局限性攝護腺癌第一線治療失敗後以海福刀，冷凍或放射線當救援性治療
江博暉、方富民1、江品葭
高雄長庚紀念醫院 泌尿科，1放射腫瘤科
Salvage high intensity focused ultrasound, cryoablation or radiotherapy after primary treatment of localized prostate cancer
Po Hui Chiang, Fu-Min Fang1, Ping-Chia Chiang
Divisions of Urology and Radiation Oncology1 Kaohsiung Chang Gung Memorial Hospital, Taiwan
Purpose: Introduction: Radical prostatectomy (RP), radiotherapy, cryoablation or high intensity focused ultrasound (HIFU) plays a primary treatment of prostate cancer. However, there are 15-50 % patients suffering from biochemical failure after either primary treatment.
Materials and Methods: HIFU, cryoablation or external beam radiotherapy (EBRT) has been used as a salvage role for these patients. We retrospectively review the treatment outcome of salvage EBRT for 42 prostate cancer patients after RP and 37 patients after HIFU with biochemical failure at our institute. Besides, patients after EBRT with biochemical failure receiving salvage HIFU or cryoablation will also be presented.
Results: The biochemical failure rate after salvage EBRT was 14.3% in the RP group and 18.9% in the HIFU group, respectively (p=0.58). The complication rate of radiation proctitis was low (all grade 1) in both groups (2.4% and 5.4%in RP and HIFU group, respectively). No patient has radiation cystitis. However, 9(24.3%) patients in the HIFU group versus 3 (7.1%) patients experienced statistically significantly higher incidence rate of urethral stricture after salvage EBRT (p=0.03). HIFU or cryoablation serves as a salvage treatment after EBRT results in a feasible biochemical free survival at a price of high morbidity.
Conclusion: All salvage treatment modalities (HIFU, cryoablation or EBRT) can achieve feasible cancer control rate. However, salvage treatment after EBRT seems to have a higher morbidity.