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Brachytherapie des Prostatakarzinoms

Brachytherapy of the prostate cancer

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Zusammenfassung

Das Prostatakarzinom (PCA) ist die häufigste Krebserkrankung des Mannes in Zentral- und Westeuropa. Jährlich erkranken etwa 202.000 Männer in Europa neu an diesem Tumor. Die kurative Behandlung des PCA per Brachytherapie gewinnt zunehmend an Bedeutung (20–30% Anteil an kurativen Behandlungen). Von außerordentlicher Bedeutung ist das initiale Staging und damit die prätherapeutische Einteilung in Risikogruppen.

Die Low-dose-rate- (LDR-)Brachytherapie (SEED Implantation) unterscheidet sich bezüglich des Verfahrens, sowie der Indikation von der High-dose-rate- (HDR-)Brachytherapie (Afterloading Verfahren). Beide Verfahren finden sowohl als Monotherapie als auch kombiniert mit externer Bestrahlung Anwendung.

Bei der LDR-Monotherapie wird im Bereich der Low-risk-Tumoren im 10-Jahres-Follow-up über eine biochemische Rezidivfreiheit von bis zu 90% berichtet. Bei der kombinierten HDR-Tele- und Brachytherapie wird in Langzeitverläufen bezüglich der Intermediate- und High-risk-Tumoren über biochemische Rezidivfreiheiten von 80–90% berichtet.

Randomisierte Studien fehlen, aber aus Anwendungsbeobachtungen und Kohortenstudien lassen sich die folgenden Anwendungsalgorithmen ableiten. Die Anwendung der LDR-Monobrachytherapie muss auf Low-risk-Tumoren beschränkt bleiben. Die kombinierte HDR-Tele- und Brachytherapie kann im Bereich der Intermediate- und High-risk-Tumoren erfolgversprechend angewendet werden.

Das Outcome hängt initial entscheidend vom prätherapeutischen PSA-Wert und Gleason-Score ab. Posttherapeutisch hat der Nadir die größte Aussagekraft bezüglich der biochemischen Rezidivfreiheit.

Abstract

Prostate cancer (PCA) is the most frequent onlocological disease in men. Every year there are ca. 202.000 new cases of prostate cancer in Europe. Curative treatment of this carcinoma via brachytherapy is becoming increasingly significant (20–30% of all curative approaches). Initial staging and thus allocation to risk groups prior to the commencement of therapy is esspecially important for successful brachytherapy treatment.

Low-dose-rate (LDR) brachytherapy (i.e. SEED implantation) distinguishes itself both with respect to the procedure as well as the indication from high-dose-rate brachytherapy (afterloading procedure). Both treatment procedures are employed as monotherapy as well as in combination with external radiation.

LDR monotherapy is reported to achieve biochemically relapse-free outcome of up to 90% in low-risk tumours during 10-year follow-up periods. Combined HDR tele- and brachytherapy is reported to achieve a biochemically relapse-free outcome of 80–90% with intermediate- and high-risk tumours in long-term follow-up.

While randomized studies are as yet missing, it is still possible to derive the following application algorithms from monitoring studies and cohort studies: application of LDR monobrachytherapy must be restricted to low-risk tumorus. Combined HDR tele- and brachytherapy can be sucessfully applied in cases of intermediate- and high-risk tumours.

The outcome depends significantly on the initial, pre-therapy PSA value and Gleason score. Posttherapeutically, the nadir value is crucial with respect to predicting the biochemically relapse-free outcome.

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Authors and Affiliations

  1. Klinik für Urologie und Kinderurologie, Universitätsklinikum Schleswig-Holstein,Campus Kiel, Brunswiker Straße 10, 24105, Kiel, Deutschland

    S.H. Stübinger, S. Kaufmann, S. Hautmann & K.P. Jünemann

  2. Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland

    R. Wilhelm, M. Döring & R. Galalae

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  1. S.H. Stübinger
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  2. R. Wilhelm
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  6. K.P. Jünemann
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  7. R. Galalae
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Correspondence to S.H. Stübinger.

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Stübinger, S., Wilhelm, R., Kaufmann, S. et al. Brachytherapie des Prostatakarzinoms. Urologe 47, 284–290 (2008). https://doi.org/10.1007/s00120-008-1634-4

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