The feasibility and safety of high-intensity focused ultrasound combined with low-dose external beam radiotherapy as supplemental therapy for advanced prostate cancer following hormonal therapy

Abstract

The aim of this study was to investigate the feasibility and safety of high-intensity focused ultrasound (HIFU) combined with (1) low-dose external beam radiotherapy (LRT) as supplemental therapy for advanced prostate cancer (PCa) following hormonal therapy (HT). Our definition of HIFU1LRT refers to treating primary tumour lesions with HIFU in place of reduced field boost irradiation to the prostate, while retaining four-field box irradiation to the pelvis in conventional-dose external beam radiotherapy (CRT). We performed a prospective, controlled and non-randomized study on 120 patients with advanced PCa after HT who received HIFU, CRT, HIFU1LRT and HT alone, respectively. CT/MR imaging showed the primary tumours and pelvic lymph node metastases visibly shrank or even disappeared after HIFU1LRT treatment. There were significant differences among four groups with regard to overall survival (OS) and disease-specific survival (DSS) curves (P50.018 and 0.015). Further comparison between each pair of groups suggested that the long-term DSS of the HIFU1LRT group was higher than those of the other three groups, but there was no significant difference between the HIFU1LRT group and the CRT group. Multivariable Cox's proportional hazard model showed that both HIFU1LRT and CRT were independently associated with DSS (P50.001 and 0.035) and had protective effects with regard to the risk of death. Compared with CRT, HIFU1LRT significantly decreased incidences of radiation-related late gastrointestinal (GI) and genitourinary (GU) toxicity grade oII. In conclusion, long-term survival of patients with advanced PCa benefited from strengthening local control of primary tumour and regional lymph node metastases after HT. As an alternative to CRT, HIFU1LRT showed good efficacy and better safety.

An overview of prostate diseases and their characteristics specific to Asian men

“…However, to prolong the period before PCa becomes refractory to HT, complementary treatments following androgen deprivation therapy should be considered with RT being a common choice. 111 Recently, Wu et al 112 reported that in Chinese patients who had undergone androgen deprivation therapy, highintensity focused ultrasound combined with low-dose RT resulted in a higher 5-year disease-specific survival rate than both conventional-dose RT and high-intensity focused ultrasound (75.29% vs. 64.47% and 46.35%, respectively) with lower incidences of radiation-related late gastrointestinal and genitourinary toxicity grades. Additionally, RP may be considered in selected cases of local advanced PCa, with 5-year PSA-free survival rates at from 45% to 62%.…”

Focused Ultrasound and Ultrasound Stimulated Microbubbles in Radiotherapy Enhancement for Cancer Treatment

“…Applications of FUS and RT in clinical settings have also seen success in enhancing RT. Wu et al 65 evaluated the feasibility of replacing reduced field boost irradiation with FUS in treating patients with locally advanced and metastatic prostate cancer. Combination treatment showed a greater overall survival in patients compared to low-dose external beam radiotherapy alone.…”

High-intensity focused ultrasound plus concomitant radiotherapy: a new weapon in oncology?

“…However, considering here mainly HIFU and EBRT, this strategy would allow also a great sparing of time and of radiation dose. A lower radiation level means, in turn, a potentially significant reduction of sequelae, as reported in a recent paper [ 27 ]. Of course the scenario described above would require a great deal of fundamental and experimental research.…”