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Perkutane Strahlentherapie in der Behandlung des Prostatakarzinoms

External beam radiotherapy in the treatment of prostate cancer

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Zusammenfassung

Das Prostatakarzinom repräsentiert die häufigste Krebsneuerkrankung in der Bundesrepublik Deutschland. Die definitive Strahlentherapie ist eine der beiden empfohlenen kurativen Therapieoptionen dieser Erkrankung. Dabei werden verschiedene Formen unterschieden: die perkutane Strahlentherapie und die interstitielle Brachytherapie. Die technischen Entwicklungen der letzten beiden Jahrzehnte haben dazu geführt, dass für Patienten aller Erkrankungsstadien durch die Strahlentherapie bessere Heilungschancen bzw. eine effektivere Linderung krankheitsbedingter Symptome erreicht werden kann. Dabei kann die Therapie immer sicherer und nebenwirkungsärmer appliziert werden. Es werden sowohl die Ergebnisse der klassischen 3-D-konformalen als auch der neuen perkutanen Strahlentherapietechniken ausführlich dargestellt. Daneben wird auch das Konzept der Hypofraktionierung mit Ergebnissen randomisierter Studien betrachtet. Welche Therapie oder Technik für den individuellen Patienten angewendet wird, muss nach Wertung der Tumorausdehnung und der Risikofaktoren auf einer interdisziplinären Entscheidung basieren.

Abstract

Prostate cancer represents the most frequently diagnosed malignant tumor in Germany. Primary radiotherapy is one of the two recommended curative treatment options for this disease. There are two types of radiotherapy: external beam radiotherapy and interstitial brachytherapy. Technical developments during the last two decades have made it possible to achieve improved chances of being cured of tumors and improved relief from disease-related symptoms for patients at all tumor stages. Moreover, treatment can be administered with a reduced rate of side effects. Results of classical 3D conformal radiotherapy as well as modern radiation therapy techniques are comprehensively presented including the concept of hypofractionation with results from available randomized trials. After comprehensive assessment of all relevant risk factors, recommendations for the type of treatment must be based on a multidisciplinary approach.

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Literatur

  1. Gesellschaft der epidemiologischen Krebsregister in Deutschland e. V. und Robert-Koch-Institut (Hrsg) (2012) Krebs in Deutschland, 8. überarbeitete und aktualisierte Ausgabe. Saarbrücken

  2. D’Amico AV, Whittington R, Malkowicz SB et al (1999) Pretreatment nomogram for prostate-specific antigen recurrence after radical prostatectomy or external-beam radiation therapy for clinically localized prostate cancer. J Clin Oncol 17:168–172

    Google Scholar 

  3. Leitlinienprogramm Onkologie der AWMF DKeVu, e. V. DK (2011) Interdisziplinäre Leitlinie der Qualität S3 zur Früherkennung, Diagnose und Therapie der verschiedenen Stadien des Prostatakarzinoms. Version 2.0, 1. Aktualisierung 2011

  4. Mottet N, Bellmunt J, Bolla M et al (2011) EAU guidelines on prostate cancer. Part II: Treatment of advanced, relapsing, and castration-resistant prostate cancer. Eur Urol 59:572–583

    Article  PubMed  Google Scholar 

  5. Al-Mamgani A, Putten WL van, Heemsbergen WD et al (2008) Update of Dutch multicenter dose-escalation trial of radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 72:980–988

    Article  PubMed  Google Scholar 

  6. Kuban DA, Levy LB, Cheung MR et al (2011) Long-term failure patterns and survival in a randomized dose-escalation trial for prostate cancer. Who dies of disease? Int J Radiat Oncol Biol Phys 79:1310–1317

    Article  PubMed  Google Scholar 

  7. Kuban DA, Tucker SL, Dong L et al (2008) Long-term results of the M. D. Anderson randomized dose-escalation trial for prostate cancer. Int J Radiat Oncol Biol Phys 70:67–74

    Article  PubMed  Google Scholar 

  8. Zietman AL, Bae K, Slater JD et al (2010) Randomized trial comparing conventional-dose with high-dose conformal radiation therapy in early-stage adenocarcinoma of the prostate: long-term results from Proton Radiation Oncology Group/American College of Radiology 95–09. J Clin Oncol 28:1106–1111

    Article  PubMed  Google Scholar 

  9. Zietman AL, DeSilvio ML, Slater JD et al (2005) Comparison of conventional-dose vs high-dose conformal radiation therapy in clinically localized adenocarcinoma of the prostate: a randomized controlled trial. JAMA 294:1233–1239

    Article  PubMed  CAS  Google Scholar 

  10. Beckendorf V, Guerif S, Le Prise E et al (2011) 70 Gy versus 80 Gy in localized prostate cancer: 5-year results of GETUG 06 randomized trial. Int J Radiat Oncol Biol Phys 80:1056–1063

    Article  PubMed  Google Scholar 

  11. Dearnaley DP, Sydes MR, Graham JD et al (2007) Escalated-dose versus standard-dose conformal radiotherapy in prostate cancer: first results from the MRC RT01 randomised controlled trial. Lancet Oncol 8:475–487

    Article  PubMed  Google Scholar 

  12. Lattanzi J, McNeeley S, Pinover W et al (1999) A comparison of daily CT localization to a daily ultrasound-based system in prostate cancer. Int J Radiat Oncol Biol Phys 43:719–725

    Article  PubMed  CAS  Google Scholar 

  13. Court LE, Dong L, Taylor N et al (2004) Evaluation of a contour-alignment technique for CT-guided prostate radiotherapy: an intra- and interobserver study. Int J Radiat Oncol Biol Phys 59:412–418

    Article  PubMed  Google Scholar 

  14. Poulsen PR, Fokdal L, Petersen J et al (2007) Accuracy of image-guided radiotherapy of prostate cancer based on the BeamCath urethral catheter technique. Radiother Oncol 83:25–30

    Article  PubMed  Google Scholar 

  15. Zhu X, Bourland JD, Yuan Y et al (2009) Tradeoffs of integrating real-time tracking into IGRT for prostate cancer treatment. Phys Med Biol 54:N393–N401

    Article  PubMed  CAS  Google Scholar 

  16. Graf R, Wust P, Budach V et al (2009) Potentials of on-line repositioning based on implanted fiducial markers and electronic portal imaging in prostate cancer radiotherapy. Radiat Oncol 4:13

    Article  PubMed  Google Scholar 

  17. Kotte AN, Hofman P, Lagendijk JJ et al (2007) Intrafraction motion of the prostate during external-beam radiation therapy: analysis of 427 patients with implanted fiducial markers. Int J Radiat Oncol Biol Phys 69:419–425

    Article  PubMed  Google Scholar 

  18. Crevoisier R de, Tucker SL, Dong L et al (2005) Increased risk of biochemical and local failure in patients with distended rectum on the planning CT for prostate cancer radiotherapy. Int J Radiat Oncol Biol Phys 62:965–973

    Article  PubMed  Google Scholar 

  19. Park SS, Yan D, McGrath S et al (2012) Adaptive image-guided radiotherapy (IGRT) eliminates the risk of biochemical failure caused by the bias of rectal distension in prostate cancer treatment planning: clinical evidence. Int J Radiat Oncol Biol Phys 83:947–952

    Article  PubMed  Google Scholar 

  20. Chung HT, Xia P, Chan LW et al (2009) Does image-guided radiotherapy improve toxicity profile in whole pelvic-treated high-risk prostate cancer? Comparison between IG-IMRT and IMRT. Int J Radiat Oncol Biol Phys 73:53–60

    Article  PubMed  Google Scholar 

  21. Zelefsky MJ, Kollmeier M, Cox B et al (2012) Improved clinical outcomes with high-dose image guided radiotherapy compared with non-IGRT for the treatment of clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 84:125–129

    Article  PubMed  Google Scholar 

  22. Pollack A, Zagars GK, Starkschall G et al (2002) Prostate cancer radiation dose response: results of the M. D. Anderson phase III randomized trial. Int J Radiat Oncol Biol Phys 53:1097–1105

    Article  PubMed  Google Scholar 

  23. Stefanelli A, Pascale G, Rainieri E et al (2012) Can we decrease the acute proctitis in prostate cancer patients using hyaluronic acid during radiation therapy: a prospective historically controlled clinical study. Eur Rev Med Pharmacol Sci 16:639–645

    PubMed  CAS  Google Scholar 

  24. Prada PJ, Jimenez I, Gonzalez-Suarez H et al (2012) High-dose-rate interstitial brachytherapy as monotherapy in one fraction and transperineal hyaluronic acid injection into the perirectal fat for the treatment of favorable stage prostate cancer: treatment description and preliminary results. Brachytherapy 11:105–110

    Article  PubMed  Google Scholar 

  25. Prada PJ, Gonzalez H, Menendez C et al (2009) Transperineal injection of hyaluronic acid in the anterior perirectal fat to decrease rectal toxicity from radiation delivered with low-dose-rate brachytherapy for prostate cancer patients. Brachytherapy 8:210–217

    Article  PubMed  Google Scholar 

  26. Prada PJ, Fernandez J, Martinez AA et al (2007) Transperineal injection of hyaluronic acid in anterior perirectal fat to decrease rectal toxicity from radiation delivered with intensity modulated brachytherapy or EBRT for prostate cancer patients. Int J Radiat Oncol Biol Phys 69:95–102

    Article  PubMed  CAS  Google Scholar 

  27. Noyes WR, Hosford CC, Schultz SE (2012) Human collagen injections to reduce rectal dose during radiotherapy. Int J Radiat Oncol Biol Phys 82:1918–1922

    Article  PubMed  CAS  Google Scholar 

  28. D’Amico AV, Manola J, McMahon E et al (2006) A prospective evaluation of rectal bleeding after dose-escalated three-dimensional conformal radiation therapy using an intrarectal balloon for prostate gland localization and immobilization. Urology 67:780–784

    Article  Google Scholar 

  29. Arcangeli G, Saracino B, Gomellini S et al (2010) A prospective phase III randomized trial of hypofractionation versus conventional fractionation in patients with high-risk prostate cancer. Int J Radiat Oncol Biol Phys 78:11–18

    Article  PubMed  Google Scholar 

  30. Pollack A, Hanlon AL, Horwitz EM et al (2006) Dosimetry and preliminary acute toxicity in the first 100 men treated for prostate cancer on a randomized hypofractionation dose escalation trial. Int J Radiat Oncol Biol Phys 64:518–526

    Article  PubMed  Google Scholar 

  31. Norkus D, Miller A, Kurtinaitis J et al (2009) A randomized trial comparing hypofractionated and conventionally fractionated three-dimensional external-beam radiotherapy for localized prostate adenocarcinoma: a report on acute toxicity. Strahlenther Onkol 185:715–721

    Article  PubMed  Google Scholar 

  32. Yeoh EE, Botten RJ, Butters J et al (2011) Hypofractionated versus conventionally fractionated radiotherapy for prostate carcinoma: final results of phase III randomized trial. Int J Radiat Oncol Biol Phys 81:1271–1278

    Article  PubMed  Google Scholar 

  33. Lukka H, Hayter C, Julian JA et al (2005) Randomized trial comparing two fractionation schedules for patients with localized prostate cancer. J Clin Oncol 23:6132–6138

    Article  PubMed  Google Scholar 

  34. Bekelman JE, Mitra N, Efstathiou J et al (2011) Outcomes after intensity-modulated versus conformal radiotherapy in older men with nonmetastatic prostate cancer. Int J Radiat Oncol Biol Phys 81:e325–e334

    Article  PubMed  Google Scholar 

  35. Sharma NK, Li T, Chen DY et al (2011) Intensity-modulated radiotherapy reduces gastrointestinal toxicity in patients treated with androgen deprivation therapy for prostate cancer. Int J Radiat Oncol Biol Phys 80:437–444

    Article  PubMed  Google Scholar 

  36. Vora SA, Wong WW, Schild SE et al (2007) Analysis of biochemical control and prognostic factors in patients treated with either low-dose three-dimensional conformal radiation therapy or high-dose intensity-modulated radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 68:1053–1058

    Article  PubMed  CAS  Google Scholar 

  37. Al-Mamgani A, Heemsbergen WD, Peeters ST et al (2009) Role of intensity-modulated radiotherapy in reducing toxicity in dose escalation for localized prostate cancer. Int J Radiat Oncol Biol Phys 73:685–691

    Article  PubMed  Google Scholar 

  38. Eade TN, Horwitz EM, Ruth K et al (2008) A comparison of acute and chronic toxicity for men with low-risk prostate cancer treated with intensity-modulated radiation therapy or (125)I permanent implant. Int J Radiat Oncol Biol Phys 71:338–345

    Article  PubMed  Google Scholar 

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung hin: Dirk Böhmer war/ist als Referent für die Firmen Takeda Pharma GmbH und Varian Medical Systems tätig.

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  1. Klinik für Radioonkologie, Charité Campus Virchow, Augustenburger Platz 1, 13353, Berlin, Deutschland

    D. Böhmer

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  1. D. Böhmer
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Correspondence to D. Böhmer.

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Die Strahlentherapie in der Behandlung des fortgeschrittenen und rezidivierenden Prostatakarzinoms wird in einem CME-Beitrag in Ausgabe 12/12 von Der Urologe behandelt.

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Böhmer, D. Perkutane Strahlentherapie in der Behandlung des Prostatakarzinoms. Urologe 51, 1591–1600 (2012). https://doi.org/10.1007/s00120-012-3017-0

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