4 februari 2021: zie ook dit artikel: https://kanker-actueel.nl/zelflerende-algoritmen-leiden-tot-optimale-effectiviteit-van-door-hifu-ultra-sound-opgewekte-hyperthermie-bij-kwaadaardige-tumoren-aldus-daniel-deelen-in-zijn-proefschrift.html

In Nederland wordt in deze privekliniek HIFU toegepast bij prostaatkanker

Deze reviewstudie uit 2019 geeft overzicht van studies gedaan met HIFU wereldwijd.

20 december 2017: Bron: Chaussy Christian G. and Thüroff Stefan. Journal of Endourology. April 2017, 31(S1): S-30-S-37.

Transrectale HIFU moet serieus worden overwogen als curatieve therapie bij gelokaliseerde prostaatkanker en als palliatieve adjuvante therapie in alle andere tumorstadia is een zin uit de conclusie van de reviewstudie van Chaussy en collega's naar gebruik van HIFU - High-Insity focused Ultra Sound.

Maar wie in Nederland zoekt naar behandelcentra voor High-Intensity focused Ultra Sound voor prostaatkanker zal deze niet vinden, want hoewel er veschillende academische ziekenhuizen zijn die dit zouden kunnen uitvoeren (Radboud, Erasmus bv.) wordt HIFU (Ultra Sound) nog nergens aangeboden als behandelingsoptie. Een van de redenen is dat HIFU nog steeds gezien wordt als een experimentele therapie en geen geregistreerde behandeling is en daarom niet vergoed wordt vanuit de basisverzekering. Terwijl meer en meer studies bewijzen dat voor een aantal patiënten met niet uitgezaaide lokale prostaatkanker die om wat voor redenen dan ook niet in aanmerking komen of willen komen voor een wel geregistreerde behandeling als operatie (da Vinci), Brachytherapie, hormoontherapie) HIFU een uitstekende behandelingsoptie blijkt. Zie o.a. in gerelateerde artikelen en deze recent gepubliceerde reviewstudie: High-Intensity Focused Ultrasound for the Treatment of Prostate Cancer: A Review

Al in 2015 schreven drie Nederlandse urologen een brief met als titel: Hoe lang mag je een behandeling experimenteel noemen?

Een artikel waarin zij aan de hand van studieresultaten met HIFU, ook een Nederlandse studie met Nederlandse patiënten, ervoor pleiten dat HIFU wordt opgenomen in de basisverzekering en een HIFU behandeling wordt mogelijk gemaakt in Nederlandse academische ziekenhuizen. Maar ook die brief heeft weinig geholpen want tot op vandaag d.d. 20 december 2017 is HIFU geen behandelingsoptie in Nederland. zelfs niet in studieverband, althans ik heb geen studieprotocol in clinical trials kunnen vinden.

En dat is toch op z'n minst opmerkelijk gezien de resultaten en conclusie uit de reviewstudie:

Conclusie:

Prostaatkanker wordt nu gediagnostiseerd in een vroeger stadium van de ziekte bij jongere patiënten met een langere levensverwachting dan 20 jaar geleden voordat een PSA screening werd uitgebreid. Als gevolg hiervan zijn de mogeljkheden voor een genezende behandeling uitgebreid en blijken patiënten langer te leven. Ook wordt nu meer de nadruk gelegd op behandelingsgerelateerde morbiditeit en de impact hiervan op de kwaliteit van leven van de patiënt. Een lokaal recidief treedt op bij 10% tot 50% van de patiënten, ongeacht de in principe genezende behandeling, en de behandeling van prostaatkanker is geëvolueerd van een enkelvoudige behandeling naar een multimodale, sequentiële benadering die in hoge mate tegemoet komt aan het gebruik van minimaal invasieve therapieën zoals HIFU.

Bovendien kan HIFU worden herhaald in gevallen van een lokaal recidief, wat geen optie is met andere behandelingsopties voor gelokaliseerde prostaatkanker zoals uitwendige bestraling, cryochirurgie en brachytherapie.

Het gebruik van HIFU moet niet worden gezien als een vervanging of vervanging voor klassieke therapie, maar in plaats daarvan als een therapeutische eerste keuze bij lokale goed gedifferentieerde ziekte. Het eerste gebruik van HIFU kan helpen de noodzaak van invasieve therapieën die gepaard gaan met grotere morbiditeit, zoals chirurgie of bestraling, uit te stellen, waardoor de patiënt een langere periode kan leven zonder het risico van overlijden aan de ziekte en minder aan de behandeling gerelateerde bijwerkingen heeft.

Transrectale HIFU moet serieus worden overwogen als curatieve therapie bij gelokaliseerde ziekte en als palliatieve adjuvante therapie in alle andere tumorstadia. Voortdurende verbeteringen in beeldvormingstechnologieën zullen naar verwachting de werkzaamheid van HIFU verder verbeteren

Hier enkele studies die in deze reviewstudie zijn meegenomen in de meta-analyse. Het abstract van de studie plus referentielijst staat onderaan artikel.

Zie verder ook deze studie: Salvage High-intensity Focused Ultrasound (HIFU) for Locally Recurrent Prostate Cancer After Failed Radiation Therapy: Multi-institutional Analysis of 418 Patients

En deze studie: Quality of life and functional outcome after infravesical desobstruction and HIFU treatment for localized prostate cancer

Uit eerst genoemde reviewstudie:

Table 1. Robotic High-Intensity Focused Ultrasound: Efficacy Summary

Study (year) [ref.]	n	Pretreatment PSA (ng/mL)	Gleason score	Stage	Median follow-up (months)	Negative biopsy rate (%)	Biochemical survival	Retreatment rate (%)
Chaussy and Thuroff (2001)²	184	12		T1–2 Nx		80	NR	26.1
Gelet et al. (2001)³²	102	8.38 (mean)	54%: 2–6 46%: 7–10	T1–2	19	75	66% at 5 years (ASTRO)	78.4
Poissonnier et al. (2003)³³	120	5.67 (mean) 100% <10	64%: 2–6 36%: 7–10	T1–2	27	86	76.9% at 5 years (ASTRO)	1.4 Tx per patient
Thüroff et al. (2003)³⁵	402	10.9 (mean)	13.2%: 2–4 77.5%: 5–7 9.3%: 8–10	T1–2	13	87.2	NR	36.7
Blana et al. (2004)³⁶	146	7.6 (mean)	5 ± 1.2	T1–2N0M0	22	93.4	84% at 22 months (PSA <1.0)	18.7
Ficarra et al. (2006)³⁹	30	18 (median)	17%: 7 33%: 8 37%: 9 13%: 10	30% T2b; 70% T3; 70% T3	6	77	90% at 1 year (PSA >0.3)	0
Poissonnier et al. (2007)³⁴	227	7.0 (mean)	67%: 2–6 33%: 7	T1–2	20.5	86	NR	42.7
Blana et al. (2008)³⁷	140	7.0 (mean)	5.2 ± 1.4	T1–2N0M0	76.8 (mean)	96.4	77% at 5 years (phoenix)	29.3
Blana et al. (2008)³⁸	163	5 (median)	7.9 ± 3.7	T1–2N0M0	57.6 (mean)	92.7	75% at 5 years (phoenix)	20.8

ASTRO = American Society for Therapeutic Radiology and Oncology; Nx = lymph nodes not tested; PSA = prostate-specific antigen; Tx = T grading unknown.

Table 2. Ten-Year Long-Term Follow-Up Studies

	Risk group	n	10-year cancer-specific survival (%)	10-year metastases-free survival (%)
Ganzer et al. (2013)⁴⁰	Low	229	100	100
	Intermediate	211	96	94
Thueroff et al. (2013)⁴¹	All localized (72% moderate or high)	704	99	95
Crouzet et al. (2014)⁴²	Low	357	99	99
	Intermediate	452	98	95
	High	174	92	86

Ganzer R. BJU Int 2013;112:322–329; Thüroff S, Chaussy C. J Urol 2013;190:702–710; Crouzet S. Eur Urol 2014;65:907–914.

Transrectal HIFU should be given serious consideration as a curative therapy in localized disease as well as a palliative adjuvant therapy in all other tumor stages. Ongoing improvements in imaging technologies are expected to further enhance the efficacy of HIFU.

Journal of Endourology

High-Intensity Focused Ultrasound for the Treatment of Prostate Cancer: A Review

To cite this article:
Chaussy Christian G. and Thüroff Stefan. Journal of Endourology. April 2017, 31(S1): S-30-S-37. https://doi.org/10.1089/end.2016.0548

Published in Volume: 31 Issue S1: April 1, 2017
Online Ahead of Print: March 29, 2017
Online Ahead of Editing: February 28, 2017

ABSTRACT

Over the past 25 years, the average life expectancy for men has increased almost 4 years, and the age of prostate cancer detection has decreased an average of 10 years with diagnosis increasingly made at early-stage disease where curative therapy is possible. These changing trends in the age and extent of malignancy at diagnosis have revealed limitations in conventional curative therapies for prostate cancer, including a significant risk of aggressive cancer recurrence, and the risk of long-term genitourinary morbidity and its detrimental impact on patient's quality of life (QOL). Greater awareness of the shortcomings in radical prostatectomy, external radiotherapy, and brachytherapy has prompted the search for alternative curative therapies that offer comparable rates of cancer control and less treatment-related morbidity to better preserve QOL. High-intensity focused ultrasound (HIFU) possesses characteristics that make it an attractive curative therapy option. HIFU is a noninvasive approach that uses precisely delivered ultrasound energy to achieve tumor cell necrosis without radiation or surgical excision. In current urologic oncology, HIFU is used clinically in the treatment of prostate cancer and is under experimental investigation for therapeutic use in multiple malignancies. Clinical research on HIFU therapy for localized prostate cancer began in the 1990s, and there have now been ∼65,000 prostate cancer patients treated with HIFU, predominantly with the Ablatherm (EDAP TMS, Lyon, France) device. Neoadjuvant transurethral resection of the prostate has been combined with HIFU since 2000 to reduce prostate size, facilitate tissue destruction, and to minimize side effects. Advances in imaging technologies are expected to further improve the already superior efficacy and morbidity outcomes, and ongoing investigation of HIFU as a focal therapy in salvage and palliative indications is serving to expand the role of HIFU as a highly versatile noninvasive therapy for prostate cancer.

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HIFU, ultrasound, RFA, MR-HIFU, prostaatkanker, Langbein, niet uitgezaaide prostaatkanker, TURP