1
|
Dubernard G, Maissiat E, Legendre G, Dennis T, Capmas P, Warembourg S, Descamps P, Chavrier F, Roman H, Fernandez H, Nguyen-Ba E, Merlot B, Rousset P, Lafon C, Philip CA. Evaluating the safety of high-intensity focused ultrasound treatment for rectal endometriosis: results from a French prospective multicentre study including 60 patients. Hum Reprod 2024; 39:1673-1683. [PMID: 38914481 PMCID: PMC11291952 DOI: 10.1093/humrep/deae127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 04/14/2024] [Indexed: 06/26/2024] Open
Abstract
STUDY QUESTION Is increasing the intensity of high-intensity focused ultrasound (HIFU) by 30% in the treatment of rectal endometriosis a safe procedure? SUMMARY ANSWER This study demonstrates the safety of a 30% increase in the intensity of HIFU in the treatment of rectal endometriosis, with no Clavien-Dindo Grade III complications overall, and namely no rectovaginal fistulae. WHAT IS KNOWN ALREADY A feasibility study including 20 patients with rectal endometriosis demonstrated, with no severe complications, a significant improvement in digestive disorders, dysmenorrhoea, dyspareunia, and health status, although the volume of the endometriosis nodule did not appear to be reduced. STUDY DESIGN, SIZE, DURATION A prospective multicentre cohort study was conducted between 2020 and 2022 with 60 patients with symptomatic rectal endometriosis. Following the failure of medical treatment, HIFU treatment was offered as an alternative to surgery. PARTICIPANTS/MATERIALS, SETTING, METHODS As the main objective of this study was to examine safety, all adverse events observed during the 6 months of follow-up were analysed and graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) and Clavien-Dindo classifications. Secondary objectives included evaluating the evolution of symptoms using validated questionnaires: gynaecological and digestive pain symptoms with a visual analogue scale, health status with the Medical Outcomes Study 36-item Short Form (SF-36) questionnaire, average post-operative daily pain level, and analgesic medication required in the 10 days following treatment. MRI was also performed at Day 1 to detect early complications. Finally, we performed a blinded MRI review of the evolution of the nodule at 6 months post-treatment. MAIN RESULTS AND THE ROLE OF CHANCE The procedure was performed under spinal anaesthesia for 30% of the patients. The median duration of treatment was 32 min. Fifty-five patients left the hospital on Day 1. MRI scans performed on Day 1 did not highlight any early-onset post-operative complication. Using the Clavien-Dindo classification, we listed 56.7% Grade I events, 3.4% Grade II events, and no events Grade III or higher. At 1, 3, and 6 months, all gynaecologic, digestive and general symptoms, as well as health status, had significantly improved. The evolution of the nodule was also significant (P < 0.001) with a 28% decrease in volume. LIMITATIONS, REASONS FOR CAUTION The main objective was safety and not effectiveness. The study was not randomized and there was no control group. WIDER IMPLICATIONS OF THE FINDINGS HIFU treatment for rectal endometriosis results in an improvement of symptoms with low morbidity; as such, for selected patients, it could be a valuable alternative to surgical approaches following the failure of medical treatment. STUDY FUNDING/COMPETING INTEREST(S) The study was funded by the company EDAP TMS. Professors Dubernard and Rousset are consultants for EDAP TMS. Dubernard received travel support from EDAP-TMS. Dr F. Chavrier received industrial grants from EDAP-TMS. He has developed a device for generating focused ultrasonic waves with reduced treatment time. This device has been patented by EDAP-TMS. Dr Lafon received industrial grants from EDAP-TMS; he declares that EDAP-TMS provided funding directly to INSERM to support a young researcher chair in therapeutic ultrasound, which is unrelated to the current study. TRIAL REGISTRATION NUMBER ClinicalTrials.gov identifier NCT04494568.
Collapse
Affiliation(s)
- G Dubernard
- Department of Gynaecology and Obstetrics, Croix-Rousse University Hospital, Hospices Civils de Lyon, Claude Bernard University, Lyon, France
- Laboratory of Therapeutic Applications of Ultrasound, Claude Bernard University, Lyon, France
| | - E Maissiat
- Department of Radiology, Croix-Rousse University Hospital, Lyon, France
| | - G Legendre
- Department of Gynaecology and Obstetrics, Angers University Hospital, Angers, France
| | - T Dennis
- Department of Gynaecology, Tivoli-Ducos Clinic, Bordeaux, France
| | - P Capmas
- Department of Gynaecology and Obstetrics, Kremlin-Bicêtre University Hospital, Paris, France
| | - S Warembourg
- Department of Gynaecology and Obstetrics, Croix-Rousse University Hospital, Hospices Civils de Lyon, Claude Bernard University, Lyon, France
| | - P Descamps
- Department of Gynaecology and Obstetrics, Angers University Hospital, Angers, France
| | - F Chavrier
- Laboratory of Therapeutic Applications of Ultrasound, Claude Bernard University, Lyon, France
| | - H Roman
- Department of Gynaecology, Tivoli-Ducos Clinic, Bordeaux, France
| | - H Fernandez
- Department of Gynaecology and Obstetrics, Kremlin-Bicêtre University Hospital, Paris, France
| | - E Nguyen-Ba
- Department of Gynaecology and Obstetrics, Croix-Rousse University Hospital, Hospices Civils de Lyon, Claude Bernard University, Lyon, France
| | - B Merlot
- Department of Gynaecology, Tivoli-Ducos Clinic, Bordeaux, France
| | - P Rousset
- Department of Radiology, South Lyon University Hospital, Lyon, France
| | - C Lafon
- Laboratory of Therapeutic Applications of Ultrasound, Claude Bernard University, Lyon, France
| | - Charles-André Philip
- Department of Gynaecology and Obstetrics, Croix-Rousse University Hospital, Hospices Civils de Lyon, Claude Bernard University, Lyon, France
- Laboratory of Therapeutic Applications of Ultrasound, Claude Bernard University, Lyon, France
| |
Collapse
|
2
|
Guang ZLP, Kristensen G, Røder A, Brasso K. Oncological and Functional Outcomes of Whole-Gland HIFU as the Primary Treatment for Localized Prostate Cancer: A Systematic Review. Clin Genitourin Cancer 2024; 22:102101. [PMID: 38811288 DOI: 10.1016/j.clgc.2024.102101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 04/02/2024] [Accepted: 04/22/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION High-intensity focused ultrasound (HIFU) is regarded as a promising alternative treatment option for localized prostate cancer (PCa) as it has been proposed to offer similar oncologic control to the standard of care, but with significantly reduced treatment-related side effects. This systematic literature review assesses the available evidence of whole-gland HIFU as primary treatment for localized PCa. METHODS MEDLINE (PubMed) was searched for studies investigating oncological and functional outcomes following whole-gland HIFU as primary treatment for localized PCa. Our primary outcomes for the review were biochemical disease-free survival rates (BDFS), overall and PCa-specific survival rates as well as negative biopsy rates. Our secondary outcomes were functional results and complications of the treatment. RESULTS A total of 375 articles were identified, of which 35 were included in the present review. All 35 articles were prospective or retrospective case series. Mean/median duration of follow-up across studies was 10.9 to 94 months, and 6618 patients were included in the review. The BDFS rate varied greatly across studies from 21.7% to 89.2% during follow-up. The 10-year PCa-specific survival rate following HIFU was 90%, 99%, and 100% in 3 studies. Negative biopsy rates post-HIFU ranged from 20% to 92.7% across studies. Common side effects to HIFU included urinary incontinence (grade 1: 0%-22.7%), erectile dysfunction (11.6%-77.1%), urinary tract infections (1.5%-47.9%), and bladder outlet obstruction mainly as urethral strictures (7%-41.2%). CONCLUSION Great variation in oncological and functional outcomes was seen across studies. More prospective trials are needed before whole-gland HIFU can be considered as a treatment option for localized PCa.
Collapse
Affiliation(s)
- Zhilin Liu Peter Guang
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Gitte Kristensen
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Røder
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Brasso
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
3
|
Ladjevardi S, Ebner A, Femic A, Huebner NA, Shariat SF, Kraler S, Kubik-Huch RA, Ahlman RC, Häggman M, Hefermehl LJ. Focal high-intensity focused ultrasound therapy for localized prostate cancer: An interim analysis of the multinational FASST study. Eur J Clin Invest 2024; 54:e14192. [PMID: 38445798 DOI: 10.1111/eci.14192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/24/2024] [Accepted: 02/25/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND High-intensity focused ultrasound (HIFU) emerged as a novel approach for the treatment of localized prostate cancer (PCa). However, prospective studies on HIFU-related outcomes and predictors of treatment failure (TF) remain scarce. MATERIALS AND METHODS We conducted a multinational prospective cohort study among patients undergoing HIFU therapy for localized, low- to intermediate-risk PCa. Follow-up data on serial prostate specific antigen (PSA), multi-parametric magnetic resonance imaging (mpMRI), targeted/systematic biopsies, adverse events and functional outcomes were collected. The primary endpoint was TF, defined as histologically confirmed PCa requiring whole-gland salvage treatment. Uni- and multi-variable adjusted hazard ratios (HRs) were calculated using Cox proportional hazard regression models. RESULTS At baseline, mean (standard deviation) age was 64.14 (7.19) years, with the majority of patients showing T-stage 1 (73.9%) and International Society of Urological Pathology grading system Grade 2 (58.8%). PSA nadir (median, 1.70 ng/mL) was reached after 6 months. Of all patients recruited, 16% had clinically significant PCa, as confirmed by biopsy, of which 13.4% had TF. Notably, T-stage and number of positive cores at initial biopsy were independent predictors of TF during follow-up (HR [95% CI] 1.27 [1.02-1.59] and 5.02 [1.80-14.03], respectively). Adverse events were minimal (17% and 8% early and late adverse events, respectively), with stable or improved functional outcomes in the majority of patients. CONCLUSIONS This interim analysis of a multinational study on HIFU therapy for the management of low-to-intermediate-risk PCa reveals good functional outcomes, minimal adverse events and low incidence of TF over the short-term. Data on long-term outcomes, specifically as it relates to oncological outcomes, are awaited eagerly.
Collapse
Affiliation(s)
- Sam Ladjevardi
- Department of Urology, University of Uppsala, Uppsala, Sweden
| | - Anna Ebner
- Department of Urology, Cantonal Hospital Baden, Baden, Switzerland
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | | | - Nicolai A Huebner
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Working Group for Diagnostic imaging in Urology (ABDU), Austrian association of Urology (ÖGU), Vienna, Austria
- Department of urology, University of California Davis, Sacramento, California, USA
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Division of Urology, Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
- Department of Urology, Weill Cornell Medical College, New York, New York, USA
- Department of Urology, University of Texas Southwestern, Dallas, Texas, USA
| | - Simon Kraler
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
- Department of Internal Medicine, Cantonal Hospital Baden, Baden, Switzerland
| | | | | | - Michael Häggman
- Department of Urology, University of Uppsala, Uppsala, Sweden
| | | |
Collapse
|
4
|
Yang Y, Wang Y, Zeng F, Chen Y, Chen Z, Yan F. Ultrasound-visible engineered bacteria for tumor chemo-immunotherapy. Cell Rep Med 2024; 5:101512. [PMID: 38640931 PMCID: PMC11148858 DOI: 10.1016/j.xcrm.2024.101512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/04/2024] [Accepted: 03/20/2024] [Indexed: 04/21/2024]
Abstract
Our previous work developed acoustic response bacteria, which enable the precise tuning of transgene expression through ultrasound. However, it is still difficult to visualize these bacteria in order to guide the sound wave to precisely irradiate them. Here, we develop ultrasound-visible engineered bacteria and chemically modify them with doxorubicin (DOX) on their surfaces. These engineered bacteria (Ec@DIG-GVs) can produce gas vesicles (GVs), providing a real-time imaging guide for remote hyperthermia high-intensity focused ultrasound (hHIFU) to induce the expression of the interferon (IFN)-γ gene. The production of IFN-γ can kill tumor cells, induce macrophage polarization from the M2 to the M1 phenotype, and promote the maturation of dendritic cells. DOX can be released in the acidic tumor microenvironment, resulting in immunogenic cell death of tumor cells. The concurrent effects of IFN-γ and DOX activate a tumor-specific T cell response, producing the synergistic anti-tumor efficacy. Our study provides a promising strategy for bacteria-mediated tumor chemo-immunotherapy.
Collapse
Affiliation(s)
- Yaozhang Yang
- Key Laboratory of Medical Imaging Precision Theranostics and Radiation Protection, University of South China, College of Hunan Province, Changsha, Hunan 410028, China; Institution of Medical Imaging, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China; CAS Key Laboratory of Quantitative Engineering Biology, Shenzhen Institute of Synthetic Biology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Yuanyuan Wang
- CAS Key Laboratory of Quantitative Engineering Biology, Shenzhen Institute of Synthetic Biology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Fengyi Zeng
- Key Laboratory of Medical Imaging Precision Theranostics and Radiation Protection, University of South China, College of Hunan Province, Changsha, Hunan 410028, China; Institution of Medical Imaging, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
| | - Yuhao Chen
- Faculty of Health Sciences, University of Macau, Taipa, Macau SAR, China
| | - Zhiyi Chen
- Key Laboratory of Medical Imaging Precision Theranostics and Radiation Protection, University of South China, College of Hunan Province, Changsha, Hunan 410028, China; Institution of Medical Imaging, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China; The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, Hunan 410028, China.
| | - Fei Yan
- CAS Key Laboratory of Quantitative Engineering Biology, Shenzhen Institute of Synthetic Biology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China.
| |
Collapse
|
5
|
Boosting the Immune Response—Combining Local and Immune Therapy for Prostate Cancer Treatment. Cells 2022; 11:cells11182793. [PMID: 36139368 PMCID: PMC9496996 DOI: 10.3390/cells11182793] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/03/2022] [Accepted: 09/06/2022] [Indexed: 11/29/2022] Open
Abstract
Due to its slow progression and susceptibility to radical forms of treatment, low-grade PC is associated with high overall survival (OS). With the clinical progression of PC, the therapy is becoming more complex. The immunosuppressive tumor microenvironment (TME) makes PC a difficult target for most immunotherapeutics. Its general immune resistance is established by e.g., immune evasion through Treg cells, synthesis of immunosuppressive mediators, and the defective expression of surface neoantigens. The success of sipuleucel-T in clinical trials initiated several other clinical studies that specifically target the immune escape of tumors and eliminate the immunosuppressive properties of the TME. In the settings of PC treatment, this can be commonly achieved with radiation therapy (RT). In addition, focal therapies usually applied for localized PC, such as high-intensity focused ultrasound (HIFU) therapy, cryotherapy, photodynamic therapy (PDT), and irreversible electroporation (IRE) were shown to boost the anti-cancer response. Nevertheless, the present guidelines restrict their application to the context of a clinical trial or a prospective cohort study. This review explains how RT and focal therapies enhance the immune response. We also provide data supporting the combination of RT and focal treatments with immune therapies.
Collapse
|
6
|
Robin D, Peyronnet B, Bentellis I, El-Akri M, Cornu JN, Brierre T, Cousin T, Gaillard V, Poussot B, Dupuis H, Tricard T, Hermieu N, Pitout A, Beraud F, Chevallier D, Bruyere F, Biardeau X, Monsaint H, Corbel L, Hermieu JF, Lecoanet P, Capon G, Saussine C, Gamé X, Léon P. Sphincter urinaire artificiel chez les patients présentant une incontinence urinaire après High Intensivity Focused Ultrasound Therapy. Prog Urol 2022; 32:284-290. [DOI: 10.1016/j.purol.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/14/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
|
7
|
Deleuze C, Blanchet P, Gourtaud G, Sénéchal C, Roux V, Brureau L, Eyraud R. [High-intensity focused ultrasound for locally prostate cancer: An Afro-Caribbean single-center study]. Prog Urol 2021; 31:699-708. [PMID: 34154956 DOI: 10.1016/j.purol.2021.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/11/2021] [Accepted: 02/11/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION High-intensity focused ultrasound (HIFU) has proved to be effective in the treatment of localized prostate cancer. The aim of this prospective study is to assess their first oncological and functional results in an Afro-Caribbean population. METHODS From May 2018 to January 2020, 77 patients issued from French West Indies were included. Several treatments were carried out: whole-gland treatment hemi or focal ablation; in a primary setting (group I) or a salvage therapy (group II). PSA level was assessed at 2, 6, 9 and 12 months. MpMRI and post HIFU biopsy were performed between 6 and 9 months postoperatively. Continence, urinary end erectile functions were assessed by ICS, IPSS and IIEF scores. RESULTS Groupe I included 71.2% patients, group II, 28.8%. The median age was 75.4 years [IQR 69.6-79.4]. The median follow-up was 8.3 months [IQR 3.5-12.25]. At inclusion, PSA was 7.7ng/ml [IQR 5.5-11.2] in group I, and 5.9ng/ml [IQR 4.4-7.9] in group II. In the whole population, there was 73.5% negative biopsies; 14.7% of the biopsies were positive in treated zone and 11.8% in non-treated zone. Regarding morbidities, urinary incontinence appeared in 7.5% and erectile dysfunction rate was 13.2%. CONCLUSION Our study reveals the first experience of HIFU by Focal One® device in an Afro-Caribbean population. It seems to be a safe and reproducible treatment with acceptable oncological results and low genitourinary morbidity. Long term follow-up and a higher number of patients are necessary to validate these results.
Collapse
Affiliation(s)
- C Deleuze
- Service d'urologie et transplantation rénale, CHU de Guadeloupe, 97110 Pointe-à-Pitre, Guadeloupe.
| | - P Blanchet
- CHU de Guadeloupe, université des Antilles, université de Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) MR_S 1085, 97110 Pointe-à-Pitre, Guadeloupe.
| | - G Gourtaud
- Service d'urologie et transplantation rénale, CHU de Guadeloupe, 97110 Pointe-à-Pitre, Guadeloupe.
| | - C Sénéchal
- Service d'urologie et transplantation rénale, CHU de Guadeloupe, 97110 Pointe-à-Pitre, Guadeloupe.
| | - V Roux
- Service d'urologie et transplantation rénale, CHU de Guadeloupe, 97110 Pointe-à-Pitre, Guadeloupe.
| | - L Brureau
- CHU de Guadeloupe, université des Antilles, université de Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) MR_S 1085, 97110 Pointe-à-Pitre, Guadeloupe.
| | - R Eyraud
- Service d'urologie et transplantation rénale, CHU de Guadeloupe, 97110 Pointe-à-Pitre, Guadeloupe.
| |
Collapse
|
8
|
Bründl J, Osberghaus V, Zeman F, Breyer J, Ganzer R, Blana A, Gierth M, Denzinger S, Burger M, Rosenhammer B. Oncological Long-term Outcome After Whole-gland High-intensity Focused Ultrasound for Prostate Cancer-21-yr Follow-up. Eur Urol Focus 2021; 8:134-140. [PMID: 33483288 DOI: 10.1016/j.euf.2020.12.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/17/2020] [Accepted: 12/18/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Owing to the morbidity of established radical treatment options for prostate cancer, alternative whole-gland and focal treatment strategies have emerged. High-intensity focused ultrasound (HIFU) is one of the most studied sources for tissue ablation and has been used since the 1990s. OBJECTIVE To provide 21-yr oncological long-term follow-up data of an unselected series of patients who underwent whole-gland HIFU for nonmetastatic prostate cancer. DESIGN, SETTING, AND PARTICIPANTS A total of 674 patients were treated between November 1997 and November 2012 in one university center. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The oncological outcome was assessed by biopsy failure-free survival (BFFS), salvage treatment-free survival (STFS), metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS). Multivariable Cox proportional hazard regression analyses were performed to estimate the prognostic relevance of clinical variables. RESULTS AND LIMITATIONS In total, 560 patients were included into the evaluation and the median follow-up was 15.1 yr, with a range up to 21.4 yr. At 15 yr, CSS rates for low-, intermediate-, and high-risk patients were 95%, 89%, and 65%, respectively; MFS, STFS-1 (salvage treatment other than HIFU), STFS-2 (salvage treatment including repeat HIFU), and BFFS rates were 91%, 85%, and 58%; 77%, 63%, and 29%; 67%, 52%, and 28%; and 82%, 73%, and 47%, respectively. Preoperative high-risk category was an independent predictor of inferior OS, CSS, MFS, STFS, and BFFS. CONCLUSIONS Although whole-gland HIFU achieved good long-term cancer control in low- and intermediate-risk patients, high-risk patients should not be treated routinely by HIFU. Intermediate-risk patients achieve high CSS and MFS rates, but a relevant salvage treatment rate has to be reckoned with. Long-term data after whole-gland therapy might help derive implications for focal treatment sources and patient selection. PATIENT SUMMARY Long-term data after whole-gland high-intensity focused ultrasound (HIFU) therapy are crucial to prove its oncological efficacy, and may help derive implications for focal treatment strategies and patient selection. In this context, whole-gland HIFU achieved good long-term cancer control up to 21 yr in low- and intermediate-risk prostate cancer (PCa) patients. Owing to considerably inferior long-term cancer control, it should not routinely be used in high-risk PCa patients.
Collapse
Affiliation(s)
- Johannes Bründl
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany.
| | - Vera Osberghaus
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Johannes Breyer
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Roman Ganzer
- Department of Urology, Asklepios Hospital Bad Tölz, Bad Tölz, Germany
| | - Andreas Blana
- Department of Urology, Fürth Hospital, Fürth, Germany
| | - Michael Gierth
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Stefan Denzinger
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Maximilian Burger
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Bernd Rosenhammer
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| |
Collapse
|
9
|
Cryoablation, high-intensity focused ultrasound, irreversible electroporation, and vascular-targeted photodynamic therapy for prostate cancer: a systemic review and meta-analysis. Int J Clin Oncol 2021; 26:461-484. [PMID: 33387088 DOI: 10.1007/s10147-020-01847-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022]
Abstract
Cryoablation (CA), high-intensity focused ultrasound (HIFU), irreversible electroporation (IRE), and vascular-targeted photodynamic therapy (VTP) have been evaluated as novel strategies for selected patients with prostate cancer (PCa). We aim to determine the current status of literature regarding the clinical outcomes among these minimally invasive therapies. A systematic search of PubMed, EMBASE, and the Cochrane Library for all English literature published from January 2001 to December 2019 was conducted to identify studies evaluating outcomes of CA, HIFU, IRE or VTP on PCa. Proportionality with 95% confidence intervals (CIs) was performed using STATA version 14.0. 56 studies consisting of 7383 participants were found to report data of interest and fulfilled the inclusion criteria in the final meta-analysis. The pooled proportions of positive biopsy after procedure were 20.0%, 24.3%, 24.2%, and 36.2% in CA, HIFU, IRE and VTP, respectively. The pooled proportions of BRFS were 75.7% for CA and 74.4% for HIFU. The pooled proportions of CSS were 96.1%, 98.2%, and 97.9% for CA, HIFU, and IRE, respectively. The pooled proportions of OS were 92.8% for CA and 85.2% for HIFU. The pooled proportions of FFS were 64.7%, 90.4%, and 76.7% for CA, IRE and VTP, respectively. The pooled proportions of MFS were 92.8% for HIFU and 99.1% for IRE. This meta-analysis shows that CA, HIFU, IRE, and VTP are promising therapies for PCa patients with similar clinical outcomes. However, further larger, well-designed randomized controlled trials are required to confirm this assertion.
Collapse
|
10
|
Philip C, Warembourg S, Dairien M, Lefevre C, Gelet A, Chavrier F, Guillen N, Tonoli H, Maissiat E, Lafon C, Dubernard G. Transrectal high-intensity focused ultrasound (HIFU) for management of rectosigmoid deep infiltrating endometriosis: results of Phase-I clinical trial. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:431-442. [PMID: 31788875 PMCID: PMC7496183 DOI: 10.1002/uog.21937] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/01/2019] [Accepted: 11/14/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Deep infiltrating endometriosis (DIE) of the rectosigmoid is associated with painful symptoms. When medical treatment is ineffective, surgical resection remains the standard treatment, despite significant risk of adverse events. High-intensity focused ultrasound (HIFU) is a minimally invasive ablative procedure. Focal One® is a transrectal HIFU (TR-HIFU) device used in prostate cancer treatment. The primary objective of this study was to confirm the feasibility of treatment with TR-HIFU in patients presenting with posterior DIE with rectosigmoid involvement. We also assessed its safety and clinical efficacy in this context. METHODS This was a non-controlled, prospective, Phase-I clinical trial in a French University Hospital which is a multidisciplinary center for management of endometriosis. Included were patients older than 25 years, without plans to conceive within 6 months, who presented with a single lesion of posterior DIE, with rectosigmoid invasion, after failure of hormonal therapy. All lesions were assessed preoperatively using transvaginal sonography and magnetic resonance imaging. Patients completed questionnaires on gynecological and intestinal symptoms (similar to a visual analog scale (VAS)), and on quality of life (Medical Outcomes Study 36-item short-form survey (SF-36) and, for the second half of patients recruited, symptom scoring system for constipation (KESS), female sexual function index (FSFI) and endometriosis health profile short-version score (EHP-5)), before, and at 1, 3 and 6 months after, TR-HIFU treatment with a Focal One real-time ultrasound-guided HIFU device. RESULTS Twenty-three consecutive patients were included in the study between September 2015 and October 2019. All 23 lesions were visualized, giving a detection rate of 100%. Twenty lesions were treated ('feasibility rate', 87.0%): in 13 the whole lesion was treated and in seven the lesion was treated partially. The mean duration of the TR-HIFU procedure was 55.6 min. We observed a significant improvement in VAS score at 6 months, with differences relative to preoperative scores as follows, for: dysmenorrhea (-3.6, P = 0.004), dyspareunia (-2.4, P = 0.006), diarrhea (-3.0, P = 0.006), constipation (-3.0, P = 0.002), dyschezia (-3.2, P = 0.003), false urge to defecate (-3.3, P = 0.007), posterior pelvic pain (-3.8, P = 0.002) and asthenia (-3.8, P = 0.002). There was also a significant improvement in the SF-36 score, with an increase at 6 months relative to the preoperative score in both the physical component summary (+ 9.3%, P = 0.002) and mental component summary (+ 10.9%, P = 0.017). No major complications occurred during or after any procedure. CONCLUSIONS TR-HIFU therapy for posterior DIE is feasible. If its efficacy and safety are confirmed, it could be a minimally invasive alternative to surgery for the treatment of rectosigmoid endometriosis. © 2019 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- C.‐A. Philip
- Gynecology DepartmentCroix‐Rousse University HospitalHospices Civils de Lyon, LyonFrance
- Claude Bernard Lyon 1 University, University of LyonLyonFrance
- LabTAU, INSERM (Unit 1032), Centre Léon Bérard, Lyon 1 UniversityF‐69003LyonFrance
| | - S. Warembourg
- Gynecology DepartmentCroix‐Rousse University HospitalHospices Civils de Lyon, LyonFrance
| | - M. Dairien
- Gynecology DepartmentCroix‐Rousse University HospitalHospices Civils de Lyon, LyonFrance
- Claude Bernard Lyon 1 University, University of LyonLyonFrance
- LabTAU, INSERM (Unit 1032), Centre Léon Bérard, Lyon 1 UniversityF‐69003LyonFrance
| | - C. Lefevre
- Gynecology DepartmentCroix‐Rousse University HospitalHospices Civils de Lyon, LyonFrance
- Claude Bernard Lyon 1 University, University of LyonLyonFrance
| | - A. Gelet
- LabTAU, INSERM (Unit 1032), Centre Léon Bérard, Lyon 1 UniversityF‐69003LyonFrance
| | - F. Chavrier
- Claude Bernard Lyon 1 University, University of LyonLyonFrance
- LabTAU, INSERM (Unit 1032), Centre Léon Bérard, Lyon 1 UniversityF‐69003LyonFrance
| | | | - H. Tonoli
- EDAP‐TMS CompanyVaulx‐en‐VelinFrance
| | - E. Maissiat
- Radiology DepartmentCroix‐Rousse University HospitalHospices Civils de Lyon, LyonFrance
| | - C. Lafon
- Claude Bernard Lyon 1 University, University of LyonLyonFrance
- LabTAU, INSERM (Unit 1032), Centre Léon Bérard, Lyon 1 UniversityF‐69003LyonFrance
| | - G. Dubernard
- Gynecology DepartmentCroix‐Rousse University HospitalHospices Civils de Lyon, LyonFrance
- Claude Bernard Lyon 1 University, University of LyonLyonFrance
- LabTAU, INSERM (Unit 1032), Centre Léon Bérard, Lyon 1 UniversityF‐69003LyonFrance
| |
Collapse
|
11
|
Napoli A, Alfieri G, Scipione R, Leonardi A, Fierro D, Panebianco V, De Nunzio C, Leonardo C, Catalano C. High-intensity focused ultrasound for prostate cancer. Expert Rev Med Devices 2020; 17:427-433. [PMID: 32275187 DOI: 10.1080/17434440.2020.1755258] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
High-intensity focused ultrasound (HIFU) is a noninvasive procedure that has shown promising results in a wide range of malignant and nonmalignant conditions, including localized prostate cancer (PCa). This review aims to describe the application of HIFU in the management of patients with PCa, explaining its basic therapeutic principles, going through the main phases during aHIFU session, and providing an overview of the main available pieces of evidence from literature. HIFU treatment for prostate cancer is increasingly performed with high success and safety. MR guidance (MR-guided HIFU) has the advantage of real-time intraprocedural thermometric feedback that ensures that the whole region of interest has been covered by critical thermal damage (and that all surrounding healthy tissues have been spared). The absence of comparative long-term trials prevents HIFU from being considered as afirst choice for the treatment of patients with PCa.
Collapse
Affiliation(s)
- Alessandro Napoli
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I - Sapienza University of Rome; Rome (RM), Italy
| | - Giulia Alfieri
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I - Sapienza University of Rome; Rome (RM), Italy
| | - Roberto Scipione
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I - Sapienza University of Rome; Rome (RM), Italy
| | - Andrea Leonardi
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I - Sapienza University of Rome; Rome (RM), Italy
| | - Davide Fierro
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I - Sapienza University of Rome; Rome (RM), Italy
| | - Valeria Panebianco
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I - Sapienza University of Rome; Rome (RM), Italy
| | - Cosimo De Nunzio
- UOC Urologia, Ospedale Sant'Andrea, Sapienza, University of Rome, Italy
| | - Costantino Leonardo
- Department of Gynecology-Obstetrics and Urology, Sapienza University of Rome; Rome (RM), Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I - Sapienza University of Rome; Rome (RM), Italy
| |
Collapse
|
12
|
Xu Z, Zhou H, Yan X, Cheng Q, Liu X. Broadband ultrasound-trapping barrier based on hollow cylinder with a periodic grating. ULTRASONICS 2019; 93:102-106. [PMID: 30476782 DOI: 10.1016/j.ultras.2018.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/20/2018] [Accepted: 09/10/2018] [Indexed: 06/09/2023]
Abstract
It is important to modulate ultrasonic waves in some ultrasonic application fields. We formed an ultrasound-trapping barrier through a hollow cylinder with a periodic grating on the surface and simulated the barrier using the finite element method. Using the Schlieren imaging technique, we visualized the ultrasound field distribution in the structure. Both the experimental and simulation results revealed that the structure can work in a broadband frequency range, demonstrating the effectiveness and practicability of the structure as a virtual ultrasound barrier. We also describe how the silent region and the ultrasound intensity can be adjusted in the hollow cylinder.
Collapse
Affiliation(s)
- Zheng Xu
- Institute of Acoustics, Tongji University, Shanghai 200092, China
| | - Hongsheng Zhou
- Shanghai Acoustics Laboratory, Chinese Academy of Sciences, Shanghai 200032, China
| | - Xu Yan
- Institute of Acoustics, Tongji University, Shanghai 200092, China
| | - Qian Cheng
- Institute of Acoustics, Tongji University, Shanghai 200092, China.
| | - Xiaojun Liu
- Key Laboratory of Modern Acoustics, School of Physics, Nanjing University, Nanjing 210093, China.
| |
Collapse
|
13
|
Oncological long-term outcome of whole gland HIFU and open radical prostatectomy: a comparative analysis. World J Urol 2019; 37:2073-2080. [DOI: 10.1007/s00345-018-2613-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 12/19/2018] [Indexed: 12/25/2022] Open
|
14
|
Durán-Rivera A, Montoliu García A, Juan Escudero J, Garrido Abad P, Fernández Arjona M, López Alcina E. High-intensity focused ultrasound therapy for the treatment of prostate cancer: Medium-term experience. Actas Urol Esp 2018; 42:450-456. [PMID: 29573835 DOI: 10.1016/j.acuro.2017.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 11/06/2017] [Accepted: 11/07/2017] [Indexed: 01/16/2023]
Abstract
INTRODUCTION The treatment of localised prostate cancer seeks to minimise the impact on sexual function and urinary continence. In this respect, therapy with high-intensity focused ultrasound offers important results. We present our experience with this technique in 2 Spanish centres. MATERIAL AND METHODS We conducted a retrospective review of 75 patients with localised prostate cancer treated with high-intensity focused ultrasound between March 2007 and July 2016. The oncological results and perioperative complications were assessed, as well as the impact on sexual function and continence. RESULTS A total of 67 patients were analysed. The mean follow-up was 7.2 years. The PSA nadir was 0.2ng/mL (0-3), 24 patients (35.5%) presented biochemical recurrence, and 18 underwent a further biopsy, with 10 cases (55.5%) presenting disease recurrence. The overall biochemical relapse-free survival at 5 and 8 years was 93.2 and 80.5%, respectively. The cancer-specific survival at 5 and 8 years was 96% in both cases. In the postoperative period, 50 patients (74.6%) were continent, 16 (23.9%) reported mild incontinence, and one (1.5%) reported moderate incontinence. The median International Index of Erectile Function-5 before and after the surgery was 17 (5-25) and 16 (2-23) points, respectively. Nine patients reported de novo erectile dysfunction (13.5%). CONCLUSION High-intensity focused ultrasound appears to be a safe alternative for the treatment of localised prostate cancer, especially for low-risk localised prostate cancer. In our experience, this technique offers advantages in preserving urinary continence, and the medium-term oncological results are encouraging. Given the natural progression of prostate cancer, long-term studies with a larger number of cases are needed to corroborate these results.
Collapse
Affiliation(s)
- A Durán-Rivera
- Hospital General Universitario de Valencia, Valencia, España.
| | | | - J Juan Escudero
- Hospital General Universitario de Valencia, Valencia, España
| | - P Garrido Abad
- Hospital Universitario del Henares, Coslada, Madrid, España
| | | | - E López Alcina
- Hospital General Universitario de Valencia, Valencia, España
| |
Collapse
|
15
|
Maestroni U, Morandin F, Ferretti S, Dinale F, Ziglioli F. Recurrence of prostate cancer after HIFU. Proposal of a novel predictive index. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:220-226. [PMID: 29957755 PMCID: PMC6179019 DOI: 10.23750/abm.v89i2.6730] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 09/07/2017] [Indexed: 12/22/2022]
Abstract
Background and aim of the work: Prostate cancer is one of the most common cancers in men over 50 years of age. Surgery, radiotherapy and hormonal manipulation represent its typical treatment. High-Intensity Focused Ultrasound (HIFU) is an alternative choice in localized prostate cancer. To date, an index for prediction of recurrence in patients treated with HIFU is not availabe. Our study proposes a novel index for the predition of recurrence able to determine if a candidate is fit for this tratment. methods: 107 patients underwent HIFU fram 2010 to 2015. A total of 12 variables were considered for the analysis. The final predictive model was obtained through a stepwise forward selection method. Results: The final model used a total of 6 variables, all correlated to the response variable. The Index is able to predict the recurrence after HIFU tratment in the most majority of candidates to treatment. The index may be used to make a more scientific decision with regard to choosing optimal candidates for HIFU. (www.actabiomedica.it)
Collapse
Affiliation(s)
| | - Francesco Morandin
- University of Parma, Department of Mathematics, Physics and Informatics, Parco Area Scienze 7/a, Parma, Italy.
| | | | - Francesco Dinale
- Department of Urology, University-Hospital of Parma, Parma, Italy.
| | | |
Collapse
|
16
|
Chen PY, Chiang PH, Liu YY, Chuang YC, Cheng YT. Primary whole-gland ablation for localized prostate cancer with high-intensity focused ultrasound: The important predictors of biochemical recurrence. Int J Urol 2018; 25:615-620. [PMID: 29756298 DOI: 10.1111/iju.13581] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 03/05/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To identify predictive factors of biochemical recurrence for patients undergoing high-intensity focused ultrasound treatment for localized prostate cancer. METHODS We retrospectively identified patients receiving whole-gland prostate ablation with high-intensity focused ultrasound for localized prostate cancer from 2009 to 2015. All the patients received pre-high-intensity focused ultrasound radical transurethral resection of the prostate. We included perioperative parameters as follows: age, preoperative prostate volume, stage of operation, initial prostate-specific antigen, T stage, postoperative prostate-specific antigen nadir, Gleason score, time to prostate-specific antigen nadir and the presence of prostate-specific antigen biochemical recurrence. Multivariable Cox regression and Kaplan-Meier analysis were used for investigating predictors of recurrence, and receiver operating characteristic analysis was used for the cut-off values of prostate-specific antigen nadir. RESULTS Among 182 patients, 26.9% had prostate-specific antigen biochemical recurrence after high-intensity focused ultrasound during the median follow-up period of 32.21 months. Gleason score ≥7 (Gleason score 7, hazard ratio 2.877, P = 0.027), stage ≥T2b (T2b, hazard ratio 3.16, P = 0.027) and prostate-specific antigen nadir (hazard ratio 1.11, P < 0.001) were statistically significant, whereas there was no significance in prostate volume and initial prostate-specific antigen. We posit that a cut-off level of prostate-specific antigen nadir 0.43 ng/mL might be considered as an independent predictive factor for prostate-specific antigen biochemical recurrence in high-intensity focused ultrasound patients in multivariate analysis (P < 0.001, hazard ratio 7.39, 95% confidence interval 3.56-15.37), and created a new nadir-related prediction model for biochemical recurrence prediction. CONCLUSIONS Postoperative prostate-specific antigen nadir of 0.43 ng/mL can be considered an important predictive factor for biochemical recurrence in primary whole-prostate gland high-intensity focused ultrasound treatment, and the nadir-related prediction model might provide a reference for early salvage treatment. Furthermore, Gleason score ≥7, stage ≥T2b might be associated with unfavorable outcomes, although prostate volume and higher initial prostate-specific antigen appear not to be associated with biochemical recurrence for the high-intensity focused ultrasound treatment.
Collapse
Affiliation(s)
- Po Yen Chen
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Po Hui Chiang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi Yang Liu
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yao Chi Chuang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yuan Tso Cheng
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| |
Collapse
|
17
|
Time to PSA rise differentiates the PSA bounce after HDR and LDR brachytherapy of prostate cancer. J Contemp Brachytherapy 2018; 10:1-9. [PMID: 29619050 PMCID: PMC5881590 DOI: 10.5114/jcb.2018.73786] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 12/28/2017] [Indexed: 11/17/2022] Open
Abstract
Purpose To investigate the differences in prostate-specific antigen (PSA) bounce (PB) after high-dose-rate (HDR-BT) or low-dose-rate (LDR-BT) brachytherapy alone in prostate cancer patients. Materials and methods Ninety-four patients with localized prostate cancer (T1-T2cN0), age ranged 50-81 years, were treated with brachytherapy alone between 2008 and 2010. Patients were diagnosed with adenocarcinoma, Gleason score ≤ 7. The LDR-BT total dose was 144-145 Gy, in HDR-BT - 3 fractions of 10.5 or 15 Gy. The initial PSA level (iPSA) was assessed before treatment, then PSA was rated every 3 months over the first 2 years, and every 6 months during the next 3 years. Median follow-up was 3.0 years. Results Mean iPSA was 7.8 ng/ml. In 58 cases, PSA decreased gradually without PB or biochemical failure (BF). In 24% of patients, PB was observed. In 23 cases (24%), PB was observed using 0.2 ng/ml definition; in 10 cases (11%), BF was diagnosed using nadir + 2 ng/ml definition. The HDR-BT and LDR-BT techniques were not associated with higher level of PB (26 vs. 22%, p = 0.497). Time to the first PSA rise finished with PB was significantly shorter after HDR-BT then after LDR-BT (median, 10.5 vs. 18.0 months) during follow-up. Predictors for PB were observed only after HDR-BT. Androgen deprivation therapy (ADT) and higher Gleason score decreased the risk of PB (HR = 0.11, p = 0.03; HR = 0.51, p = 0.01). The higher PSA nadir and longer time to PSA nadir increased the risk of PB (HR 3.46, p = 0.02; HR 1.04, p = 0.04). There was no predictors for PB after LDR-BT. Conclusions HDR-BT and LDR-BT for low and intermediate risk prostate cancer had similar PB rate. The PB occurred earlier after HDR-BT than after LDR-BT. ADT and higher Gleason score decreased, and higher PSA nadir and longer time to PSA nadir increased the risk of PB after HDR-BT.
Collapse
|
18
|
[Focal therapies: An alternative option for low-risk prostate cancer management?]. Presse Med 2017; 46:935-939. [PMID: 29031683 DOI: 10.1016/j.lpm.2017.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Revised: 09/20/2017] [Accepted: 09/20/2017] [Indexed: 11/20/2022] Open
Abstract
Recommended options for low-risk prostate cancer treatment are active surveillance, radical treatments or watchful waiting. Focal therapies are currently assessed for low risk prostate cancer treatment. Focal therapies can be performed in research protocols. Oncologic results of these focal treatments are encouraging and show excellent tolerance with few complications. Radical treatments are still possible after focal therapies failure. Focal therapies are a possible solution to over-treatment issue of low risk prostate cancers.
Collapse
|
19
|
Schlesinger D, Lee M, Ter Haar G, Sela B, Eames M, Snell J, Kassell N, Sheehan J, Larner JM, Aubry JF. Equivalence of cell survival data for radiation dose and thermal dose in ablative treatments: analysis applied to essential tremor thalamotomy by focused ultrasound and gamma knife. Int J Hyperthermia 2017; 33:401-410. [PMID: 28044461 PMCID: PMC6203314 DOI: 10.1080/02656736.2016.1278281] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Thermal dose and absorbed radiation dose have historically been difficult to compare because different biological mechanisms are at work. Thermal dose denatures proteins and the radiation dose causes DNA damage in order to achieve ablation. The purpose of this paper is to use the proportion of cell survival as a potential common unit by which to measure the biological effect of each procedure. Survival curves for both thermal and radiation doses have been extracted from previously published data for three different cell types. Fits of these curves were used to convert both thermal and radiation dose into the same quantified biological effect: fraction of surviving cells. They have also been used to generate and compare survival profiles from the only indication for which clinical data are available for both focused ultrasound (FUS) thermal ablation and radiation ablation: essential tremor thalamotomy. All cell types could be fitted with coefficients of determination greater than 0.992. As an illustration, survival profiles of clinical thalamotomies performed by radiosurgery and FUS are plotted on a same graph for the same metric: fraction of surviving cells. FUS and Gamma Knife have the potential to be used in combination to deliver a more effective treatment (for example, FUS may be used to debulk the main tumour mass, and radiation to treat the surrounding tumour bed). In this case, a model which compares thermal and radiation treatments is valuable in order to adjust the dose between the two.
Collapse
Affiliation(s)
- D Schlesinger
- a Department of Radiation Oncology , University of Virginia , Charlottesville , VA , USA
- c Department of Neurosurgery , University of Virginia , Charlottesville , VA , USA
| | - M Lee
- b Focused Ultrasound Foundation , Charlottesville , VA , USA
| | - G Ter Haar
- d Division of Radiotherapy and Imaging , The Institute of Cancer Research:Royal Marsden Hospital , London , UK
| | - B Sela
- b Focused Ultrasound Foundation , Charlottesville , VA , USA
| | - M Eames
- b Focused Ultrasound Foundation , Charlottesville , VA , USA
| | - J Snell
- b Focused Ultrasound Foundation , Charlottesville , VA , USA
- c Department of Neurosurgery , University of Virginia , Charlottesville , VA , USA
| | - N Kassell
- b Focused Ultrasound Foundation , Charlottesville , VA , USA
- c Department of Neurosurgery , University of Virginia , Charlottesville , VA , USA
| | - J Sheehan
- a Department of Radiation Oncology , University of Virginia , Charlottesville , VA , USA
- c Department of Neurosurgery , University of Virginia , Charlottesville , VA , USA
| | - J M Larner
- a Department of Radiation Oncology , University of Virginia , Charlottesville , VA , USA
| | - J-F Aubry
- a Department of Radiation Oncology , University of Virginia , Charlottesville , VA , USA
- e ESPCI Paris, PSL Research University, CNRS, INSERM, Institut Langevin , Paris , France
| |
Collapse
|
20
|
Juho YC, Wu ST, Cha TL, Sun GH, Yu DS, Kao CC. Single session of high-intensity focused ultrasound therapy for the management of organ-confined prostate cancer: A single-institute experience. UROLOGICAL SCIENCE 2016. [DOI: 10.1016/j.urols.2016.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
21
|
Bessiere F, N'djin WA, Colas EC, Chavrier F, Greillier P, Chapelon JY, Chevalier P, Lafon C. Ultrasound-Guided Transesophageal High-Intensity Focused Ultrasound Cardiac Ablation in a Beating Heart: A Pilot Feasibility Study in Pigs. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1848-1861. [PMID: 27158083 DOI: 10.1016/j.ultrasmedbio.2016.03.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 03/02/2016] [Accepted: 03/11/2016] [Indexed: 06/05/2023]
Abstract
Catheter ablation for the treatment of arrhythmia is associated with significant complications and often-repeated procedures. Consequently, a less invasive and more efficient technique is required. Because high-intensity focused ultrasound (HIFU) enables the generation of precise thermal ablations in deep-seated tissues without harming the tissues in the propagation path, it has the potential to be used as a new ablation technique. A system capable of delivering HIFU into the heart by a transesophageal route using ultrasound (US) imaging guidance was developed and tested in vivo in six male pigs. HIFU exposures were performed on atria and ventricles. At the time of autopsy, visual inspection identified thermal lesions in the targeted areas in three of the animals. These lesions were confirmed by histologic analysis (mean size: 5.5 mm(2) × 11 mm(2)). No esophageal thermal injury was observed. One animal presented with bradycardia due to an atrio-ventricular block, which provides real-time confirmation of an interaction between HIFU and the electrical circuits of the heart. Thus, US-guided HIFU has the potential to minimally invasively create myocardial lesions without an intra-cardiac device.
Collapse
Affiliation(s)
- Francis Bessiere
- Hospices Civils de Lyon, Hôpital Cardiovasculaire Louis Pradel, Lyon, France; Inserm, LabTau, Lyon, France; Université de Lyon, Lyon, France.
| | | | | | | | - Paul Greillier
- Hospices Civils de Lyon, Hôpital Cardiovasculaire Louis Pradel, Lyon, France; Inserm, LabTau, Lyon, France
| | | | - Philippe Chevalier
- Hospices Civils de Lyon, Hôpital Cardiovasculaire Louis Pradel, Lyon, France; Université de Lyon, Lyon, France
| | - Cyril Lafon
- Inserm, LabTau, Lyon, France; Université de Lyon, Lyon, France
| |
Collapse
|
22
|
|
23
|
Rouget B, Capon G, Bernhard J, Robert G, Ballanger P, Pierquet G, Bensadoun H, Ferrière JM, Pasticier G. Huit ans d’expérience dans le traitement du cancer de prostate par HIFU, résultats oncologiques et fonctionnels. Prog Urol 2016; 26:50-7. [DOI: 10.1016/j.purol.2015.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 06/25/2015] [Accepted: 09/07/2015] [Indexed: 11/30/2022]
|
24
|
Prostate Focused Ultrasound Therapy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 880:21-41. [PMID: 26486330 DOI: 10.1007/978-3-319-22536-4_2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
|
25
|
Eames MDC, Farnum M, Khaled M, Elias WJ, Hananel A, Snell JW, Kassell NF, Aubry JF. Head phantoms for transcranial focused ultrasound. Med Phys 2015; 42:1518-27. [PMID: 25832042 DOI: 10.1118/1.4907959] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE In the ongoing endeavor of fine-tuning, the clinical application of transcranial MR-guided focused ultrasound (tcMRgFUS), ex-vivo studies wlkiith whole human skulls are of great use in improving the underlying technology guiding the accurate and precise thermal ablation of clinically relevant targets in the human skull. Described here are the designs, methods for fabrication, and notes on utility of three different ultrasound phantoms to be used for brain focused ultrasound research. METHODS Three different models of phantoms are developed and tested to be accurate, repeatable experimental options to provide means to further this research. The three models are a cadaver, a gel-filled skull, and a head mold containing a skull and filled with gel that mimics the brain and the skin. Each was positioned in a clinical tcMRgFUS system and sonicated at 1100 W (acoustic) for 12 s at different locations. Maximum temperature rise as measured by MR thermometry was recorded and compared against clinical data for a similar neurosurgical target. Results are presented as heating efficiency in units (°C/kW/s) for direct comparison to available clinical data. The procedure for casting thermal phantom material is presented. The utility of each phantom model is discussed in the context of various tcMRgFUS research areas. RESULTS The cadaveric phantom model, gel-filled skull model, and full head phantom model had heating efficiencies of 5.3, 4.0, and 3.9 °C/(kW/s), respectively, compared to a sample clinical heating efficiency of 2.6 °C/(kW/s). In the seven research categories considered, the cadaveric phantom model was the most versatile, though less practical compared to the ex-vivo skull-based phantoms. CONCLUSIONS Casting thermal phantom material was shown to be an effective way to prepare tissue-mimicking material for the phantoms presented. The phantom models presented are all useful in tcMRgFUS research, though some are better suited to a limited subset of applications depending on the researchers needs.
Collapse
Affiliation(s)
| | - Mercy Farnum
- Focused Ultrasound Foundation, Charlottesville, Virginia 22903
| | - Mohamad Khaled
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia 22908
| | - W Jeff Elias
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia 22908
| | - Arik Hananel
- Focused Ultrasound Foundation, Charlottesville, Virginia 22903 and Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia 22908
| | - John W Snell
- Focused Ultrasound Foundation, Charlottesville, Virginia 22903 and Department of Neurosurgery, University of Virginia, Charlottesville, Virginia 22908
| | - Neal F Kassell
- Focused Ultrasound Foundation, Charlottesville, Virginia 22903 and Department of Neurosurgery, University of Virginia, Charlottesville, Virginia 22908
| | - Jean-Francois Aubry
- Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia 22908 and Institut Langevin, ESPCI ParisTech, CNRS UMR 7587, INSERM U979, Paris 75005, France
| |
Collapse
|
26
|
An Ultrasound Image-Based Dynamic Fusion Modeling Method for Predicting the Quantitative Impact of In Vivo Liver Motion on Intraoperative HIFU Therapies: Investigations in a Porcine Model. PLoS One 2015; 10:e0137317. [PMID: 26398366 PMCID: PMC4580572 DOI: 10.1371/journal.pone.0137317] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 08/15/2015] [Indexed: 11/19/2022] Open
Abstract
Organ motion is a key component in the treatment of abdominal tumors by High Intensity Focused Ultrasound (HIFU), since it may influence the safety, efficacy and treatment time. Here we report the development in a porcine model of an Ultrasound (US) image-based dynamic fusion modeling method for predicting the effect of in vivo motion on intraoperative HIFU treatments performed in the liver in conjunction with surgery. A speckle tracking method was used on US images to quantify in vivo liver motions occurring intraoperatively during breathing and apnea. A fusion modeling of HIFU treatments was implemented by merging dynamic in vivo motion data in a numerical modeling of HIFU treatments. Two HIFU strategies were studied: a spherical focusing delivering 49 juxtapositions of 5-second HIFU exposures and a toroidal focusing using 1 single 40-second HIFU exposure. Liver motions during breathing were spatially homogenous and could be approximated to a rigid motion mainly encountered in the cranial-caudal direction (f = 0.20 Hz, magnitude > 13 mm). Elastic liver motions due to cardiovascular activity, although negligible, were detectable near millimeter-wide sus-hepatic veins (f = 0.96 Hz, magnitude < 1 mm). The fusion modeling quantified the deleterious effects of respiratory motions on the size and homogeneity of a standard "cigar-shaped" millimetric lesion usually predicted after a 5-second single spherical HIFU exposure in stationary tissues (Dice Similarity Coefficient: DSC < 45%). This method assessed the ability to enlarge HIFU ablations during respiration, either by juxtaposing "cigar-shaped" lesions with spherical HIFU exposures, or by generating one large single lesion with toroidal HIFU exposures (DSC > 75%). Fusion modeling predictions were preliminarily validated in vivo and showed the potential of using a long-duration toroidal HIFU exposure to accelerate the ablation process during breathing (from 0.5 to 6 cm3 · min(-1)). To improve HIFU treatment control, dynamic fusion modeling may be interesting for assessing numerically focusing strategies and motion compensation techniques in more realistic conditions.
Collapse
|
27
|
High Intensity Focused Ultrasound versus Brachytherapy for the Treatment of Localized Prostate Cancer: A Matched-Pair Analysis. Adv Urol 2015; 2015:350324. [PMID: 26357511 PMCID: PMC4556829 DOI: 10.1155/2015/350324] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/09/2015] [Indexed: 12/15/2022] Open
Abstract
Purpose. To evaluate postoperative morbidity and long term oncologic and functional outcomes of high intensity focused ultrasound (HIFU) compared to brachytherapy for the treatment of localized prostate cancer. Material and Methods. Patients treated by brachytherapy were matched 1 : 1 with patients who underwent HIFU. Differences in postoperative complications across the two groups were assessed using Wilcoxon's rank-sum or χ (2) test. Kaplan-Meier curves, log-rank tests, and Cox regression models were constructed to assess differences in survival rates between the two groups. Results. Brachytherapy was significantly associated with lower voiding LUTS and less frequent acute urinary retention (p < 0.05). Median oncologic follow-up was 83 months (13-123 months) in the HIFU cohort and 44 months (13-89 months) in the brachytherapy cohort. Median time to achieve PSA nadir was statistically shorter in the HIFU. Biochemical recurrence-free survival rate was significantly higher in the brachytherapy cohort compared to HIFU cohort (68.5% versus 53%, p < 0.05). No statistically significant difference in metastasis-free, cancer specific, and overall survivals was observed between the two groups. Conclusion. HIFU and brachytherapy are safe with no significant difference in cancer specific survival on long term oncologic follow-up. Nonetheless, a randomized controlled trial is needed to confirm these results.
Collapse
|
28
|
Veereman G, Jonckheer P, Desomer A, Van Brabandt H, D'Hont C, Van Velthoven R, Tombal B. Systematic Review of the Efficacy and Safety of High-intensity Focussed Ultrasound for Localised Prostate Cancer. Eur Urol Focus 2015; 1:158-170. [PMID: 28723429 DOI: 10.1016/j.euf.2015.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 04/01/2015] [Accepted: 04/25/2015] [Indexed: 11/19/2022]
Abstract
CONTEXT High-intensity focussed ultrasound (HIFU) has been used for 10 yr to treat localised prostate cancer (PCa). OBJECTIVE To evaluate systematically the evidence on the efficacy and side effects of HIFU in the primary treatment of localised PCa. EVIDENCE ACQUISITION We performed a critical review and appraisal of Medline (Ovid), PreMedline, Embase, and Cochrane Database of Systematic Reviews publications on HIFU up to May 2013. One systematic review and 18 primary studies, all case series, were eligible. EVIDENCE SYNTHESIS Outcomes were summarised and evidence was evaluated using Grading of Recommendations, Assessment, Development and Evaluation methodology. Low-quality evidence suggests an overall survival rate after Ablatherm HIFU ranging from 80% to 89% for >5 yr. The PCa survival rate ranges from 97% to 99% for >5 yr. Effect of HIFU on quality of life remains undetermined. Erectile dysfunction was the most frequent adverse event reported from zero but up to 74% of patients. Adverse events affecting the urinary tract occurred in 0.7-31% of patients, bladder outlet obstruction in 4-51.5%, and they were more frequent in patients who had transurethral resection of the prostate the same day or within 2 d of HIFU. Outcomes vary for low- and high-risk categories. CONCLUSIONS Good quality evidence on the efficacy of HIFU treatment for localised PCa is lacking. PATIENT SUMMARY We reviewed all the data on treatment with high-intensity focussed ultrasound (HIFU) for localised prostate cancer (PCa). The quality of the evidence is very low because the information is based on a series of patients who received HIFU treatment with no comparison with active surveillance or radical treatment. Case series suggest an overall survival rate up to 89% and a PCa survival rate up to 99% after 5 yr, but these numbers vary according to the patient's risk category. Longer term and effects on quality of life are unknown.
Collapse
Affiliation(s)
| | | | - Anja Desomer
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
| | | | - Chris D'Hont
- Department of Urology, AZ Middelheim, Ziekenhuis Netwerk Antwerpen, Antwerp, Belgium
| | | | | |
Collapse
|
29
|
Role of active surveillance and focal therapy in low- and intermediate-risk prostate cancers. World J Urol 2015; 33:907-16. [PMID: 26037891 DOI: 10.1007/s00345-015-1603-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 04/26/2015] [Indexed: 01/19/2023] Open
|
30
|
Mearini L, D'Urso L, Collura D, Nunzi E, Muto G, Porena M. High-intensity focused ultrasound for the treatment of prostate cancer: A prospective trial with long-term follow-up. Scand J Urol 2014; 49:267-74. [PMID: 25485722 DOI: 10.3109/21681805.2014.988174] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE High-intensity focused ultrasound (HIFU) is a minimally invasive treatment for prostate cancer. Data from the literature show promising oncological outcomes with a favourable side-effect profile. The aim of this study was to re-evaluate and bring up to date the follow-up of a previously published, prospective trial on HIFU as the primary treatment for prostate cancer. MATERIALS AND METHODS Between 2004 and 2007, 163 consecutive men with T1-T3N0M0 prostate cancer underwent HIFU with the Sonablate 500. Follow-up included prostate-specific antigen (PSA) tests every 3 months after treatment and a random prostate biopsy at 6 months. Failure was defined according to positive findings at the 6 month biopsy and biochemical failure was defined according to the Phoenix criteria. Biochemical-free survival, metastasis-free survival and cancer-specific survival were calculated by Kaplan-Meier curves. RESULTS Median follow-up was 72.0 months. Of the 160 evaluable patients, 104 (65%) were biochemically disease free; in low- to intermediate-risk disease, on Kaplan-Meier analysis the 8 year biochemical-non-evidence of disease (bNED), metastasis-free survival and cancer-specific survival rates were 69.6%, 81.3%, 100% and 40.5%, 60.6%, 100%, respectively. A PSA nadir below 0.40 ng/ml and risk stratification have an independent predictive value for bNED and metastasis-free survival. CONCLUSIONS A long-term favourable outcome of HIFU is associated with careful patient selection, with low- to intermediate-risk disease being the ideal case. A low postoperative PSA nadir is a predictor of long-term bNED.
Collapse
Affiliation(s)
- Luigi Mearini
- University of Perugia, Urology Department, Ospedale Santa Maria della Misericordia, Sant'Andrea delle Fratte , Perugia , Italy
| | | | | | | | | | | |
Collapse
|
31
|
Gómez-Veiga F, Martínez-Breijo S, Solsona-Narbón E, Hernández C, Ciudin A, Ribal M, Dickinson L, Moore C, Ahmed H, Rodríguez Antolín A, Breda A, Gaya J, Portela-Pereira P, Emberton M. Focal therapy for prostate cancer. Alternative treatment. Actas Urol Esp 2014; 38:465-75. [PMID: 24612733 DOI: 10.1016/j.acuro.2013.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 12/19/2013] [Indexed: 02/04/2023]
Abstract
CONTEXT The great controversy surrounding the treatment of localized prostate cancer is related with its possibilities of radical treatment or active surveillance. The objective of this paper is to analyze the rationale selection among current focal therapy modalities regarding tumor and patient selection. EVIDENCE ACQUISITION Current articles about advantages and disadvantages on the treatment of localized prostate cancer as well as information about focal therapy regarding tumour selection, characteristics and indications cited in MEDLINE search were reviewed. SUMMARY OF EVIDENCE Focal therapy standardized criteria must be: low risk tumors, PSA<10-15, Gleason score ≤ 6, and unilateral presentation all supported by image-guided biopsy and nuclear magnetic resonance (NMR). There are doubts about the suitability of focal therapy in cases of bilateralism or in those with Gleason score 3+4 or PSA>15. CONCLUSIONS Focal therapy is an alternative for localized prostate cancer treatment. However, some aspects of their diagnosis and selection criteria should be defined by prospective studies which should provide knowledge about the indication for focal therapy.
Collapse
|
32
|
Tumor boundary detection in ultrasound imagery using multi-scale generalized gradient vector flow. J Med Ultrason (2001) 2014; 42:25-38. [DOI: 10.1007/s10396-014-0559-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 06/18/2014] [Indexed: 01/29/2023]
|
33
|
Abstract
Surgery remains a mainstay in the management of localized prostate cancer. This article addresses surgical aspects germane to the management of men with prostate cancer, including patient selection for surgery, nerve-sparing approaches, minimization of positive surgical margins, and indications for pelvic lymph node dissection. Outcomes for men with high-risk prostate cancer following surgery are reviewed, and the present role of neoadjuvant therapy before radical prostatectomy is discussed. In addition, there is a review of the published literature on surgical ablative therapies for prostate cancer.
Collapse
|
34
|
Crouzet S, Chapelon JY, Rouvière O, Mege-Lechevallier F, Colombel M, Tonoli-Catez H, Martin X, Gelet A. Whole-gland Ablation of Localized Prostate Cancer with High-intensity Focused Ultrasound: Oncologic Outcomes and Morbidity in 1002 Patients. Eur Urol 2014; 65:907-14. [DOI: 10.1016/j.eururo.2013.04.039] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Accepted: 04/20/2013] [Indexed: 12/20/2022]
|
35
|
Ganzer R, Bründl J, Koch D, Wieland WF, Burger M, Blana A. Correlation of pretreatment clinical parameters and PSA nadir after high-intensity focused ultrasound (HIFU) for localised prostate cancer. World J Urol 2014; 33:99-104. [PMID: 24696277 DOI: 10.1007/s00345-014-1289-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 03/21/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To determine which pretreatment clinical parameters were predictive of a low prostate-specific antigen (PSA) nadir following high-intensity focused ultrasound (HIFU) treatment. PATIENTS AND METHODS Retrospective study of patients with clinically localised prostate cancer undergoing HIFU at a single centre between December 1997 and September 2009. Whole-gland treatment was applied. Patients also included if they had previously undergone transurethral resection of the prostate (TURP). TURP was also conducted simultaneously to HIFU. Biochemical failure based on Phoenix definition (PSA nadir + 2). Univariate and multivariate analysis of pretreatment clinical parameters conducted to assess those factors predictive of a PSA nadir ≤0.2 and >0.2 ng/ml. RESULTS Mean (SD) follow-up was 6.2 (2.8) years; median (range) was 6.3 (1.1-12.2) years. Kaplan-Meier estimate of biochemical disease-free survival rate at 8 years was 83 and 48 % for patients achieving a PSA nadir of ≤0.2 and >0.2 ng/ml, respectively. Prostate volume and incidental finding of cancer were significant predictors of low PSA nadir (≤0.2 ng/ml). CONCLUSIONS Prostate volume and incidental finding of cancer could be predictors for oncologic success of HIFU based on post-treatment PSA nadir.
Collapse
Affiliation(s)
- Roman Ganzer
- Department of Urology, University of Regensburg, Regensburg, Germany
| | | | | | | | | | | |
Collapse
|
36
|
Muto S, Kaminaga T, Horiuchi A, Kitamura K, Saito K, Isotani S, Yamaguchi R, Ide H, Furui S, Horie S. Usefulness of proton magnetic resonance spectroscopy in predicting positive biopsy after high-intensity focused ultrasound for treatment of localized prostate cancer. Int J Urol 2014; 21:776-80. [PMID: 24650235 DOI: 10.1111/iju.12442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 02/11/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the clinical effectiveness of proton magnetic resonance spectroscopy in predicting local recurrence or residual disease after high-intensity focused ultrasound for treatment of localized prostate cancer. METHODS The present study included patients with localized prostate cancer who underwent high-intensity focused ultrasound of whole-gland ablation as primary therapy. Clinicopathological variables including proton magnetic resonance spectroscopy, T2-weighted magnetic resonance imaging, and prostate-specific antigen and its derivatives were analyzed to predict the positive prostate biopsy results using univariate and multivariate analyses. Furthermore, the presence of tumor in each of the 12 prostate sectors by T2-weighted magnetic resonance imaging and proton magnetic resonance spectroscopy were evaluated and compared with prostate biopsy results in each of the 12 prostate sectors in order to evaluate the local cancer distribution in the prostate after high-intensity focused ultrasound. RESULTS Overall, we carried out 85 prostate biopsies in 52 patients. Multivariate logistic regression analysis showed that the positive finding of proton magnetic resonance spectroscopy was the only statistically significant prognostic parameter of pathological tumor progression in patients after high-intensity focused ultrasound. Prostate biopsy cores were obtained from 952 prostate sectors of 52 patients and 85 prostate biopsies. Compared with T2-weighted magnetic resonance imaging, proton magnetic resonance spectroscopy (sensitivity 52.8%, specificity 97.4%, positive predictive value 44.2% and negative predictive value 98.1%, P < 0.001) has higher values to predict local tumor progression in prostate sectors after high-intensity focused ultrasound. CONCLUSIONS Proton magnetic resonance spectroscopy is a useful, non-invasive diagnostic modality that predicts local tumor progression in patients after high-intensity focused ultrasound, as well as local cancer distribution at each of the prostate sectors with pinpoint accuracy.
Collapse
Affiliation(s)
- Satoru Muto
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Schlesinger D, Benedict S, Diederich C, Gedroyc W, Klibanov A, Larner J. MR-guided focused ultrasound surgery, present and future. Med Phys 2014; 40:080901. [PMID: 23927296 DOI: 10.1118/1.4811136] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
MR-guided focused ultrasound surgery (MRgFUS) is a quickly developing technology with potential applications across a spectrum of indications traditionally within the domain of radiation oncology. Especially for applications where focal treatment is the preferred technique (for example, radiosurgery), MRgFUS has the potential to be a disruptive technology that could shift traditional patterns of care. While currently cleared in the United States for the noninvasive treatment of uterine fibroids and bone metastases, a wide range of clinical trials are currently underway, and the number of publications describing advances in MRgFUS is increasing. However, for MRgFUS to make the transition from a research curiosity to a clinical standard of care, a variety of challenges, technical, financial, clinical, and practical, must be overcome. This installment of the Vision 20∕20 series examines the current status of MRgFUS, focusing on the hurdles the technology faces before it can cross over from a research technique to a standard fixture in the clinic. It then reviews current and near-term technical developments which may overcome these hurdles and allow MRgFUS to break through into clinical practice.
Collapse
Affiliation(s)
- David Schlesinger
- Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia 22908, USA.
| | | | | | | | | | | |
Collapse
|
38
|
Kamaya A, Machtaler S, Safari Sanjani S, Nikoozadeh A, Graham Sommer F, Pierre Khuri-Yakub BT, Willmann JK, Desser TS. New technologies in clinical ultrasound. Semin Roentgenol 2014; 48:214-23. [PMID: 23796372 DOI: 10.1053/j.ro.2013.03.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Aya Kamaya
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Wolfram F, Boltze C, Schubert H, Bischoff S, Lesser TG. Effect of lung flooding and high-intensity focused ultrasound on lung tumours: an experimental study in an ex vivo human cancer model and simulated in vivo tumours in pigs. Eur J Med Res 2014; 19:1. [PMID: 24393333 PMCID: PMC3892005 DOI: 10.1186/2047-783x-19-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 12/19/2013] [Indexed: 12/19/2022] Open
Abstract
Background High-intensity focused ultrasound is a valuable tool for minimally invasive tumour ablation. However, due to the air content in ventilated lungs, lung tumours have never been treated with high-intensity focused ultrasound. Lung flooding enables efficient lung sonography and tumour imaging in ex vivo human and in vivo porcine lung cancer models. The current study evaluates the effectiveness of lung flooding and sonography-guided high-intensity focused ultrasound for lung tumour ablation in ex vivo human and in vivo animal models. Methods Lung flooding was performed in four human lung lobes which were resected from non-small cell lung cancers. B-mode imaging and temperature measurements were simultaneously obtained during high-intensity focused ultrasonography of centrally located lung cancers. The tumour was removed immediately following insonation and processed for nicotinamide adenine dinucleotide phosphate-diaphorase and H&E staining. In addition, the left lungs of three pigs were flooded. Purified BSA in glutaraldehyde was injected centrally into the left lower lung lobe to simulate a lung tumour. The ultrasound was focused transthoracically through the flooded lung into the simulated tumour with the guidance of sonography. The temperature of the tumour was simultaneously measured. The vital signs of the animal were monitored during the procedure. Results A well-demarcated lesion of coagulation necrosis was produced in four of four human lung tumours. There did not appear to be any damage to the surrounding lung parenchyma. After high-intensity focused ultrasound insonation, the mean temperature increase was 7.5-fold higher in the ex vivo human tumour than in the flooded lung tissue (52.1 K ± 8.77 K versus 7.1 K ± 2.5 K). The transthoracic high-intensity focused ultrasound of simulated tumours in the in vivo model resulted in a mean peak temperature increase up to 53.7°C (±4.5). All of the animals survived the procedure without haemodynamic complications. Conclusions High-intensity focused ultrasound with lung flooding produced a thermal effect in an ex vivo human lung carcinoma and in vivo simulated lung tumours in a porcine model. High-intensity focused ultrasound is a potential new strategy for treating lung cancer.
Collapse
Affiliation(s)
| | | | | | | | - Thomas Günther Lesser
- Department of Thoracic and Vascular Surgery, SRH Wald-Klinikum Gera, Teaching Hospital of Friedrich-Schiller-University of Jena, Strasse des Friedens 122, D-07548 Gera, Germany.
| |
Collapse
|
40
|
Kripfgans OD, Zhang M, Fabiilli ML, Carson PL, Padilla F, Swanson SD, Mougenot C, Fowlkes JB, Mougenot C. Acceleration of ultrasound thermal therapy by patterned acoustic droplet vaporization. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2014; 135:537-44. [PMID: 24437794 PMCID: PMC3985868 DOI: 10.1121/1.4828832] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 09/11/2013] [Accepted: 10/21/2013] [Indexed: 05/28/2023]
Abstract
One application of acoustic droplet vaporization (ADV), a method of converting biocompatible microdroplets into microbubbles, is to enhance locally high intensity focused ultrasound (HIFU) therapy. Two objectives are pursued here: (1) the controlled creation of a bubble trench prior to HIFU using ADV and (2) use of the trench for increasing ablation volumes, lowering acoustic powers, and decreasing therapy duration. Thermally responsive phantoms were made with perfluorocarbon emulsion. Compound lesions were formed in a laboratory setting and a clinical magnetic resonance imaging (MRI)-guided HIFU system. Linear and spiral patterned compound lesions were generated in trenches. A larger fraction of the HIFU beam is contained to increase the generation of heat. Using the laboratory system, a 90 mm linear length spiral trench was formed in 30 s with mechanical beam steering. Comparatively, the clinical HIFU system formed a 19.9 mm linear length spiral trench in approximately 1 s with electronic beam steering. Lesions were imaged optically and with MRI. A uniform thermal ablation volume of 3.25 mL was achieved in 55.4 s (4-times faster than standard clinical HIFU and 14-times larger volume versus sum of individual lesions). Single lesions showed a 400% volume increase.
Collapse
Affiliation(s)
- Oliver D Kripfgans
- Department of Radiology, University of Michigan Health System, 1301 Catherine Street, Med Sci 1, Room 3218D, Ann Arbor, Michigan 48109-5667
| | - Man Zhang
- Department of Radiology, University of Michigan Health System, 1301 Catherine Street, Med Sci 1, Room 3218D, Ann Arbor, Michigan 48109-5667
| | - Mario L Fabiilli
- Department of Radiology, University of Michigan Health System, 1301 Catherine Street, Med Sci 1, Room 3218D, Ann Arbor, Michigan 48109-5667
| | - Paul L Carson
- Department of Radiology, University of Michigan Health System, 1301 Catherine Street, Med Sci 1, Room 3218D, Ann Arbor, Michigan 48109-5667
| | - Frederic Padilla
- Department of Radiology, University of Michigan Health System, 1301 Catherine Street, Med Sci 1, Room 3218D, Ann Arbor, Michigan 48109-5667
| | - Scott D Swanson
- Department of Radiology, University of Michigan Health System, 1301 Catherine Street, Med Sci 1, Room 3218D, Ann Arbor, Michigan 48109-5667
| | - Charles Mougenot
- Department of Radiology, University of Michigan Health System, 1301 Catherine Street, Med Sci 1, Room 3218D, Ann Arbor, Michigan 48109-5667
| | - J Brian Fowlkes
- Department of Radiology, University of Michigan Health System, 1301 Catherine Street, Med Sci 1, Room 3218D, Ann Arbor, Michigan 48109-5667
| | - Charles Mougenot
- Philips Healthcare, 281 Hilmount Road, Markham, Ontario L6C 2S3, Canada
| |
Collapse
|
41
|
Komura K, Inamoto T, Takai T, Uchimoto T, Saito K, Tanda N, Kono J, Minami K, Uehara H, Fujisue Y, Takahara K, Hirano H, Nomi H, Watsuji T, Kiyama S, Azuma H. Single session of high-intensity focused ultrasound for localized prostate cancer: treatment outcomes and potential effect as a primary therapy. World J Urol 2013; 32:1339-45. [PMID: 24270943 PMCID: PMC4176571 DOI: 10.1007/s00345-013-1215-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 11/14/2013] [Indexed: 11/17/2022] Open
Abstract
Purpose To investigate the treatment outcomes of a single-session high-intensity focused ultrasound (HIFU) using the Sonablate® for patients with localized prostate cancer. Methods Biochemical failure was defined according to the Stuttgart definition [a rise of 1.2 ng/ml or more above the nadir prostate-specific antigen (PSA)] and the Phoenix definition (a rise of 2 ng/ml or more above the nadir PSA). Disease-free survival rate was defined using the Phoenix criteria and positive follow-up biopsy. Results A total of 171 patients were identified. Fifty-two (30.4 %) patients were identified to be with D’Amico low risk, 47 (27.5 %) with intermediate risk, and 72 (42.1 %) with high risk. In the median follow-up time of 43 months, there was 44 (25.7 %) and 36 (21.1 %) patients experienced biochemical failure for Stuttgart and Phoenix definition with mean (±SD) time to failure of 17.8 ± 2.1 and 19.4 ± 2.3 months, respectively. A total of 44 (25.7 %) patients were diagnosed as disease failure. Cox multivariate analysis revealed PSA nadir level (PSA cutoff = 0.2 ng/ml; HR = 9.472, 95 % CI 4.527–19.820, p < 0.001) and D’amico risk groups [HR = 3.132 (95 % CI 1.251–6.389), p = 0.033] were the predictor for failure in single-session HIFU. Conclusions Single-session HIFU treatment using the Sonablate® seems to be potentially curative approach. When treated carefully with neoadjuvant hormonal therapy or preoperative transurethral resection of the prostate, higher-risk disease might be able to choose this minimally invasive procedure as primary therapy.
Collapse
Affiliation(s)
- Kazumasa Komura
- Department of Urology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Salomon L, Bastide C, Beuzeboc P, Cormier L, Fromont G, Hennequin C, Mongiat-Artus P, Peyromaure M, Ploussard G, Renard-Penna R, Rozet F, Azria D, Coloby P, Molinié V, Ravery V, Rebillard X, Richaud P, Villers A, Soulié M. Recommandations en onco-urologie 2013 du CCAFU : Cancer de la prostate. Prog Urol 2013; 23 Suppl 2:S69-101. [DOI: 10.1016/s1166-7087(13)70048-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|
43
|
Schade GR, Styn NR, Ives KA, Hall TL, Roberts WW. Prostate histotripsy: evaluation of prostatic urethral treatment parameters in a canine model. BJU Int 2013; 113:498-503. [PMID: 24176120 DOI: 10.1111/bju.12333] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the impact of histotripsy treatment parameters (pulse number and pulse-repetition frequency [PRF]) on the efficiency of histotripsy induced homogenisation of the prostatic urethra. MATERIALS AND METHODS In all, 34 transabdominal prostate histotripsy treatments were applied along a perpendicular plane traversing the prostatic urethra of 21 dogs. Prostate histotripsy was applied with (i) escalating pulse number with fixed PRF or (ii) at fixed pulse number with varying PRFs. The development of urethral homognisation ≤14 days of histotripsy was evaluated endoscopically and confirmed histologically. RESULTS Within 14 days of histotripsy 50%, 83%, 83%, and 100% of dogs receiving 12 500, 25 000, 50 000, and 100 000 pulses/mm of treatment path (delivered at 500 Hz PRF), respectively developed prostatic urethral disintegration. Delivery of 100 000 pulses/mm was required to achieve urethral disintegration in all dogs within 24 h of histotripsy treatment. Increasing histotripsy PRF from 50 to 500 to 2000 Hz while applying a constant dose of 25 000 pulses/mm treatment was associated with increased rate of urethral disintegration (50% vs 75% vs 100% at 14 days, respectively). CONCLUSIONS Increasing the number of histotripsy pulses and/or increasing the PRF of histotripsy treatment applied to the urethra may improve the rate and efficiency of prostatic urethral disintegration in the canine model. This understanding will aid in the development of treatment strategies for prostate histotripsy for benign prostatic hyperplasia in human trials.
Collapse
Affiliation(s)
- George R Schade
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | | | | | | | | |
Collapse
|
44
|
Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, Mason M, Matveev V, Wiegel T, Zattoni F, Mottet N. EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol 2013; 65:124-37. [PMID: 24207135 DOI: 10.1016/j.eururo.2013.09.046] [Citation(s) in RCA: 1379] [Impact Index Per Article: 125.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 09/26/2013] [Indexed: 12/18/2022]
Abstract
CONTEXT The most recent summary of the European Association of Urology (EAU) guidelines on prostate cancer (PCa) was published in 2011. OBJECTIVE To present a summary of the 2013 version of the EAU guidelines on screening, diagnosis, and local treatment with curative intent of clinically organ-confined PCa. EVIDENCE ACQUISITION A literature review of the new data emerging from 2011 to 2013 has been performed by the EAU PCa guideline group. The guidelines have been updated, and levels of evidence and grades of recommendation have been added to the text based on a systematic review of the literature, which included a search of online databases and bibliographic reviews. EVIDENCE SYNTHESIS A full version of the guidelines is available at the EAU office or online (www.uroweb.org). Current evidence is insufficient to warrant widespread population-based screening by prostate-specific antigen (PSA) for PCa. Systematic prostate biopsies under ultrasound guidance and local anesthesia are the preferred diagnostic method. Active surveillance represents a viable option in men with low-risk PCa and a long life expectancy. A biopsy progression indicates the need for active intervention, whereas the role of PSA doubling time is controversial. In men with locally advanced PCa for whom local therapy is not mandatory, watchful waiting (WW) is a treatment alternative to androgen-deprivation therapy (ADT), with equivalent oncologic efficacy. Active treatment is recommended mostly for patients with localized disease and a long life expectancy, with radical prostatectomy (RP) shown to be superior to WW in prospective randomized trials. Nerve-sparing RP is the approach of choice in organ-confined disease, while neoadjuvant ADT provides no improvement in outcome variables. Radiation therapy should be performed with ≥ 74 Gy in low-risk PCa and 78 Gy in intermediate- or high-risk PCa. For locally advanced disease, adjuvant ADT for 3 yr results in superior rates for disease-specific and overall survival and is the treatment of choice. Follow-up after local therapy is largely based on PSA and a disease-specific history, with imaging indicated only when symptoms occur. CONCLUSIONS Knowledge in the field of PCa is rapidly changing. These EAU guidelines on PCa summarize the most recent findings and put them into clinical practice. PATIENT SUMMARY A summary is presented of the 2013 EAU guidelines on screening, diagnosis, and local treatment with curative intent of clinically organ-confined prostate cancer (PCa). Screening continues to be done on an individual basis, in consultation with a physician. Diagnosis is by prostate biopsy. Active surveillance is an option in low-risk PCa and watchful waiting is an alternative to androgen-deprivation therapy in locally advanced PCa not requiring immediate local treatment. Radical prostatectomy is the only surgical option. Radiation therapy can be external or delivered by way of prostate implants. Treatment follow-up is based on the PSA level.
Collapse
|
45
|
Crouzet S. Reply from author re: J. Kellogg Parsons. High-intensity focused ultrasound for prostate cancer: tempering our enthusiasm. Eur Urol 2014;65:915-6: High-intensity focused ultrasound for prostate cancer: feeding our enthusiasm. Eur Urol 2013; 65:916-7. [PMID: 24021388 DOI: 10.1016/j.eururo.2013.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 08/12/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Sébastien Crouzet
- Urology and Transplantation Department, Edouard Herriot Hospital, Lyon, France.
| |
Collapse
|
46
|
Thüroff S, Chaussy C. Evolution and Outcomes of 3 MHz High Intensity Focused Ultrasound Therapy for Localized Prostate Cancer During 15 Years. J Urol 2013; 190:702-10. [DOI: 10.1016/j.juro.2013.02.010] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Stefan Thüroff
- Harlachinger Krebshilfe e.V., Munich, Germany
- Department of Urology, Klinikum Harlaching, Munich, Germany
| | - Christian Chaussy
- Harlachinger Krebshilfe e.V., Munich, Germany
- Department of Urology, University of Regensburg, Regensburg, Germany
| |
Collapse
|
47
|
Foley JL, Eames M, Snell J, Hananel A, Kassell N, Aubry JF. Image-guided focused ultrasound: state of the technology and the challenges that lie ahead. ACTA ACUST UNITED AC 2013. [DOI: 10.2217/iim.13.38] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
48
|
Contemporary Grading for Prostate Cancer: Implications for Patient Care. Eur Urol 2013; 63:892-901. [DOI: 10.1016/j.eururo.2012.10.015] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 10/09/2012] [Indexed: 01/19/2023]
|
49
|
Treatment of urethral/bladder neck stricture after high-intensity focused ultrasound for prostate cancer with holmium: yttrium-aluminium-garnet laser. Int Neurourol J 2013; 17:24-9. [PMID: 23610708 PMCID: PMC3627995 DOI: 10.5213/inj.2013.17.1.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 03/18/2013] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the efficacy and safety of the Holmium: yttrium-aluminium-garnet (YAG) laser for the treatment of urethral/bladder neck strictures after high-intensity focused ultrasound for prostate cancer. Methods Between February 2007 and July 2010, Holmium: YAG laser urethrotomies were performed in eleven patients for bladder neck strictures or prostatic urethral strictures. The laser was used with a 550-µm fiber at 2 J and frequency 30 to 50 Hz. The medical records were retrospectively reviewed for medical history, perioperative and postoperative data, uroflowmetry, International Prostate Symptoms Score/quality of life, and stricture recurrence. Results At a median follow-up of 12.0 months (range, 4 to 35 months), the mean postoperative maximal flow rate and residual volume were improved significantly (P<0.05). The mean postoperative total, voiding and quality of life of international prostate symptom score were improved significantly (P<0.05). Of the 11 patients, 7 patients required one treatment, 4 patients two treatment, and 1 patients three treatment. 2 patients who had a documented urinary incontinence prior to the laser treatment subsequently required artificial urinary sphincter implantation and reported satisfaction without developing any recurrent strictures or artificial urinary sphincter erosion. All patients exhibited well-healed strictures and could void without difficulty. Conclusions Holmium: YAG laser therapy represents a safe, effective and minimally invasive treatment for urethral/bladder neck strictures occurring secondary to high-intensity focused ultrasound for prostate cancer.
Collapse
|
50
|
Shoji S, Uchida T, Nakamoto M, Kim H, de Castro Abreu AL, Leslie S, Sato Y, Gill IS, Ukimura O. Prostate swelling and shift during high intensity focused ultrasound: implication for targeted focal therapy. J Urol 2013; 190:1224-32. [PMID: 23583532 DOI: 10.1016/j.juro.2013.03.116] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE We quantified prostate swelling and the intraprostatic point shift during high intensity focused ultrasound using real-time ultrasound. MATERIALS AND METHODS The institutional review board approved this retrospective study. Whole gland high intensity focused ultrasound was done in 44 patients with clinically localized prostate cancer. Three high intensity focused ultrasound sessions were required to cover the entire prostate, including the anterior zone (session 1), middle zone (session 2) and posterior zone (session 3). Computer assisted 3-dimensional reconstructions based on 3 mm step-section images of intraoperative transrectal ultrasound were compared before and after each session. RESULTS Most prostate swelling and intraprostatic point shifts occurred during session 1. The median percent volume increase was 18% for the transition zone, 9% for the peripheral zone and 13% for the entire prostate. The volume percent increase in the transition zone (p <0.001), peripheral zone (p = 0.001) and entire prostate (p = 0.001) statistically depended on the volume of each area measured preoperatively. The median 3-dimensional intraprostatic shift was 3.7 mm (range 0.9 to 13) in the transition zone and 5.5 mm (range 0.2 to 14) in the peripheral zone. A significant negative linear correlation was found between the preoperative presumed circle area ratio, and the percent increase in prostate volume (p = 0.001) and shift (p = 0.01) during high intensity focused ultrasound. CONCLUSIONS We quantified significant prostate swelling and shift during high intensity focused ultrasound. Smaller prostates and a smaller preoperative presumed circle area ratio were associated with greater prostate swelling and intraprostatic shifts. Real-time intraoperative adjustment of the treatment plan impacts the achievement of precise targeting during high intensity focused ultrasound, especially in prostates with a smaller volume and/or a smaller preoperative presumed circle area ratio.
Collapse
Affiliation(s)
- Sunao Shoji
- University of Southern California Institute of Urology, Hillard and Roclyn Herzog Center for Prostate Cancer Focal Therapy, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Urology, Tokai University Hachioji Hospital, Hachioji, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|