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Systematic Review of the Efficacy and Safety of High-intensity Focussed Ultrasound for Localised Prostate Cancer

机译:高强度聚焦超声对局部前列腺癌疗效和安全性的系统评价

摘要

Context: High-intensity focussed ultrasound (HIFU) has been used for 10 yr to treat localised prostate cancer (PCa). Objective: To evaluate systematically the evidence on the efficacy and side effects of HIFU in the primary treatment of localised PCa. Evidence acquisition: We performed a critical review and appraisal of Medline (Ovid), PreMedline, Embase, and Cochrane Database of Systematic Reviews publications on HIFU up to May 2013. One systematic review and 18 primary studies, all case series, were eligible. Evidence synthesis: Outcomes were summarised and evidence was evaluated using Grading of Recommendations, Assessment, Development and Evaluation methodology. Low-quality evidence suggests an overall survival rate after Ablatherm HIFU ranging from 80% to 89% for >5 yr. The PCa survival rate ranges from 97% to 99% for >5 yr. Effect of HIFU on quality of life remains undetermined. Erectile dysfunction was the most frequent adverse event reported from zero but up to 74% of patients. Adverse events affecting the urinary tract occurred in 0.7-31% of patients, bladder outlet obstruction in 4-51.5%, and they were more frequent in patients who had transurethral resection of the prostate the same day or within 2 d of HIFU. Outcomes vary for low- and high-risk categories. Conclusions: Good quality evidence on the efficacy of HIFU treatment for localised PCa is lacking. Patient summary: We reviewed all the data on treatment with high-intensity focussed ultrasound (HIFU) for localised prostate cancer (PCa). The quality of the evidence is very low because the information is based on a series of patients who received HIFU treatment with no comparison with active surveillance or radical treatment. Case series suggest an overall survival rate up to 89% and a PCa survival rate up to 99% after 5 yr, but these numbers vary according to the patient's risk category. Longer term and effects on quality of life are unknown. Case series with high-intensity focussed ultrasound (HIFU) as a radical treatment for localised prostate cancer (PCa) suggest an overall survival rate up to 89% and a PCa-survival rate up to 99% after 5 yr, but these numbers vary according to the patient's risk category. Adverse events are not negligible. Longer term and effects on quality of life are unknown. HIFU should be limited to well-conducted study protocols.
机译:背景:高强度聚焦超声(HIFU)已用于治疗局部前列腺癌(PCa)达10年之久。目的:系统评价HIFU在局部PCa的初级治疗中的疗效和副作用的证据。证据收集:截至2013年5月,我们对HIFU的Medline(Ovid),PreMedline,Embase和Cochrane系统评价数据库出版物进行了严格的审查和评估。符合条件的系统评价和18项主要研究(所有病例系列)均合格。证据综合:总结结果,并使用建议分级,评估,发展和评估方法对证据进行评估。低质量的证据表明,Ablatherm HIFU术后5年以上的总生存率为80%至89%。 > 5年的PCa生存率从97%到99%不等。 HIFU对生活质量的影响尚未确定。勃起功能障碍是从零开始报告的最常见不良事件,但高达74%的患者。影响尿路的不良事件发生在0.7-31%的患者中,膀胱出口梗阻发生在4-51.5%,在经尿道切除的同一天或HIFU 2天之内的患者中更常见。对于低风险类别和高风险类别,结果有所不同。结论:缺乏有关HIFU治疗局部PCa疗效的高质量证据。患者摘要:我们回顾了有关高强度聚焦超声(HIFU)治疗局限性前列腺癌(PCa)的所有数据。证据的质量非常低,因为该信息是基于接受HIFU治疗的一系列患者,没有与主动监测或彻底治疗相提并论。病例系列表明5年后总体生存率可达89%,PCa生存率可达99%,但这些数字因患者的风险类别而异。长期和对生活质量的影响尚不清楚。高强度聚焦超声(HIFU)作为局限性前列腺癌(PCa)根治性治疗的病例系列显示5年后总体生存率高达89%,PCa生存率高达99%,但这些数字因人而异病人的风险类别。不良事件不可忽略。长期和对生活质量的影响尚不清楚。 HIFU应该限于进行良好的研究方案。

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