局部不可逆电穿孔治疗局限性前列腺癌——mpMRI和经会阴活检随访的肿瘤学和安全性结果。

IF 2 Q2 UROLOGY & NEPHROLOGY Research and Reports in Urology Pub Date : 2023-01-01 DOI:10.2147/RRU.S393243

Ilan Gielchinsky, Naama Lev-Cohain

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引用次数: 1

摘要

简介:不可逆电穿孔(IRE)技术用于前列腺癌(PC)，该技术在避免组织热效应的同时，在一对电极之间产生连续的电脉冲，电脉冲穿过肿瘤细胞，不可逆地穿透其膜，最终导致细胞死亡。该技术用于原发性局灶性病变以及局灶性抢救病例。本系列报道短期肿瘤控制、生活质量和安全性结果。方法:回顾性分析45例经IRE治疗的原发性PC(38例)和补救性PC(7例)患者的资料。所有患者在治疗前均行会阴MRI/US融合活检和PET-PSMA扫描，以验证单一病变。经会阴纳米刀IRE系统应用于日间护理手术室。术后患者进行6个月mpMRI，血液PSA和1年的确认性活检。第一年的生活质量被记录下来。结果:初始亚组分析中位数(N=38):年龄69岁，初始PSA 5.6 ng/dL，病变大小0.8 mL, ISUP组2(1-3)。中位挽救亚组分析(N=7):年龄76岁，初始PSA 11.9 ng/dL，病变大小2.0 mL, ISUP组4(1-5)。中位置管时间5(3-7)天。无Clavien-Dindo>1并发症报告，无再入院、尿失禁、狭窄或瘘管。5%的患者给予PDE-5i药物。原发组PSA下降39%，mpMRI清除率84%，外场新病变12%，内场病变4%。1年活检:4例有外场临床显著PC，其中3例有re-IRE, 1例有放疗。救助亚组MRI清除率为60%，52%的人在1年内仍保持主动监测。结论:如果有一支技术熟练、训练有素的团队，并在严格的方案下进行IRE治疗，对于原发性和抢救性局灶性PC是安全的。短期肿瘤学结果是有希望的，特别是对原发性病变。长期的肿瘤学结果将随时间公布。

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Focal Irreversible Electroporation for Localized Prostate Cancer - Oncological and Safety Outcomes Using mpMRI and Transperineal Biopsy Follow-Up.

Introduction: Irreversible electroporation (IRE) technology for prostate cancer (PC) generates consecutive electrical pulses between pairs of electrodes which move through tumorous cells, irreversibly perforate their membranes and eventually lead to cell death, while avoiding tissue thermal effect. The technique is used for primary focal lesions as well as for focal salvage cases. This series reports short term oncological control, quality of life and safety results.

Methods: Retrospective data were collected from 45 consecutive cases of primary (N=38) and salvage (N=7) PC patients treated with IRE. All patients had transperineal MRI/US fusion biopsy and PET-PSMA scan prior to treatment, to verify single lesion. Transperineal Nano-Knife IRE system was used in day-care theatre. Patients had 6 months mpMRI, blood PSA and 1 year confirmatory biopsy following procedure. Quality of life was recorded during the first year.

Results: Median primary subgroup analysis (N=38): age 69 years, initial PSA 5.6 ng/dL, lesion size 0.8 mL and ISUP Group 2 (1-3). Median salvage subgroup analysis (N=7): age 76 years, initial PSA 11.9 ng/dL, lesion size 2.0 mL and ISUP Group 4 (1-5). Median catheter time 5 (3-7) days. No Clavien-Dindo>1 complications were reported nor re-admissions, incontinence, strictures or fistulas. 5% of patients were given PDE-5i drugs. Primary group PSA dropped by 39%, mpMRI clearance in 84%, out-field new lesion in 12%, in-field lesion in 4%. Biopsy at 1 year: 4 patients had out-field clinically significant PC, thus 3 had re-IRE and 1 had radiation therapy. Salvage subgroup MRI clearance was 60%, and 52% remained on active surveillance by 1 year.

Conclusion: IRE treatment for focal PC is safe for primary and salvage cases, if done by a meticulously skilled and trained team, and under strict protocols. The short term oncological results are promising especially for primary lesions. Long term oncological results will be published over time.

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来源期刊

Research and Reports in Urology UROLOGY & NEPHROLOGY-

CiteScore

3.40

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0.00%

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审稿时长

16 weeks

期刊介绍： Research and Reports in Urology is an international, peer-reviewed, open access, online journal. Publishing original research, reports, editorials, reviews and commentaries on all aspects of adult and pediatric urology in the clinic and laboratory including the following topics: Pathology, pathophysiology of urological disease Investigation and treatment of urological disease Pharmacology of drugs used for the treatment of urological disease Although the main focus of the journal is to publish research and clinical results in humans; preclinical, animal and in vitro studies will be published where they will shed light on disease processes and potential new therapies. Issues of patient safety and quality of care will also be considered.