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专题报告: 没有解剖刀的手术

Brendon Nafziger, DOTmed News Associate Editor | August 30, 2013
From the September 2013 issue of HealthCare Business News magazine

By far, until recently at least, the biggest cancer focus of HIFU has been on prostate cancer. While the FDA has not approved any prostate cancer-treating HIFU device in the United States, treatments are available in other countries, and the controversy around centers trying to lure patients to places like Cancun for HIFU therapy has even made it into the mainstream media — The New York Times, for instance, covered the kerfuffle in 2008.

But some of the newer devices are relying on MR, and not ultrasound, for guidance, which means they might give better soft tissue delineation and more accurate site temperature readings and thus potentially better results, according to Thomas Andreae, with Philips Healthcare’s MRC Therapy Business Development unit in Helsinki, Finland.

Also, new studies suggest HIFU offers a promising kind of prostate cancer treatment called focal therapy. In this, instead of removing or ablating the whole prostate, as is usually done, only the tumors are destroyed, in what its backers describe as a prostate “lumpectomy.”

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“Theoretically, the less tissue that you would treat, the fewer side effects you would experience,” Dr. Jonathan Coleman, a urologic surgeon at Memorial Sloan-Kettering Cancer Center in New York, tells DOTmed News.

Early results suggest that might indeed be the case. A study led by University College London physician Dr. Hashim Ahmed and published last year in The Lancet found that 95 percent of the 41 men treated by focal HIFU prostate therapy were cancer-free one year following the treatment. In the study, which used MR to map the tumor (but not to guide treatment in real-time), side effects were also minimal, with most patients retaining urinary continence and erectile function.

“Men who undergo traditional treatment have a 50 percent chance of achieving the so-called trifecta status – the ‘perfect outcome’ with no urine leak, good erections and cancer control at 12 months after surgery or radiotherapy,” a UCL press release claimed. “In this study, the researchers showed that after focal therapy men have a nine in 10 chance of achieving the trifecta outcome at 12 months.”

However, the study, as promising as it might seem, still has a problem – the results are too short-term.

“We don’t have long-term outcomes yet to be able to tell us what the durability of these treatments might be,” Dr. Coleman says.

The problem is that even in men with aggressive forms of prostate cancer, outcomes such as overall survival and disease-free survival can take at least five years to be determined,

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