapy impacts local tumor control as evident by the high frequency of negative posttreatment biopsies. A double freeze-thaw cycle appears more effective than a single cycle. Like salvage prostatectomy, salvage cryotherapy causes significant morbidity.
开展一项I/II期研究，以评估挽救性冷冻疗法作为全剂量放射治疗和/或全身治疗后局部复发性前列腺癌的一种治疗方法的疗效及并发症。以治疗后前列腺特异性抗原（PSA）水平和前列腺活检为终点，比较单次和双次冻融循环的疗效。
共有150例放射、激素治疗和/或全身化疗后局部复发性前列腺癌患者接受了挽救性冷冻疗法，其中单次冻融循环71例（平均随访17.3个月），双次冻融循环79例（平均随访10.0个月）。术后约每3个月测量一次PSA，并在术后6个月重复进行六分区活检。通过回顾病历和邮寄生活质量调查问卷来评估并发症。
总体而言，45例患者（31%）的PSA持续检测不到。仅接受过放射治疗且进行双次冻融循环的患者，其活检阴性率较高（93%对71%，p<0.02），生化失败率较低（定义为血清PSA比最低点值升高0.2 ng/ml，44%对65%，p<0.03），高于接受单次冻融循环的患者。挽救性冷冻疗法的主要并发症包括尿失禁（73%的患者）、梗阻症状（67%）、阳痿（72%）和严重会阴部疼痛（8%）。
挽救性冷冻疗法对局部肿瘤有控制作用，治疗后活检阴性的高频率即证明了这一点。双次冻融循环似乎比单次循环更有效。与挽救性前列腺切除术一样，挽救性冷冻疗法会导致明显的发病率。
