Prostat Kanserinde HIFU ile Ablasyon
Özet
Lokalize prostat kanserinin (PKa) tedavisinde yüksek yoğunlukta odaklanmış ultrason (HIFU) yöntemi, teknik özellikleri ve klinik sonuçları açısından önemli bir alternatif sunmaktadır. Radikal prostatektomi ve radyoterapi gibi standart tedavilerin yol açtığı cinsel işlev bozukluğu ve idrar kaçırma benzeri yan etkileri azaltmak amacıyla, minimal invazif bir yaklaşım olan HIFU fokal tedavileri giderek önem kazanmaktadır. Dalgaların ısıya ve kavitasyona dönüşmesiyle doku ablasyonu sağlayan bu işlem, en az invazif yöntemlerden biri olarak öne çıkar. Ultrasonografi veya MRG kılavuzluğunda yapılan ablasyonda temel amaç, sadece indeks lezyonu hedef alıp çevre sağlam dokuları korumaktır. Prostat boyutunun 30 gramı geçtiği durumlarda işleme neoadjuvan TURP eklenmesi rutin hale gelmiştir. Klinik verilere göre HIFU, düşük ve seçilmiş orta riskli hastalar ile radyoterapi sonrası nüks gelişen vakalarda başarılı sağkalım oranları sunmaktadır. Zamanla gelişen cihaz teknolojisi sayesinde idrar darlığı ve inkontinans gibi komplikasyon oranları önemli ölçüde gerilemiştir. Ancak standart bir tedavi olarak kılavuzlarda yer alması için hasta seçimi, cihaz ve teknik standartlar konusunda net bir fikir birliğine ve daha fazla karşılaştırmalı çalışmaya ihtiyaç duyulmaktadır.
High-Intensity Focused Ultrasound (HIFU) presents a significant alternative in the treatment of localized prostate cancer (PCa) regarding its technical features and clinical outcomes. To reduce quality-of-life-impairing adverse effects like sexual dysfunction and urinary incontinence caused by standard radical prostatectomy and radiotherapy, minimally invasive focal methods like HIFU are gaining prominence. Achieving tissue ablation through the conversion of ultrasonic waves into heat and cavitation, this procedure stands out as a minimally invasive option. The primary goal of focal ablation, performed under USG or MRI guidance, is to destroy the index lesion while preserving surrounding healthy tissues. For prostates exceeding 30 grams, neoadjuvant TURP application has almost become routine. Long-term data demonstrate promising disease-free survival rates for low and selected intermediate-risk patients, as well as for salvage cases after radiotherapy recurrence. Advanced device technology has significantly reduced complication rates such as strictures and incontinence over time. However, establishing HIFU as a standard therapy in guidelines requires a global consensus on patient selection, devices, and techniques, alongside more comparative clinical trials.
Referanslar
Mottet N, van den Bergh RC, Briers E, Van den Broeck T, Cumberbatch MG, De Santis M, Fanti S, Fossati N, Gandaglia G, Gillessen S, Grivas N. EAU-EANM-ESTROESUR-SIOG guidelines on prostate cancer-2020 update. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol. 2021;79(2):243-62.
Mariotto AB, Yabroff KR, Shao Y, Feuer EJ, Brown ML. Projections of the cost of cancer care in the United States: 2010-2020. J Natl Cancer Inst. 2011;103:117–28.
Ramsay CR, Adewuyi TE, Gray J, Hislop J, Shirley MD, Jayakody S, MacLennan G, Fraser C, MacLennan S, Brazzelli M, N'Dow J. Ablative therapy for people with localised prostate cancer: a systematic review and economic evaluation. Health Technol Assess. 2015;19(49):1.
Izadifar Z, Izadifar Z, Chapman D, Babyn P. An Introduction to High Intensity Focused Ultrasound: Systematic Review on Principles, Devices, and Clinical Applications. J Clin Med. 2020; 9: 460
Jenne, JW, Preusser T, Günther M. High-intensity focused ultrasound: principles, therapy guidance, simulations and applications. Z Med Phys. 2012; 22(4):311-22.
Chaussy CG, Thüroff S. High-Intensity Focused Ultrasound for the Treatment of Prostate Cancer: A Review. J Endourol. 2017; 31: S30-S37.
Villers A, McNeal JE, Freiha FS,Stamey TA . Multiple cancers in the prostate. Morphologic features of clinically recognized versus incidental tumors. Cancer. 1992;70:2313-8.
Wise AM, Stamey TA, McNeal JE, Clayton JL. Morphologic and clinical significance of multifocal prostate cancers in radical prostatectomy specimens. Urology. 2002;60:264-9.
Ohori M, Eastham JA, Koh H, Kurolwa K, Slawin K, Wheeler TM, Scardino PT. Is focal therapy reasonable in patients with early stage prostate cancer (CaP)— an analysis of radical prostatectomy (RP) specimens. J Urol. 2006;175:507.
Noguchi M, Stamey TA, McNeal JE, Nolley R. Prognostic factors for multifocal prostate cancer in radical prostatectomy specimens: lack of significance of secondary cancers. J Urol. 2003;170:459-63.
Blana A, Murat FJ, Walter B, Thuroff S, Wieland WF, Chaussy C, Gelet A. First analysis of the long-term results with transrectal HIFU in patients with localised prostate cancer. Eur Urol. 2008;53(6):1194–201.
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(2):702-10.
Rischmann P, Gelet A, Riche B, Villers A, Pasticier G, Bondil P, et al. Focal High Intensity Focused Ultrasound of Unilateral Localized Prostate Cancer: A Prospective Multicentric Hemiablation Study of 111 Patients. Eur Urol. 2017;71:267-73.
Claros OR, Tourinho-Barbosa RR, Carneiro A, Collura-Merlier S, Macek P, Lanz C. et al. HIFU focal therapy for prostate cancer using intraoperatory contrast enhanced ultrasound. Arch Esp Urol. 2019;72:825–30.
von Hardenberg J, Westhoff N, Baumunk D, Hausmann D, Martini T, Marx A, et al. Prostate cancer treatment by the latest focal HIFU device with MRI/TRUS-fusion control biopsies: a prospective evaluation. Urol Oncol Semin Orig Investig. 2018;36:401.e1–401.e9.
Dellabella M, Branchi A, Di Rosa M, Pucci M, Gasparri L, Claudini R, et al. Oncological and functional outcome after partial prostate HIFU ablation with Focal-One®: a prospective single-center study. Prostate Cancer Prostatic Dis. 2021:1-9
Crouzet S, Chapelon JY, Rouvière O, Mege-Lechevallier F, Colombel M, Tonoli-Catez H, et al. Whole-gland ablation of localized prostate cancer with high-intensity focused ultrasound: oncologic outcomes and morbidity in 1002 patients. Eur Urol. 2014;65(5):907-914
Dosanjh A, Harvey P, Baldwin S, Mintz H, Evison F, Gallier S, et al. High-intensity Focused Ultrasound for the Treatment of Prostate Cancer: A National Cohort Study Focusing on the Development of Stricture and Fistulae. Eur Urol Focus. 2020;S2405-4569(19):30355-30364
Enikeev D, Taratkin M, Amosov A, Rivas JG, Podoinitsin A, Potoldykova N, Karageziyan M, Glybochko P, Barret E. Whole-gland ablation therapy versus active surveillance for low-risk prostate cancer: a prospective study. Cent European J Uro. 2020;73(2):127.
Wang L, Yang H, Li B. Photodynamic therapy for prostate cancer: a systematic review and meta-analysis. Prostate Int. 2019;7:83–90.
Heidenreich A, Richter S, Thüer D, Pfister D. Prognostic parameters, complications, and oncologic and functional outcome of salvage radical prostatectomy for locally recurrent prostate cancer after 21st-century radiotherapy. Eur Urol. 2010;57(3):437–443.
Murat FJ, Poissonnier L, Rabilloud M, Belot A, Bouvier R, Rouviere O, et al. Mid-term Results Demonstrate Salvage High-Intensity Focused Ultrasound (HIFU) as an Effective and Acceptably Morbid Salvage Treatment Option for Locally Radiorecurrent Prostate Cancer. Eur Urol. 2009;55: 640-649
Baco E, Gelet A, Crouzet S, Rud E, Rouvière O, Catez HT, et al. Hemi salvage high-intensity focused ultrasound (HIFU) in unilateral radiorecurrent prostate cancer: a prospective two-centre study. BJU Int. 2014;114(4):532–40.
Ahmed HU, Cathcart P, McCartan N, Kirkham A, Allen C, Freeman A, et al. Focal salvage therapy for localized prostate cancer recurrence after external beam radiotherapy: a pilot study. Cancer. 2012;118:4148–55.
Li YH, Elshafei A, Agarwal G, Ruckle H, Powsang J, Jones, JS. Salvage focal prostate cryoablation for locally recurrent prostate cancer after radiotherapy: initial results from the cryo on-line data registry. Prostate. 2015;75(1):1–7.
Siddiqui KM, Billia M, Al-Zahrani A, Williams A, Goodman C, Arifin A, et al. Long term oncologic outcomes of salvage cryoablation for radio-recurrent prostate cancer. J Urol. 2016;196(4):1105-1111.
van Son M, Peters M, Moerland M Kerkmeijer L, Lagendijk J, Van der Voort van Zyp J. Focal Salvage Treatment of Radiorecurrent Prostate Cancer: A Narrative Review of Current Strategies and Future Perspectives. Cancers. 2018;10:480
Asimakopoulos AD, Miano R, Virgili G Vespasiani G,. AgròM.EF... HIFU as salvage first-line treatment for palpable, TRUS-evidenced, biopsy-proven locally recurrent prostate cancer after radical prostatectomy: a pilot study. Urol Oncol. 2012;30:577-583.
