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Can pre- and postoperative magnetic resonance imaging predict recurrence-free survival after whole-gland high-intensity focused ablation for prostate cancer?

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Abstract

Objectives

Our aim was to assess whether magnetic resonance imaging (MRI) features predict recurrence-free survival (RFS) after prostate cancer high-intensity focused ultrasound (HIFU) ablation.

Methods

We retrospectively selected 81 patients who underwent (i) whole-gland HIFU ablation between 2007 and 2011 as first-line therapy or salvage treatment after radiotherapy or brachytherapy, and (ii) pre- and postoperative MRI. On preoperative imaging, two senior (R1, R2) and one junior (R3) readers assessed the number of sectors invaded by the lesion with the highest Likert score (dominant lesion) using a 27-sector diagram. On postoperative imaging, readers assessed destruction of the dominant lesion using a three-level score. Multivariate analysis included the number of sectors invaded by the dominant lesion, its Likert and destruction scores, the pre-HIFU prostate-specific antigen (PSA) level, Gleason score, and the clinical setting (primary/salvage).

Results

The most significant predictor was the number of prostate sectors invaded by the dominant lesion for R2 and R3 (p≤0.001) and the destruction score of the dominant lesion for R1 (p = 0.011). The pre-HIFU PSA level was an independent predictor for R2 (p = 0.014), but with only marginal significance for R1 (p = 0.059) and R3 (p = 0.053).

Conclusion

The dominant lesion’s size and destruction assessed by MRI provide independent prognostic information compared with usual predictors.

Key Points

• The size of the MR-dominant lesion significantly influences post-HIFU recurrence-free survival.

• The destruction score of the MR-dominant lesion predicts post-HIFU recurrence-free survival.

• Patients with a completely devascularized MR-dominant lesion show better recurrence-free survival

• Pre- and post-HIFU MRI provide prognostic information independent of usual predictors.

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Abbreviations

HIFU:

High-intensity focused ultrasound

MR:

Magnetic resonance

TSE:

turbo spin echo

T2w:

T2-weighted

DCE:

dynamic contrast-enhanced

IQR:

Interquartile range

RFS:

recurrence-free survival

ADC:

apparent coefficient diffusion

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Acknowledgments

The scientific guarantor of this publication is Olivier Rouvière. The authors of this manuscript declare relationships with the following companies: Olivier Rouvière, Sébastien Crouzet and Albert Gelet are consultants for EDAP-TMS and participated to clinical studies funded by EDAP-TMS. The authors state that this work has not received any funding. Jean-Pierre Giraud (EDAP-TMS) kindly provided statistical advice for this manuscript.

Institutional Review Board approval was not required because this is a retrospective study. In France retrospective studies do not need approval by Institutional Review Board. Written informed consent was obtained from all subjects (patients) in this study. Written informed consent was not required for this study because this is not required in France for retrospective studies; please note that, since Institutional Review Board do not assess retrospective studies in France, they do not deliver waivers for informed consent as in other countries.

Some study subjects or cohorts have been previously reported in studies reporting the global outcome of HIFU ablations:

• Crouzet S, Chapelon JY, Rouvière O, Mege-Lechevallier F, Colombel M, Tonoli-Catez H, Martin X, Gelet A. Whole-gland Ablation of Localized Prostate Cancer with High-intensity Focused Ultrasound: Oncologic Outcomes and Morbidity in 1002 Patients. Eur Urol. 2013 Apr 30

• Crouzet S, Murat FJ, Pommier P, Poissonnier L, Pasticier G, Rouviere O, Chapelon JY, Rabilloud M, Belot A, Mège-Lechevallier F, Tonoli-Catez H, Martin X, Gelet A. Locally recurrent prostate cancer after initial radiation therapy: Early salvage high-intensity focused ultrasound improves oncologic outcomes. Radiother Oncol. 2012 Nov;105(2):198-202

• Crouzet S, Rebillard X, Chevallier D, Rischmann P, Pasticier G, Garcia G, Rouviere O, Chapelon JY, Gelet A. Multicentric oncologic outcomes of high-intensity focused ultrasound for localized prostate cancer in 803 patients. Eur Urol. 2010; 58:559-66

• Murat FJ, Poissonnier L, Rabilloud M, Belot A, Bouvier R, Rouviere O, Chapelon JY, Gelet A. Mid-term Results Demonstrate Salvage High-Intensity Focused Ultrasound (HIFU) as an Effective and Acceptably Morbid Salvage Treatment Option for Locally Radiorecurrent Prostate Cancer. Eur Urol. 2009, 55:640-647

Methodology: retrospective, prognostic study, performed at one institution.

Author information

Authors and Affiliations

  1. Hospices Civils de Lyon, Department of Urinary and Vascular Radiology, Hôpital Edouard Herriot, Lyon, F-69437, France

    Rémy Rosset, Flavie Bratan & Olivier Rouvière

  2. Hospices Civils de Lyon, Department of Urology, Hôpital Edouard Herriot, Lyon, F-69437, France

    Sébastien Crouzet, Hélène Tonoli-Catez & Albert Gelet

  3. Université de Lyon, Lyon, F-69003, France

    Sébastien Crouzet & Olivier Rouvière

  4. Université Lyon 1, faculté de médecine Lyon Est, Lyon, F-69003, France

    Sébastien Crouzet & Olivier Rouvière

  5. Inserm, U1032, LabTau, Lyon, F-69003, France

    Sébastien Crouzet, Albert Gelet & Olivier Rouvière

  6. Hospices Civils de Lyon, Department of Pathology, Hôpital Edouard Herriot, Lyon, F-69437, France

    Florence Mège-Lechevallier

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  1. Rémy Rosset
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  7. Olivier Rouvière
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Correspondence to Olivier Rouvière.

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Rosset, R., Bratan, F., Crouzet, S. et al. Can pre- and postoperative magnetic resonance imaging predict recurrence-free survival after whole-gland high-intensity focused ablation for prostate cancer?. Eur Radiol 27, 1768–1775 (2017). https://doi.org/10.1007/s00330-016-4491-3

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