高强度聚焦超声对恶性肿瘤患者血浆D-二聚体的影响

目的:探究高强度聚焦超声对肿瘤患者血浆D-二聚体水平的影响。方法:分析35例经高强度聚焦超声治疗的恶性肿瘤患者,检测治疗前后患者血浆D-二聚体水平,分析比较治疗前后浓度变化。结果:经高强度聚焦超声治疗的35例恶性肿瘤患者的血浆D-二聚体水平较治疗前降低,差异有统计学意义。60岁及以上的恶性肿瘤患者经高强度聚焦超声治疗后血浆D-二聚体水平有所下降,高强度聚焦超声可明显降低临床Ⅳ期的恶性肿瘤患者的血浆D-二聚体水平,治疗前后的D-二聚体水平均具有显著性差异。结论:高强度聚焦超声可降低恶性肿瘤患者血浆D-二聚体水平。     

高强度聚焦超声治疗原发性肝癌的初步临床应用

目的：探讨应用高强度聚焦超声(HIFU)治疗原发性肝癌的临床疗效。方法：回顾分析28例原发性肝癌患者应用重庆海扶公司研制的JC型高强度聚焦超声肿瘤治疗系统进行治疗的病例资料，观察HIFU治疗前后临床症状、肝功能、AFP、影像学(CT或MKI)的变化。结果：28例患者经HIFU治疗后，多数患者临床症状缓解、肝功能好转、AFP降低，CT或MRI显示靶区肿瘤已凝固性坏死，肿瘤血供减少或消失。结论：应用高强度聚焦超声(HIFU)治疗原发性肝癌是一种安全、有效和非侵入性的治疗肝癌的新方法。     

高强度聚焦超声与替吉奥联合治疗晚期胰腺癌的临床观察

目的:探讨高强度聚焦超声肿瘤消融与口服替吉奥联合治疗晚期胰腺癌的疗效。方法:将43例晚期胰腺癌患者随机分为高强度聚焦超声治疗组和高强度聚焦超声＋替吉奥治疗组,观察不良反应和疗效。结果:高强度聚焦超声、高强度聚焦超声＋替吉奥的近期有效率分别为: 22.73％（5/22）和52.38%（11/21）,联合治疗的效果明显优于单纯治疗（P<0.05）;临床获益反应率分别为81.82％（18/22）和76.19%（16/21）,两组无明显差异（P>0.05）;不良反应方面,接受高强度聚焦超声治疗的患者明显少于联合使用替吉奥的患者（P<0.05）;中位生存期分别为7.6和13.6个月,接受联合使用替吉奥治疗的患者生存期明显优于仅接受高强度聚焦超声治疗的患者（P<0.05）。结论:在高强度聚焦超声治疗的基础上,联合口服替吉奥治疗晚期胰腺癌患者治疗效果更好。     

高强度聚焦超声治疗晚期胰腺癌

目的寻求胰腺癌局部治疗新方法,探讨高强度聚焦超声(HIFU)治疗胰腺癌的安全性、有效性及可行性.方法应用高强度聚焦超声治疗胰腺癌25例,其中7例给予术后化疗.结果治疗后临床症状缓解,MRI和彩色超声检查示肿瘤内血供减少,甚至消失,近期生存时间延长.结论高强度聚焦超治疗胰腺癌是安全、有效、可行的.     

高强度聚焦超声治疗实体瘤临床应用进展

高强度聚焦超声(HIFU)作为一种无创的治疗方法,在临床试验中取得显著疗效。研究证明,HIFU已成为治疗肿瘤,特别是肝癌、胰腺癌、前列腺癌的有效方法,在临床实践中显示出良好前景,能在一定程度上提高生存率,改善预后。     

前列腺、精囊

慢性前列腺炎／慢性盆底疼痛综合征（CWCPPS）治疗有效性和安全性的系统评价（Mere分析）;更换抗雄药物治疗转移性激素非依赖型前列腺癌;经直肠高强度聚焦超声联合内分泌疗法治疗前列腺癌;前列腺癌根治术切缘阳性的诊断和治疗;检测尿NAG活性对判断BPH患者早期肾功能损害的意义……     

高强度聚焦超声治疗实体瘤临床应用进展

高强度聚焦超声（HIFU）作为一种无创的治疗方法，在临床试验中取得显著疗效。研究证明，HIFU已成为治疗肿瘤，特别是肝癌、胰腺癌、前列腺癌的有效方法，在临床实践中显示出良好前景，能在一定程度上提高生存率，改善预后。     

吉西他滨联合高强度聚焦超声治疗中晚期胰腺癌的临床观察

目的:探讨吉西他滨联合高强度聚焦超声(HIFU)治疗中晚期胰腺癌的疗效和安全性.方法:64例中晚期胰腺癌患者随机分为两组,A组:高强度聚焦超声治疗;B组:吉西他滨联合高强度聚焦超声治疗,比较两组的疗效、临床受益率和不良反应.结果:A组有效率43.8%、B组75.0%(P＜0.05),A组临床受益率56.3%,B组84.4%(P＜0.05);B组6个月、12个月生存率分别高于A组;两组不良反应差异无统计学意义(P＞0.05).结论:吉西他滨联合高强聚焦超声治疗中晚期胰腺癌具有更好的疗效.     

21世纪肿瘤治疗新技术——高强度超声聚焦治疗肿瘤

随着科技的发展,不断出现新的肿瘤治疗方法.其中很多治疗方法随着时间的推移,因为没有实际的治疗作用渐渐被人抛弃.而另有一些治疗方法,却逐渐在临床治疗中扎下根来,并且不断发展,不断深入,成为临床可靠的治疗手段.比如肝癌的介入治疗,白血病的砒霜诱导治疗,肿瘤微创性腔镜外科治疗,放疗的伽玛刀、X刀等等,给肿瘤病人带来福音.新近发展起来,由我国率先在肿瘤临床广泛应用的高强度超声聚焦治疗,因为良好的治疗和无创性,已经成为体外肿瘤局部治疗的新方法.由于超声聚焦治疗与传统手术、放化疗三大肿瘤治疗性质完全不同,许多肿瘤在常规治疗方法没有效果的情况下,超声聚焦却具有很好的治疗作用.因此我们可以说,高强度超声聚焦开辟了临床肿瘤治疗的新领域.我们知道,在肿瘤治疗中任何治疗方法,只要能安全有效地治疗某一种肿瘤,都是肿瘤治疗的重要进步.     

高强度聚焦超声联合化疗对女性宫颈癌的疗效研究

目的 探究高强度聚焦超声联合化疗对女性宫颈癌的疗效和安全性.方法 选择女性宫颈癌患者68例,并将其随机平均分为对照组34例和实验组34例.对照组患者采用PF方案化疗,实验组患者采用PF方案化疗联合高强度聚焦超声治疗,比较两组患者的疗效和安全性.治疗后对患者随访12个月,分析12个月生存率.结果 与对照组比较,实验组治疗后完全缓解患者比例较高(P<0.05),且病情进展患者(PD)比例较低(P<0.05),临床治疗效果优于单纯化疗.与对照组比较,实验组发生疼痛(P<0.05)和下肢麻木(P<0.05)的比例较高,其它不良反应事件发生率两组比较差异不显著.两组比较,实验组患者治疗后12个月生存率较高.结论 高强度聚焦超声可以显著增强化疗对女性宫颈癌的疗效,提高患者治疗后12个月生存率,值得临床进一步研究应用.     

Minimally-invasive technologies in uro-oncology: The role of cryotherapy, HIFU and photodynamic therapy in whole gland and focal therapy of localised prostate cancer

The use of minimally-invasive ablative therapies in localised prostate cancer offer potential for a middle ground between active surveillance and radical therapy. This article reviews the evidence for cryotherapy, high intensity focused ultrasound (HIFU) and photodynamic therapy in the treatment of localised prostate cancer. These ablative technologies can deliver a minimally invasive, day case treatment with effective early cancer control and low genitourinary morbidity. In addition, all have the ability to deliver focal therapy of only the malignant lesions within the prostate.     

Value of and indications for pelvic lymph node dissection in the staging of prostate cancer

Pelvic lymphadenectomy is valuable as a staging procedure prior to radical prostatectomy in patients with clinical stages A2, B1 (except low-grade lesions), and B2 prostate cancer who seem to be good candidates for an attempt at curative surgery. Survival rates are promising in patients with negative pelvic lymph nodes and local tumors who undergo radical prostatectomy. In the presence of positive nodes, there is little reason to proceed with radical prostatectomy. Noninvasive alternatives to pelvic node dissection are appealing, but lymphangiography, ultrasound, computed tomography scanning, and magnetic resonance imaging are all less reliable than pelvic lymphadenectomy. Some morbidity is associated with surgical staging, and it is important that this be minimized. Pelvic lymph node dissection can play a role in treatment planning for patients who will be given external-beam radiation therapy. However, the role depends on the physician's treatment philosophy. In a recently reported series of patients receiving radiation therapy for localized prostate carcinoma, prior surgical staging by pelvic lymphadenectomy is uncommonly performed.     

The role of active treatment in early prostate cancer.

The dramatic increase in the number of patients diagnosed with localized prostate cancer in the last decade presents a difficult challenge for physicians. Because the window of opportunity for cure is short it is vital to begin treatment before the cancer cells invade neighbouring tissues and organs or metastasise to other sites. This pressure of increased patient numbers provided clinicians with the opportunity to investigate other treatment options. New surgical techniques including laparoscopic radical prostatectomy, improving therapeutic radiation by the introduction of conformal radiotherapy, neutron radiation, cryosurgery, high intensity focussed ultrasound (HIF) and the revival of brachytherapy with or without external beam radiation are currently being investigated. The goal of these techniques is to treat localized prostate cancer based on the endpoints of disease specific mortality, no evidence of disease, absent or low levels of prostate-specific antigen (PSA), reduced side-effects, improved quality of life and importantly increased cost-efficacy. It is important to remember however, that watchful waiting and endocrine therapy are still valid therapy options in certain patient groups. The lack of randomized, prospective trials on local treatment of prostate cancer, makes it difficult to compare the efficacy of the different treatments, especially in terms of disease-specific survival. Trials are now in progress but it will be several years before results are available. In the meantime, we need to focus on surrogate endpoints, side effects, quality of life and the cost-efficacy of each treatment. It is also important to ensure that patients are kept informed and up-to-date with any new therapeutic developments.     

The effect of androgen deprivation on the early changes in prostate volume following transperineal ultrasound guided interstitial therapy for localized carcinoma of the prostate

Purpose: To determine the change in volume of the prostate as a result of neoadjuvant androgen deprivation prior to prostate implant and in the early postimplant period following transperineal ultrasound guided palladium-103 brachytherapy for early-stage prostate cancer.

Methods and Materials: Sixty-nine men received 3 to 6 months of androgen deprivation therapy followed by treatment planning ultrasound followed 4 to 8 weeks later by palladium-103 implant of the prostate. All patients had clinical and radiographic stage T1c–T2b adenocarcinoma of the prostate. A second ultrasound study was carried out 11 to 13 days following the implant to determine the change in volume of the prostate as a result of the implant. The prehormonal and preimplant volumes were compared to the postimplant volume to determine the effect of hormones and brachytherapy on prostate volume.

Results: The median decrease in prostate volume as a result of androgen deprivation was 33% among the 54 patients with prostate volume determinations prior to hormonal therapy. The reduction in volume was greatest in the quartile of men with the largest initial gland volume (59%) and least in the quartile of men with smallest glands (10%). The median reduction in prostate volume between the treatment planning ultrasound and the follow-up study after implant was 3%, but 23 (33%) patients had an increase in prostate volume, including 16 (23%) who had an increase in volume >20%; 11 of these patients (16%) had an increase in volume >30%. The time course of development and resolution of this edema is not known. The severity of the edema was not related to initial or preimplant prostate volume or duration of hormonal therapy.

Conclusions: Prostate edema may significantly affect the dose delivered to the prostate following transperineal ultrasound guided brachytherapy. The effect on the actual delivered dose will be greater when shorter lived isotopes are used. It remains to be observed whether this edema will affect outcome.     

Management of a hormone dependent cancer with endocrine therapy--prostate cancer

We offer a historical overview of endocrine therapy for prostate cancer. Hormone therapy remains the cornerstone of treatment for patients with locally advanced or metastatic prostate cancer. Although this therapy has been traditionally performed by oral estrogen or bilateral orchiectomy, there are now two most important pharmacological hormonal therapies: LH-RH agonist and antiandrogen therapy. We do not have yet sufficient data to conclude whether maximal androgen blockade from the combined use of an LH-RH agonist and an antiandrogen will prolong the survival in patients with metastatic prostate cancer, nor to conclude whether neoadjuvant androgen ablation therapy improves the disease-free survival of patients after radical prostatectomy. New treatment strategies and modalities such as LH-RH antagonists, intermittent hormonal therapy, and antiandrogen monotherapy are appearing and being tested in clinical trials. However, to date there is still no effective therapy for patients who have hormone refractory disease.     

多学科综合治疗——改善高危前列腺癌患者的预后

手术和放疗是局限性前列腺癌主要的治疗方法,但对于高危前列腺癌单用局部治疗预后不佳,超过50％的患者会复发。手术、放疗、内分泌治疗和化疗的联合应用目前被认为是提高高危前列腺癌疗效的重要途径。本文总结了目前高危前列腺癌综合治疗的相关文献,期望能为我国高危前列腺癌综合治疗方案的选择提供借鉴和参考。     

A prospective study of prostate specific antigen levels in patients receiving radiotherapy for localized carcinoma of the prostate.

Prostate Specific Antigen (PSA) is becoming the preferred tumor marker in the management of prostate cancer. Prostate Specific Antigen levels fall exponentially after radical prostatectomy with a half-life of between 2 and 3 days. Persistently elevated Prostate Specific Antigen levels beyond 7 half-lives suggest occult residual disease and may serve as an indication for post operative adjunctive therapy. The change in Prostate Specific Antigen levels during a course of radical external beam radiotherapy for prostate cancer has not been described. In this study of 81 patients receiving radiotherapy for primary prostate cancer, 47 had elevated Prostate Specific Antigen levels prior to therapy and 35 had serial measurement of Prostate Specific Antigen during their course of treatment. Working on an assumption that in patients with radioresponsive localized prostate cancer Prostate Specific Antigen levels will fall exponentially during the radiotherapy, a half-life of 43 +/- 11 days was derived. Prostate Specific Antigen half-life appears independent of stage, grade, or pretreatment Prostate Specific Antigen level and may be an independent prognostic indicator. A prolonged Prostate Specific Antigen half-life may suggest untreated or resistant disease and serve as an indication for adjuvant hormonal treatment in patients receiving radiotherapy for primary prostate cancer.     

Quantitative analysis of 3-D conformal MRI-guided transurethral ultrasound therapy of the prostate: Theoretical simulations

Purpose: The capability of MRI-guided transurethral ultrasound therapy to produce continuous regions of thermal coagulation that conform to human prostate geometries was evaluated using 3-D anatomical models of prostate cancer patients.

Methods: Numerical simulations incorporating acoustic and biothermal modeling and a novel temperature control feedback algorithm were used to evaluate treatment accuracy of a rotating dual-frequency multi-element transducer. Treatments were simulated on twenty anatomical models obtained from the manual segmentation of the prostate and surrounding structures on MR images of prostate cancer patients obtained prior to radical prostatectomy.

Results: Regions of thermal coagulation could be accurately shaped to predefined volumes within 1 mm across the vast majority of the prostates. Over- and under-treated volumes remained smaller than 4% of the corresponding prostate volumes which ranged from 14 to 60 cc. Treatment times were typically 30 min and remained below 60 min even for large 60 cc prostates. Heating of the rectal wall remained below 30 min_43°C in half of the patient models with only minor, superficial heating in the other cases. The simulated feedback control algorithm adjusted the ultrasound transducer parameters such that high treatment accuracy was maintained despite variable blood perfusion, changing tissue ultrasound attenuation, and practical temperature measurement noise and sampling rate.

Conclusions: Numerical simulations predict that MRI-guided transurethral ultrasound therapy is capable of producing highly accurate volumes of thermal coagulation that conform to human prostate glands.     

High precision radiotherapy with ultrasonic imaging guidance]

Conformal radiation therapy with or without intensity modulation is the standard treatment of localized prostate cancer and facilitates dose escalation. The implementation of three-dimensional conformal radiotherapy necessitates focusing on target volume delineation, dosimetry, reproducibility of treatment and quality control. Recently, ultrasound systems that allow direct daily visualization of the prostate have become available. This non-invasive technique can be used to correct both prostate organ motion and set-up error and leads to increase treatment accuracy.     

MRI-controlled transurethral ultrasound therapy for localised prostate cancer

Minimally invasive treatments for localised prostate cancer are being developed with the aim of achieving effective disease control with low morbidity. High-temperature thermal therapy aimed at producing irreversible thermal coagulation of the prostate gland is attractive because of the rapid onset of thermal injury, and the immediate visualisation of tissue response using medical imaging. High-intensity ultrasound therapy has been shown to be an effective means of achieving thermal coagulation of prostate tissue using minimally invasive devices inserted into the rectum, urethra, or directly into the gland itself. The focus of this review is to describe the work done in our group on the development of MRI-controlled transurethral ultrasound therapy. This technology utilises high intensity ultrasound energy delivered from a transurethral device to achieve thermal coagulation of prostate tissue. Control over the spatial pattern of thermal damage is achieved through closed-loop temperature feedback using quantitative MR thermometry during treatment. The technology, temperature feedback algorithms, and results from numerical modelling, along with experimental results obtained in animal and human studies are described. Our experience suggests that this form of treatment is technically feasible, and compatible with existing MR imaging systems. Temperature feedback control algorithms using MR thermometry can achieve spatial treatment accuracy of a few millimetres in vivo. Patient-specific simulations predict that surrounding tissues can be spared from thermal damage if appropriate measures are taken into account during treatment planning. Recent human experience has been encouraging and motivates further evaluation of this technology as a potential treatment for localised prostate cancer.