GUSTAVO CARDOSO GUIMARÃES
DIRETOR GERAL DOS DEPARTAMENTOS DE CIRURGIA ONCOLÓGICA
BP A BENEFICENCIA PORTUGUESA DE SÃO PAULO
DIRETOR – IUCR DR GUSTAVO GUIMARAES
INSTITUTO DE UROLOGIA, ONCOLOGIA E CIRURGIA ROBOTICA
TRATAMENTO DA RECIDIVA LOCAL APÓS TERAPIA RADICAL
HIFU - BEST TREATMENT AND BEST OUTCOMES
Cancer 2008, 112; 307-14
HIFU - BEST TREATMENT AND BEST OUTCOMES
HIFU - BEST TREATMENT AND BEST OUTCOMES
HIFU - BEST TREATMENT AND BEST OUTCOMES
HIFU - BEST TREATMENT AND BEST OUTCOMES
Cancer 2008, 112; 307-14
HIFU - BEST TREATMENT AND BEST OUTCOMES
• 30 a 60% - Relapse after Radiotherapy
Kuban DA, et al. Int. J. Radiat. Oncol. Biol. Phys. 2003; 57: 915–28.
Lee WR, et al. A. J. Clin. Oncol. 1997; 15: 230–8.
Agarwal PK, et al. Cancer. 2008 Jan 15;112(2):307-14.
473 pts, D’Amico
QUAIS AS OPÇÕES DE TRATAMENTO APÓS
FALHA DA RADIOTERAPIA ??
Câncer de Próstata - Falha Pós Radioterapia
(Poucos estudos randomizados controlados)
• Observação
• Hormonioterapia
• Prostatectomia de Resgate
• Braquiterapia de Resgate
• Crioterapia de Resgate
• HIFU de Resgate
HIFU CAN BE USED AS:
Whole gland, hemi and zonal ablation and true focal therapy
• PRIMARY TREATMENT
• SALVAGE TREATMENT
• PALLIATIVE AND ADJUVANT (Investigational)
HIFU - BEST TREATMENT AND BEST OUTCOMES
SALVAGE HIFU
HIFU - BEST TREATMENT AND BEST OUTCOMES
SALVAGE HIFU
HIFU - BEST TREATMENT AND BEST OUTCOMES
HIFU - BEST TREATMENT AND BEST OUTCOMES
Cancer 2008, 112; 307-14
HIFU - BEST TREATMENT AND BEST OUTCOMES
Cancer 2014, 120; 507-12 2/366 (0,54%)
6275 pts submitted to radical therapy
839 pts with biochemical relapse (13,4%)
HIFU - BEST TREATMENT AND BEST OUTCOMES
HIFU - BEST TREATMENT AND BEST OUTCOMES
2018
HIFU - BEST TREATMENT AND BEST OUTCOMES
2019
Candidate for Salvage local therapy: (whole gland)
(Salvage FT – investigational only in clinical trial)
• Original clinical stage T1-T2, Nx or N0
• Life expectancy >10 y
• PSA now <10 ng/mL
• Exclude metastatic disease (MRI, PET-Ct, etc)
HIFU - BEST TREATMENT AND BEST OUTCOMES
Multicentric oncologic outcomes of salvage HIFU for local failure after external beam radiotherapy: 7 years biochemical survival of 929 patients
S. Crouzet, Lyon (FR)
• Mean follow-up: 66 ± 35 months
No Pre Treatment Hormone
Therapy
Pre Treatment Hormone Therapy
PSA ≤ 4 PSA:4-10 PSA>10 PSA ≤ 4 PSA:4-10 PSA>10
5-year
BDFS
78% 59% 49% 49% 38% 32%
6-year
BDFS
67% 56% 43% 49% 34% 26%
7-year
BDFS
59% 56% 31% 49% 34% 17%
HIFU DE RESGATE É EFETIVO, COM RESULTADOS
DURÁVEIS E REPRODUTÍVEIS
929 salvage patients
7 year follow-up
HIFU - BEST TREATMENT AND BEST OUTCOMES
• 418 pts
• Retrospective Study – 1995 – 2009
• Two diferente HIFU parameters
• bFFS rate at 5 years was 49%
• CSS at 7 years was 82%
HIFU - BEST TREATMENT AND BEST OUTCOMES
• Continence (no pads+ grade 1)
Overall - 78,7%
Post-RT parameters – 81,2%
• Rectal Fistula – 0,6%
Câncer de Próstata - Falha Pós Radioterapia
7 anos
OS - 72%CSS - 82%MFS – 81%
Câncer de Próstata - Falha Pós Radioterapia
Resultado - Falha bioquímica
PSA <4Não usar ADT
Câncer de Próstata - Falha Pós Radioterapia
Resultado – Falha bioquímica
Baixo risco = intermediário>Gleason --> pior result.
Câncer de Próstata - Falha Pós Radioterapia
Sobrevida livre de terapia de resgate
HIFU - BEST TREATMENT AND BEST OUTCOMES
• 418 pts
• Retrospective Study – 1995 – 2009
• bFFS rate at 5 years was 49%
• CSS at 7 years was 82%
• 404 pts
• Colaborative /retropective study
• bFFS rate at 10 years was 37%
• CSS at 10 years was 83%
Eur Urol, 2011. 60: 205
Câncer de Próstata - Falha Pós Radioterapia
150 pcts
Seguimento mediano 35 meses (22-52)
BDFS –(3 anos) 48%
dDFS grupo risco %(2,7%) Baixo – 100%(39,3%) Interm. – 61%(41,3%) Alto - 32%
HIFU - BEST TREATMENT AND BEST OUTCOMES
Potência
(26pcts dados disponíveis >18 meses)
11,5% Potente
3,8% - Potente sem droga
7,7% - Potente com droga
11,5% - Impotente
76,9% - Impotente prévio
RESULTADOS
(Seguimento mediano 36 meses)
56 (16,7%) HIFU de resgate
Continência
(35 pcts dados disponíveis > 18 meses)
74,3% - Continente (até 1 forro)
8,6% - Incontinente leve a moderado
5,7% - Incontinente grave
8,6% - Incontinente prévio
2,9% - Bricker (1 pct – progressão tumoral)
HIFU - BEST TREATMENT AND BEST OUTCOMESRESULTADOS
Vivo sem doença – 46,4%
Vivo com doença – 26,8%
Morte pelo Câncer – 1,8%
Perdido de vista – 25,0%
TRATAMENTO APÓS FALHA
RE-HIFU 4,8% (2 CASOS)
HT 52,4%
QUIMIO 14,3%
OBSERV 28,6%
56 (16,7%) HIFU de resgate
CONCLUSIONS
Candidatos para HIFU de resgate - whole gland
(Salvage FT – investigational)
HIFU - BEST TREATMENT AND BEST OUTCOMES