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Strahlentherapie des Prostatakarzinoms in der neuen S3-Leitlinie

Teil 2: Postoperative Strahlentherapie und Brachytherapie

Radiation therapy for prostate cancer in the new S3 guideline

Part 2: postoperative radiation therapy and brachytherapy

Zusammenfassung

Der postoperativen adjuvanten Strahlentherapie kommt durch das Vorliegen dreier randomisierter Studien im Stadium pT3R1 besondere Bedeutung zu, da hier eine Überlebensverlängerung gegenüber der „Wait-and-see-Strategie“ nachgewiesen wurde. Als Alternative steht die Bestrahlung bei persistierendem oder ansteigendem PSA-Wert nach radikaler Prostatektomie zur Verfügung. In diesem Fall jedoch sollte die Salvagestrahlentherapie so früh wie möglich erfolgen, am besten, wenn der PSA-Wert <0,5 ng/ml ist. Die Nebenwirkungen der perkutanen Strahlentherapie mit modernen Techniken in diesem Stadium sind sehr gering, schwere Spätfolgen Grad III oder IV treten in <3% der Fälle auf. Die LDR-Brachytherapie als Monotherapie ist eine primäre Therapieoption des „Low-risk-Tumors“. Bei Patienten mit „Intermediate-risk-Tumoren“ ist die Datenlage kontrovers und noch nicht abschließend beurteilbar. Bei „High-risk-Tumoren“ sollte die LDR-Brachytherapie nicht eingesetzt werden. Auch die High-dose-rate- (HDR-)Brachytherapie“ in Verbindung mit einer perkutanen Strahlentherapie ist als Beispiel einer typischen Dosiseskalation eine primäre Option bei „Intermediate-risk-“ und „High-risk-Prostatakarzinom“. Die Notwendigkeit einer zusätzlichen Hormontherapie bei der HDR-Brachytherapie ist unklar. Eine HDR-Monotherapie kann nur in Studien empfohlen werden.

Abstract

Postoperative adjuvant radiation therapy has achieved special significance based on the results of three randomized studies on stage pT3R1 prostate cancer which provided evidence for prolonged survival in comparison to the “wait and see” strategy. When PSA levels persist or increase after radical prostatectomy, irradiation represents an alternative. In this instance, salvage radiotherapy should be initiated as early as possible, most suitably when the PSA level is <0.5 ng/ml. Side effects of percutaneous radiotherapy using modern techniques are minimal in this stage; severe grade 3 or 4 late sequelae occur in <3% of cases. Low dose rate (LDR) brachytherapy as monotherapy is a primary treatment option for low-risk tumors. In patients with intermediate-risk tumors, data are controversial and cannot be assessed conclusively. LDR brachytherapy should not be administered in high-risk tumors. High dose rate (HDR) brachytherapy combined with percutaneous radiotherapy as an example of a typical dose escalation approach is a primary option for intermediate- and high-risk prostate cancer. Whether additional hormone therapy is needed with HDR brachytherapy is unclear. HDR monotherapy can only be recommended in the clinical trial setting.

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Literatur

  1. 1.

    Blasko JC, Grimm PD, Sylsvester JE, Cavanagh W (2000) The role of external beam radiotherapy with I-125/Pd-103 brachytherapy for prostate carcinoma. Radiother Oncol 57(3):273–278

  2. 2.

    Bolla M, Poppel H van, Collette L et al (2005) Postoperative radiotherapy after radical prostatectomy: a randomised controlled trial (EORTC trial 22911). Lancet 366(9485):572–578

  3. 3.

    Bottke D, Reijke TM de, Barkowiak D, Wiegel T (2009) Salvage radiotherapy in patients with persisting/rising PSA after radical prostatectomy for prostate cancer. Eur J Cancer 45(Suppl 1):148–157

  4. 4.

    Catton C, Gospodarowicz M, Warde P et al (2001) Adjuvant and salvage radiation therapy after radical prostatectomy for adenocarcinoma of the prostate. Radiother Oncol 59(1):51–60

  5. 5.

    Collette L, Poppel H van, Bolla M et al (2005) Patients at high risk of progression after radical prostatectomy: do they all benefit from immediate post-operative irradiation? (EORTC trial 22911). Eur J Cancer 41(17):2662–2672

  6. 6.

    Corner C, Rojas AM, Bryant L et al (2008) A Phase II study of high-dose-rate afterloading brachytherapy as monotherapy for the treatment of localized prostate cancer. Int J Radiat Oncol Biol Phys 72(2):441–446

  7. 7.

    Deger S, Boehmer D, Roigas J et al (2005) High dose rate (HDR) brachytherapy with conformal radiation therapy for localized prostate cancer. Eur Urol 47(4):441–448

  8. 8.

    Demanes DJ, Rodriguez RR, Schour L et al (2005) High-dose-rate intensitymodulated brachytherapy with external beam radiotherapy for prostate cancer: California endocurietherapy’s 10-year results. Int J Radiat Oncol Biol Phys 61(5):1306–1316

  9. 9.

    Galalae RM, Martinez A, Mate T et al (2004) Long-term outcome by risk factors using conformal high-dose-rate brachytherapy (HDR-BT) boost with or without neoadjuvant androgen suppression for localized prostate cancer. Int J Radiat Oncol Biol Phys 58(4):1048–1055

  10. 10.

    Galalae RM, Martinez A, Nuernberg N et al (2006) Hypofractionated conformal HDR brachytherapy in hormone naive men with localized prostate cancer. Is escalation to very high biologically equivalent dose beneficial in all prognostic risk groups? Strahlenther Onkol 182(3):135–141

  11. 11.

    Ganswindt U, Stenzl A, Bamberg M, Belka C (2008) Adjuvant radiotherapy for patients with locally advanced prostate cancer-a new standard? Eur Urol 54(3):528–542

  12. 12.

    Garg MK, Tekyi-Mensah S, Bolton S et al (1998) Impact of postprostatectomy prostate-specific antigen nadir on outcomes following salvage radiotherapy. Urology 51(6):998–1002

  13. 13.

    Hoskin PJ, Motohashi K, Bownes P et al (2007) High dose rate brachytherapy in combination with external beam radiotherapy in the radical treatment of prostate cancer: initial results of a randomised phase three trial. Radiother Oncol 84(2):114–120

  14. 14.

    Khaksar SJ, Langley SE, Lovell D, Laing RW (2006) Interstitial low dose rate brachytherapy for prostate cancer–a focus on intermediate- and high-risk disease. Clin Oncol (R Coll Radiol) 18(7):513–518

  15. 15.

    Kovacs G, Potter R, Loch T et al (2005) GEC/ESTRO-EAU recommendations on temporary brachytherapy using stepping sources for localised prostate cancer. Radiother Oncol 74(2):137–148

  16. 16.

    Loeb S, Roehl KA, Viprakasit DP, Catalona WJ (2008) Long-term rates of undetectable PSA with initial observation and delayed salvage radiotherapy after radical prostatectomy. Eur Urol 54(1):88–94

  17. 17.

    Martin T, Baltas D, Kurek R et al (2004) 3-D conformal HDR brachytherapy as monotherapy for localized prostate cancer. A pilot study. Strahlenther Onkol 180(4):225–232

  18. 18.

    Martinez AA, Pataki I, Edmundson G et al (2001) Phase II prospective study of the use of conformal high-dose-rate brachytherapy as monotherapy for the treatment of favorable stage prostate cancer: a feasibility report. Int J Radiat Oncol Biol Phys 49(1):61–69

  19. 19.

    Merrick GS, Butler WM, Galbreath RW et al (2003) Does hormonal manipulation in conjunction with permanent interstitial brachytherapy, with or without supplemental external beam irradiation, improve the biochemical outcome for men with intermediate or high-risk prostate cancer? BJU Int 91(1):23–29

  20. 20.

    Morgan SC, Waldron TS, Eapen L et al (2008) Adjuvant radiotherapy following radical prostatectomy for pathologic T3 or margin-positive prostate cancer: a systematic review and meta-analysis. Radiother Oncol 88(1):1–9

  21. 21.

    Nilsson S, Norlen BJ, Widmark A (2004) A systematic overview of radiation therapy effects in prostate cancer. Acta Oncol 43(4):316–381

  22. 22.

    Pasquier D, Ballereau C (2008) Adjuvant and salvage radiotherapy after prostatectomy for prostate cancer: a literature review. Int J Radiat Oncol Biol Phys 72(4):972–979

  23. 23.

    Potters L, Torre T, Ashley R, Leibel S (2000) Examining the role of neoadjuvant androgen deprivation in patients undergoing prostate brachytherapy. J Clin Oncol 18(6):1187–1192

  24. 24.

    Sathya JR, Davis IR, Julian JA et al (2005) Randomized trial comparing iridium implant plus external-beam radiation therapy with external-beam radiation therapy alone in node-negative locally advanced cancer of the prostate. J Clin Oncol 23(6):1192–1199

  25. 25.

    Sautter-Bihl ML, Sedlmayer F, Wiegel T (2009) Postoperative radiotherapy for advanced prostate cancer:improved local control translates into increased survival. Strahlenther Onkol 185(8):485–487

  26. 26.

    Sharkey J, Cantor A, Solc Z et al (2005) 103Pd brachytherapy versus radical prostatectomy in patients with clinically localized prostate cancer: a 12-year experience from a single group practice. Brachytherapy 4(1):34–44

  27. 27.

    Stephenson AJ, Scardino PT, Katton MW et al (2007) Predicting the outcome of slavage radiation therapy for recurrent prostate cancer after radical prostatectomy. J Clin Oncol 25(15):2035–2034

  28. 28.

    Sylvester JE, Blasko JC, Grimm PD et al (2003) Ten-year biochemical relapse-free survival after external beam radiation and brachytherapy for localized prostate cancer: the Seattle experience. Int J Radiat Oncol Biol Phys 57(4):944–952

  29. 29.

    Thompson IM, Tangen CM, Paradelo J et al (2009) Adjuvant radiotherapy for pathological T3N0M0 prostate cancer significantly reduces risk of metastases and improves survival: long-term followup of a randomized clinical trial. J Urol 181(3):956–962

  30. 30.

    Thompson IM Jr, Tangen CM, Paradelo J et al (2006) Adjuvant radiotherapy for pathologically advanced prostate cancer: a randomized clinical trial. JAMA 296(19):2329–2335

  31. 31.

    Trock BJ, Han M, Freedland SJ et al (2008) Prostate cancer-specific survival following salvage radiotherapy vs observation in men with biochemical recurrence after radical prostatectomy. JAMA 299(23):2760–2769

  32. 32.

    Van der Kwast TH, Bolla M, Van Poppel H et al (2007) EORTC 22911. Identification of patients with prostate cancer who benefit from immediate postoperative radiotherapy: EORTC 22911. J Clin Oncol 25(27):4178–4186

  33. 33.

    Wiegel T, Bottke D, Steiner U et al (2009) Phase III postoperative adjuvant radiotherapy after radical prostatectomy compared with radical prostatectomy alone in pT3 prostate cancer with postoperative undetectable prostate-specific antigen: ARO 96–02/AUO AP 09/95. J Clin Oncol 27(18):2924–2930

  34. 34.

    Wiegel T, Lohm G, Bottke D et al (2009) Achieving an undetectable PSA after radiotherapy for biochemical progression after radical prostatectomy is an independent predictor of biochemical outcome-results of a retrospective study. Int J Radiat Oncol Biol Phys 73(4):1009–1016

  35. 35.

    Zelefsky MJ, Wallner KE, Ling CC et al (1999) Comparison of the 5-year outcome and morbidity of threedimensional conformal radiotherapy versus transperineal permanent iodine-125 implantation for early-stage prostatic cancer. J Clin Oncol 17(2):517–522

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Correspondence to T. Martin.

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Martin, T., Wenz, F., Böhmer, D. et al. Strahlentherapie des Prostatakarzinoms in der neuen S3-Leitlinie. Urologe 49, 216–220 (2010). https://doi.org/10.1007/s00120-010-2242-7

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Schlüsselwörter

  • Prostatakarzinom
  • Postoperative Strahlentherapie
  • HDR-Brachytherapie
  • LDR-Brachytherapie

Keywords

  • Prostate cancer
  • Postoperative radiation therapy
  • HDR brachytherapy
  • LDR brachytherapy