Established focal therapy-HIFU, IRE, or cryotherapy-where are we now?-a systematic review and meta-analysis.

IF 5.1 2区医学 Q1 ONCOLOGY Prostate Cancer and Prostatic Diseases Pub Date : 2024-10-28 DOI:10.1038/s41391-024-00911-2

Kae Jack Tay, Khi Yung Fong, Armando Stabile, Jose Luis Dominguez-Escrig, Osamu Ukimura, Lara Rodriguez-Sanchez, Andreas Blana, Ezequiel Becher, M Pilar Laguna

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Abstract

Introduction: Focal Therapy (FT) is a treatment option for the treatment of limited volume clinically significant prostate cancer (csPCa). We aim to systematically review outcomes of established FT modalities to assess the contemporary baseline and identify gaps in evidence that will aid in further trial and study design.

Methods: We conducted a systematic review and meta-analysis of all primary studies reporting outcomes of FT using cryotherapy, high-intensity focused ultrasound (HIFU), and irreversible electroporation (IRE). We described patient inclusion criteria, selection tools, treatment parameters, and surveillance protocols, and pooled overall survival (OS), cancer-specific survival (CSS), metastasis-free survival (MFS), biochemical progression (BP), biopsy, secondary treatment, sexual, and urinary function outcomes. Composite failure was defined as salvage whole gland ablation, radical treatment, hormonal therapy or transition to watchful waiting.

Synthesis: We identified 49 unique cohorts of men undergoing FT between 2008 and 2024 (21 cryotherapy, 20 HIFU, and 8 IRE). Median follow-up ranged from 6 to 63 months. Pooled OS was 98.0%, CSS 99.3%, and MFS 98.5%. Pooled BP was 9.4%/year. Biopsy was mandated post-FT within 24 months in 36/49 (73.5%) cohorts, with pooled csPCa (GG ≥ 2) rates of 22.2% overall, 8.9% infield, and 12.3% outfield. The pooled rate of secondary FT was 5.0%, radical treatment 10.5%, and composite failure 14.1%. Of 35 studies reporting sexual function, 45.7% reported a low, 48.6% moderate, and 5.7% severe impact. For 34 cohorts reporting urinary function, 97.1% reported a low impact. No differences were noted between cryotherapy, HIFU, or IRE in any of the outcomes.

Conclusion: FT with cryotherapy, HIFU, and IRE is associated with good short-intermediate term oncological and functional outcomes. However, outcome reporting is heterogeneous and often incomplete. Long-term follow-up and standardized reporting are required to better define and report FT outcomes.

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成熟的病灶疗法--HIFU、IRE 或冷冻疗法--我们现在在哪里？

前言：病灶治疗（FT）是治疗体积有限、有临床意义的前列腺癌（csPCa）的一种治疗方法。我们旨在系统回顾已确立的病灶治疗模式的结果，以评估当代的基线并找出证据差距，从而有助于进一步的试验和研究设计：方法：我们对所有报告冷冻疗法、高强度聚焦超声（HIFU）和不可逆电穿孔（IRE）FT 结果的主要研究进行了系统回顾和荟萃分析。我们介绍了患者纳入标准、选择工具、治疗参数和监测方案，并汇总了总生存期（OS）、癌症特异性生存期（CSS）、无转移生存期（MFS）、生化进展（BP）、活检、二次治疗、性功能和泌尿功能结果。综合失败的定义是挽救性全腺体消融、根治性治疗、激素治疗或转为观察等待：我们在 2008 年至 2024 年间确定了 49 个独特的男性队列（21 个冷冻疗法、20 个 HIFU 和 8 个 IRE）。中位随访时间从 6 个月到 63 个月不等。汇总 OS 为 98.0%，CSS 为 99.3%，MFS 为 98.5%。汇总血压为 9.4%/年。有 36/49 个队列（73.5%）在 FT 后 24 个月内必须进行活检，汇总的 csPCa（GG ≥ 2）总发生率为 22.2%，内场为 8.9%，外场为 12.3%。继发性 FT 的汇总率为 5.0%，根治性治疗的汇总率为 10.5%，复合失败的汇总率为 14.1%。在 35 项报告性功能的研究中，45.7% 的研究报告了低度影响，48.6% 报告了中度影响，5.7% 报告了严重影响。在 34 项报告泌尿功能的队列中，97.1% 的研究报告了低度影响。冷冻疗法、HIFU 或 IRE 在任何结果上都没有差异：结论：使用冷冻疗法、HIFU 和 IRE 进行 FT 治疗可获得良好的中短期肿瘤学和功能结果。结论：采用冷冻疗法、HIFU 和 IRE 的 FT 具有良好的中短期肿瘤和功能疗效。需要进行长期随访和标准化报告，以更好地定义和报告 FT 的结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Prostate Cancer and Prostatic Diseases 医学-泌尿学与肾脏学

CiteScore

10.00

自引率

6.20%

发文量

142

审稿时长

6-12 weeks

期刊介绍： Prostate Cancer and Prostatic Diseases covers all aspects of prostatic diseases, in particular prostate cancer, the subject of intensive basic and clinical research world-wide. The journal also reports on exciting new developments being made in diagnosis, surgery, radiotherapy, drug discovery and medical management. Prostate Cancer and Prostatic Diseases is of interest to surgeons, oncologists and clinicians treating patients and to those involved in research into diseases of the prostate. The journal covers the three main areas - prostate cancer, male LUTS and prostatitis. Prostate Cancer and Prostatic Diseases publishes original research articles, reviews, topical comment and critical appraisals of scientific meetings and the latest books. The journal also contains a calendar of forthcoming scientific meetings. The Editors and a distinguished Editorial Board ensure that submitted articles receive fast and efficient attention and are refereed to the highest possible scientific standard. A fast track system is available for topical articles of particular significance.