Chi-Hang Yee, Peter Ka-Fung Chiu, Jeremy Yuen-Chun Teoh, Chi-Fai Ng, Chi-Kwok Chan, See-Ming Hou
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Secondary outcomes included tumor recurrence in follow-up biopsy, PSA change, perioperative complications, and postoperative functional outcomes.</p><p><strong>Results: </strong>Twenty patients underwent HIFU focal ablation. HIFU on an MRI-US fusion platform had a trend of a longer total operative time than the conventional counterpart (124.2 min vs. 107.1 min, <i>p</i>=0.066). There was no difference in the mean ablation volume to lesion volume ratio between the two. The mean PSA percentage change from baseline to 6-month is more significant in the conventional group (63.3% vs. 44.6%, <i>p</i>=0.035). No suspicious lesion was seen at 6-month mpMRI in all 20 patients. Two patients, one from each group, eventually underwent radical treatment because of the presence of clinically significant prostate cancer in the form of out-of-field recurrences during follow-up biopsy. No significant difference was observed before and after HIFU concerning uroflowmetry, SF-12 score, and EPIC-26 score. 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引用次数: 7
摘要
目的:本研究旨在探讨利用MRI-US融合平台进行前列腺HIFU病灶治疗的定位和输送效果。方法:前瞻性设计HIFU治疗局限性前列腺癌的病例系列。纳入标准:临床肿瘤分期≤T2，多参数MRI可见病变指数直径小于20mm，前列腺活检未见Gleason 5型，PSA≤20ng /ml。在该系列的前50%采用传统方式进行HIFU局灶治疗，而随后的病例采用MRI-US融合平台进行治疗。主要结果是治疗失败率，这是由挽救性治疗的需要来定义的。次要结局包括随访活检中肿瘤复发、PSA变化、围手术期并发症和术后功能结局。结果:20例患者行HIFU局灶消融。MRI-US融合平台HIFU的总手术时间比常规HIFU的总手术时间更长(124.2 min vs 107.1 min, p=0.066)。两者的平均消融体积与病变体积之比无差异。常规组从基线到6个月的平均PSA百分比变化更为显著(63.3%比44.6%，p=0.035)。20例患者6个月mpMRI未见可疑病变。两名患者，每组一名，最终接受了根治性治疗，因为在随访活检期间以视野外复发的形式出现临床显著的前列腺癌。HIFU前后尿流测量、SF-12评分、EPIC-26评分无显著差异。我们观察到，每体积使用的能量与患者PSA密度呈正相关(r = 0.6364, p=0.014)。结论:总之，HIFU与传统或MRI-US融合平台提供相似的肿瘤和功能结果。
High-Intensity Focused Ultrasound (HIFU) Focal Therapy for Localized Prostate Cancer with MRI-US Fusion Platform.
Objective: The study aimed at investigating the outcome of prostate HIFU focal therapy using the MRI-US fusion platform for treatment localization and delivery.
Methods: It is a prospectively designed case series of HIFU focal therapy for localized prostate cancer. The inclusion criteria include clinical tumor stage ≤T2, visible index lesion on multiparametric MRI less than 20 mm in diameter, absence of Gleason 5 pattern on prostate biopsy, and PSA ≤ 20 ng/ml. HIFU focal therapy was performed in the conventional manner in the beginning 50% of the series, whereas the subsequent cases were performed with MRI-US fusion platform. The primary outcome was treatment failure rate which is defined by the need of salvage therapy. Secondary outcomes included tumor recurrence in follow-up biopsy, PSA change, perioperative complications, and postoperative functional outcomes.
Results: Twenty patients underwent HIFU focal ablation. HIFU on an MRI-US fusion platform had a trend of a longer total operative time than the conventional counterpart (124.2 min vs. 107.1 min, p=0.066). There was no difference in the mean ablation volume to lesion volume ratio between the two. The mean PSA percentage change from baseline to 6-month is more significant in the conventional group (63.3% vs. 44.6%, p=0.035). No suspicious lesion was seen at 6-month mpMRI in all 20 patients. Two patients, one from each group, eventually underwent radical treatment because of the presence of clinically significant prostate cancer in the form of out-of-field recurrences during follow-up biopsy. No significant difference was observed before and after HIFU concerning uroflowmetry, SF-12 score, and EPIC-26 score. It was observed that energy used per volume was positively correlated with PSA density of the patient (r = 0.6364, p=0.014).
Conclusion: In conclusion, HIFU with conventional or MRI-US fusion platform provided similar oncological and functional outcomes.
期刊介绍：
Advances in Urology is a peer-reviewed, open access journal that publishes state-of-the-art reviews and original research papers of wide interest in all fields of urology. The journal strives to provide publication of important manuscripts to the widest possible audience worldwide, without the constraints of expensive, hard-to-access, traditional bound journals. Advances in Urology is designed to improve publication access of both well-established urologic scientists and less well-established writers, by allowing interested scientists worldwide to participate fully.
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