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Konformierende Strahlentherapie des lokalisierten Prostatakarzinoms: akute toleranz und frühe Wirksamkeit

Conformal radiation therapy of localized prostate cancer: Acute tolerance and early evaluation of effectiveness

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Zusammenfassung

Ziel

Quantifizierung der frühen Wirksamkeit und akuten Toxizität der 3D-geplanten und konformierenden Strahlentherapie des lokalisierten Prostatakarzinoms mittels Dosis-Volumen-Histogramm sowie Untersuchung der Abhängigkeit von der Bestrahlungstechnik in einer prospektiven Studie.

Patienten und Methode

32 Patienten (Alter 44 bis 80 Jahre) mit lokal fortgeschrittenem Prostatakarzinom (Stadien B2 und C) erhielten nach einer 3D-Bestrahlungsplanung eine konformierende Radiotherapie am Linearbeschleuniger. Bei 28/32 der Patienten wurde eine monoaxiale bisegmentale Rotation mit irregulären Feldern angewendet. Bei Einzeldosen von 2 Gy wurde eine mittlere Gesamtdosis von 63,9 Gy± 4,9 Gy nach ICRU innerhalb von 46±4 Tagen appliziert. Das Dosismaximum lag bei durchschnittlich 105,1%±3,8%. Die Größe des Zielvolumens betrug im Mittel 274,1±113,4 cm3. Die mittlere Nachbeobachtungszeit liegt bei 1,8 Jahren (15 bis 34 Monate). Die Toxizität wurde prospektiv nach RTOG-EORTC-Kriterien durch wöchentliche Patientengespräche und klinische Untersuchungen während der Strahlentherapie sowie durch regelmäßige Nachsorgeuntersuchungen bestimmt.

Ergebnisse

Elf Patienten hatten keine, 15 leichte (RTOG Grad I) und sechs mäßiggradige Nebenwirkungen (RTOG Grad II, meist Diarrhö, Dysurie und Polyurie). Bei keinem Patienten mußte die Therapie aufgrund von Nebenwirkungen abgebrochen werden. Bei 16 Patienten besserte sich die klinische Beschwerdesymptomatik innerhalb von sechs Wochen. Nur bei zwei Patienten hielten die Beschwerden länger als drei Monate nach Therapieende an und wurden endoskopisch kontrolliert. Bislang wurden keine Spätkomplikationen beobachtet. Die Inzidenz und die Ausprägung der Nebenwirkungen korrelierte statistisch signifikant (p<0,05) mit der Größe des Zielvolumens. Zusätzlich fand sich eine signifikante Abhängigkeit (p<0,05) der Akuttoxizität vom prozentualen Volumenanteil von Blase oder Rektum, der mit über 35 Gy belastet wurde. Bei 81% der Patienten mit erhöhtem prätherapeutischen PSA konnte eine Normalisierung des PSA erreicht werden. Der durchschnittliche prätherapeutische PSA-Wert von 15,7±22,6 μg/l fiel innerhalb von sechs Wochen nach Strahlentherapie auf durchschnittlich 2,1±3,7 μg/l. Ein Lokalrezidiv wurde bislang erst bei einem Patienten 22 Monate nach Strahlentherapie beobachtet.

Schlußfolgerung

Durch 3D-geplante tumorkonforme Bestrahlungstechniken und Dosisoptimierung mit verbesserter Schonung der Risikoorgane Blase und Rektum stellt die Strahlentherapie eine effektive und gut verträgliche Therapie des lokalisierten Prostatakarzinoms dar.

Abstract

Aim

In a prospective trial early effectiveness and acute toxicity of conformal 3D-planned radiotherapy for localized prostate cancer was quantified using dose-volume-histogramms and evaluated with respect of treatment technique.

Patients and Method

Thirty-two men (44 to 80 years old) with locally advanced carcinoma of the prostate (stage B2 or C) have been treated by 3D-planned conformal radiotherapy using high energy photons. In 28/32 men treatment technique was a monoaxial bisegmental rotation, with irregular fields. With single doses of 2.0 Gy a mean total dose of 63.9±4.9 Gy according to ICRU was applied within 46±4 days. Maximum dose was in the mean 105.1%±3.8%. 3D treatment volume was 274.1±113.4 cm3. Median follow-up is 1.8 years (15 to 34 months). Toxicity was evaluated according to RTOG-EORTC by patient interview and physical examination on a weekly basis during radiotherapy and by regular follow-up.

Results

Eleven patients had none, 15 mild (RTOG grade 1) and 6 moderate symptoms (RTOG grade 2, mainly diarrhoea, dysuria and polyuria). Acute complications leading to treatment interruption did not occur. In 16 patients symptoms disappeared within 6 weeks after radiotherapy. Only 2 men had symptoms which lasted longer than 3 months and were endoscopically examined. Up to now no late complications were detected. Incidence and severity of toxicity was significantly (p<0,05) related to the size of treatment volume. Akute toxicity was found to depend statistically significant (p<0,05) on the proportional volume of bladder and rectum, irradiated with more than 35 Gy. In 81% of the patients with pretherapeutic elevated PSA levels normalisation of PSA was observed. Overall mean PSA levels of 15.7±22.6 μg/l at the beginning of radiotherapy fell to 2.1±3.7 μg/l 6 weeks after irradiation. Only 1 Patient relapsed locally 22 months after radiation therapy.

Conclusion

We conclude that due to modern 3D-planned conformal techniques with optimization of treatment dose and improved protection of critical organs such as urinary bladder and rectum, radiotherapy, allows an effective and well tolerated therapy of localized prostatic carcinoma.

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  1. Klinische Radiologie, Radiologische Universitätsklinik Heidelberg, Im Neuenheimer Feld 400, D-69120, Heidelberg

    D. Zierhut, M. Flentje, G. Sroka-Perez, V. Rudat, R. Engenhart-Cabillic & M. Wannenmacher

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Zierhut, D., Flentje, M., Sroka-Perez, G. et al. Konformierende Strahlentherapie des lokalisierten Prostatakarzinoms: akute toleranz und frühe Wirksamkeit. Strahlenther. Onkol. 173, 98–105 (1997). https://doi.org/10.1007/BF03038929

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