海福刀前列腺癌治療後復發之救援性放射治療
吳彥廷、黃冠霖、方富民、王友明、徐淳建、莊燿吉、江博暉
高雄長庚紀念醫院 泌尿科
Salvage Radiotherapy for Recurrence of Localized Prostate Cancer after High-Intensity Focused Ultrasound (HIFU)
Yen-Ting Wu, Guan-Lin Huang, Fu-Min Fang, You-Ming Wang, Chun-Chien Hsu, Yao-Chi Chuang, Po-Hui Chiang
Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
Purpose: Despite increasing application of high-intensity focused ultrasound (HIFU), there was few published experience regarding to salvage management for recurrent localized prostate cancer. We aim to evaluate tolerance and oncologic control with salvage radiotherapy (SRT) after HIFU failure and to identify predictive factors of success.
Materials and Methods: In this single-centre retrospective study, retrospective analysis on 121 localized prostate cancer patients status post the HIFU therapy from December 2009 to July 2015 were performed with perioperative data. Total 11 patients underwent salvage radiotherapy with dose ranging from 2400-7200 cGy. The median dose of conformal treatment was 7000 cGy. The primary outcome measure was progression-free survival (PFS) defined as no biochemical relapse (two consecutive rises in prostate-specific antigen [PSA] with a velocity>0.4 ng/ml per year or PSA >1.5 ng/ml) and no additional treatment. Adverse events in terms of genitourinary and gastrointestinal toxicity were reported.
Results: The mean follow-up of the 121 patients was 32.7 months and total 11 patients underwent salvage radiotherapy. Six patients received SRT and hormone therapy. Five patients received SRT alone. 6-month progression-free survival was observed in total 6 patients receiving SRT and hormone therapy achieved. However, biochemical relapse was documented in two patients, 9.47 and 12.20 months after salvage treatment completed, respectively. Among 5 patients receiving SRT alone, two patients encountered treatment failure. There is 1 patients who had histologically proven local relapse. 6-month progression-free survival was observed in the other 2 patients. Salvage radiotherapy was discontinued on 1 patient, who developed grade 4 ileus after 2400 cGy of radiation. There was also 2 patients getting grade 3 gastrointestinal toxicity, bloody stool and anal ulcer with bleeding, respectively. Otherwise, gastrointestinal toxicity was low. All genitourinary toxicity are grade 1-2. Three patients had no genitourinary symptom.
Conclusion: In this preliminary study, combined radiotherapy and hormone therapy seemed provied satisfactory oncologic control after for salvage treatment after primary HIFU failure. Though genitourinary and gastrointestinal toxicity were usually low, Grade 3-4 toxicity was still noted. These results warrant further and longer investigation.