Ablatherm efficiency on longterm results

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Ablatherm efficiency on long-term results

• Dr. F.J. Murat Lyon, France

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Ablatherm efficiency on long-term resultsHIFU
device evolution
First generation ABLATHERM  maxis  2000-2005
First prototype 1993 -1995
1993 1995
2006
Study period
Second prototype 1995-2000
Last generation  Integrated Imaging  2006-
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Ablatherm efficiency on long-term results

• October 1997-August 2001
• 3 centers
• Edouard Herriot Hospital, Lyon, France
• Krankenhaus, Munich, Germany
• St Josef Hospital , Regensburg, Germany
• Inclusion criteria
• cT1-T2 Nx/0 M0
• PSA 15 ng/mL
• Gleason score 7
• No radical treatment for prostate cancer.
• Previous hormone-therapy 3 months
• 5-year minimum follow-up
• Prototypes and First generation HIFU devices

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Ablatherm efficiency on long-term results

• Follow-up
• PSA 3 months and every 6 months thereafter.
• Prostate biopsies
• 3 - 6 months after HIFU
• in case of rising PSA (gt 0.75 ng/ml/year).
• Patient record updates May and August 2006.

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Ablatherm efficiency on long-term resultsStudy
Population

• 140 patients
• Mean age 69.1 6.6 years
• Mean PSA 7.0 3.5 ng/ml
• Mean prostatic volume 25.9 11.2 cc

51,4 Low risk48,6 Intermediate risk
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Ablatherm efficiency on long-term resultsStudy
Population

• HIFU devices
• Average HIFU sessions 1.3
• 3 months hormone-therapy
• 16.4
• stopped by the time of HIFU treatment
• no statistical influence on oncological data

54,3 Prototypes 45,7 First generation
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Ablatherm efficiency on long-term
resultsGeneral Results

• Mean Follow-up
• 6.4 1.1 years
• PSA
• Mean PSA nadir 0.62 1.15 ng/ml.
• Median PSA nadir 0.16 ng/ml
• Mean time to PSA nadir 5 months
• Control Biopsy
• Negative in 86.4
• Low / intermediate risk patients No difference
  (p 0.31)

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Ablatherm efficiency on long-term
resultsOverall survival
time of death, regardless of cause
90 at 5 years83 at 8 years
No death related to HIFU treatment
(p 0.23)
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Ablatherm efficiency on long-term
resultsProstate cancer-specific survival
time of death from prostate cancer
100 at 5 years98 at 8 years
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Ablatherm efficiency on long-term
resultsSalvage treatment-free survival
time of a salvage treatment introduction
89
69
86 at 5 years79 at 8 years
(p 0.006)
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Ablatherm efficiency on long-term
resultsBiochemical failure-free survival
PSA lt PSA nadir 2 ng/ml (ASTRO 2005)

73 at 5 years69 at 6 years
(p 0.086)
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Ablatherm efficiency on long-term
resultsDisease-free survival
PSA lt PSA nadir 2 ng/ml and negative biopsy
and no hormone therapy (ASTRO 2005)

63 at 5 years59 at 6 years
(p 0.012)
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Ablatherm efficiency on long-term
resultsConclusions

• Local control achieved in 86.4
• The following survival rates achieved at 5 years
  
• Overall 90
• Prostate cancer-specific 100
• Salvage treatment-free 86
• Biochemical failure-free 73
• Disease-free 63.

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Ablatherm efficiency on long-term
resultsBiochemical failure-free survival at 5
years

Katz AE and Rewcastle JC. Current Oncology
Reports 5(3) pp. 231238 (2003)
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Ablatherm efficiency on long-term
resultsBiochemical failure-free survival at 5
years

Katz AE and Rewcastle JC. Current Oncology
Reports 5(3) pp. 231238 (2003)
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Ablatherm efficiency on long-term resultsHIFU
device evolution
First generation ABLATHERM  maxis  2000-2005
First prototype 1993 -1995
1993 1995
2006
Study period
Second prototype 1995-2000
Last generation  Integrated Imaging  2006-
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Ablatherm efficiency on long-term resultsTake
home message

• HIFU is a valid indication for localized prostate
  cancer in patients not suitable (age,
  co-morbidity) or refusing surgery.
• HIFU offers
• A high tumor local control
• A long-term efficacy comparable to other
  non-surgical options
• A real ALTERNATIVE TO RADIATION or any other
  minimally invasive therapy

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The authors thanks
Prof. C. Chaussy and Dr. S. Thüroff, Krankenhaus,
Munich, Germany Prof. WF. Wieland and Dr. A.
Blana, St Josef Hospital, Regensburg,
Germany Dr. A. Gelet and Dr. L.
Poissonnier, Edouard Herriot Hospital, Lyon,
France.