Ablatherm longterm results as a salvage option after radiotherapy failure - PowerPoint PPT Presentation

Loading...

PPT – Ablatherm longterm results as a salvage option after radiotherapy failure PowerPoint presentation | free to view - id: 1466c8-OTNmY



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Ablatherm longterm results as a salvage option after radiotherapy failure

Description:

External beam radiotherapy (EBRT) is a curative treatment of localised prostate cancer. ... The prognosis for patients with a biochemical recurrence following ... – PowerPoint PPT presentation

Number of Views:39
Avg rating:3.0/5.0
Slides: 14
Provided by: carina6
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Ablatherm longterm results as a salvage option after radiotherapy failure


1
Ablatherm long-term results as a salvage option
after radiotherapy failure
  • Pr. G. ContiComo, Italy

2
Introduction
  • External beam radiotherapy (EBRT) is a curative
    treatment of localised prostate cancer.
  • The local recurrence rate is between 25 and 32
  • The prognosis for patients with a biochemical
    recurrence following radiotherapy is poor
  • DAmico in 2003 reported a biochemical recurrence
    rate of 39 after radiotherapy five years after
    biochemical recurrence 23 of patients had died.
  • The risk of death was correlated with the patient
    initial Gleason score.

3
Introduction
  • It therefore appears logical to propose curative
    salvage treatment for patients with a local
    recurrence after radiotherapy whose life
    expectancy is 5 years.
  • Salvage treatments includes radical
    prostatectomy and, more recently, cryotherapy and
    brachytherapy.
  • HIFU is an alternative.

4
Salvage HIFU post EBRT patient characteristics
  • 1995 2007
  • 167 pts with local recurrence proven by biopsy
    after RBT failure
  • Age 68,9 7,8 years
  • Pre HIFU
  • PSA 6,89 7,8 ng/ml (median 4,86 ng/ml)
  • Gleason score
  • undefined 23
  • lt 7 40 patients
  • 7 38 patients
  • gt 7 66 patients
  • Prostate volume 18,01 8,7 cc (median 18 cc)
  • Negative metastatic evaluation

5
Salvage HIFU post EBRT Results
  • Mean follow-up 17,5 months 3 121 months
  • Retreatment rate 18
  • CONTROL BIOPSIES negatives in 73
  • Median nadir PSA at 3 months post HIFU0.19 NG/ML

pts
pts
pre HIFU PSA median PSA 4.86 ng/ml
post HIFU PSA median PSA 0.19 ng/ml
PSA
ng/ml
ng/ml
PSA
6
Salvage HIFU after EBRT Cancer specific
survival
84 at 5 years
  • No hormonal deprivation in 63 patients (40.5)
  • 6 deaths related to prostate cancer

7
Salvage HIFU after EBRT stratified DFSR() by
pre-EBRT risk level
Low T1-T2a PSA10ng/ml Gleasonlt7
low risk53
InterT2b or PSA10-20 or Gleason7
inter risk42
high risk25
High T2c-T3a or PSAgt20ng/ml or Gleasongt7
() ASTRO 2005negative biopsy no adjuvant
therapy last PSA lt nadir 2ng
8
Salvage HIFU after EBRT stratified DFSR() by
pre HIFU PSA
() ASTRO 2005negative biopsy no adjuvant
therapy PSA lt nadir 2ng
9
Salvage HIFU after EBRT stratified DFR() by
pre HIFU Gleason
() ASTRO 2005negative biopsy no adjuvant
therapy PSA lt nadir 2ng
10
Salvage HIFU after EBRT Complications

11
Salvage HIFU after EBRT Uretro-rectal fistula

No more uretro-rectal fistulas with the specific
RBTfailure treatment protocol
12
Conclusions
  • HIFU allowed local tumour control in 73 of
    patients after radiotherapy failure.
  • Disease control is highly dependent on initial
    pre EBRT risk level.
  • High-risk patients are not good candidates for
    salvage HIFU treatment they must be strictly
    selected as the majority have silent metastases
    associated with the local recurrence.
  • HIFU is a valid curative option for low or
    intermediate-risk patients.

13
Conclusions
  • Complications have decreased with specific
    post-radiation treatment parameters
  • Urinary incontinence dominates
  • No uretro-rectal fistula
About PowerShow.com