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Strahlentherapie des fortgeschrittenen und rezidivierenden Prostatakarzinoms

Radiotherapy in the treatment of advanced and recurrent prostate cancer

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Zusammenfassung

Die Häufigkeit, ein fortgeschrittenes Prostatakarzinom zu diagnostizieren, ist seit Einführung der PSA-Diagnostik drastisch gesunken. Die Therapie dieser Patientengruppe ist jedoch aufgrund der schlechten Prognose eine Herausforderung, welche seit Jahren kontrovers diskutiert wird. Neben der Frage der Radiatio der Lymphabflusswege wird die aktuelle Datenlage zur kombinierten Strahlentherapie mit hormonablativer Therapie dargestellt. Das Risiko von PSA-Rezidiven nimmt zu, seit radikale Prostatektomien von Patienten mit hohen Risikofaktoren oder fortgeschrittenen Tumoren häufiger durchgeführt werden. Hier hat entweder die adjuvante oder die Salvage-Radiatio einen festen Platz im Therapiealgorithmus des Prostatakarzinoms. Die LDR- und die HDR-Brachytherapie sind primäre Therapieoptionen bei Patienten mit niedrigen bzw. hohen Risikofaktoren und lokalisierter Erkrankung. Ein gutes Nebenwirkungsmanagement ist notwendig, um auftretende therapieassoziierte Symptome anhaltend zu lindern. Dieser Artikel vermittelt die möglichen Nebenwirkungen einer Strahlentherapie und die Behandlungskonzepte. Radiogene Zweittumoren stellen eine schwerwiegende Folge nach Strahlentherapie dar; auch hierzu wird eine Einschätzung der vorhandenen Daten dargelegt.

Abstract

The incidence of advanced prostate cancer has decreased since the introduction of prostate-specific antigen (PSA) measurements. The treatment of these patients remains a challenge due to the bad prognosis and continues to be controversially discussed. The article discusses the questions concerning radiotherapy including pelvic lymph nodes as well as an additional androgen deprivation therapy. The risk of recurrent cancer has increased since the introduction of radical prostatectomy for patients with high risk factors or locally advanced tumors. In these cases adjuvant and salvage radiotherapy represent a mainstay of therapy. Low-dose rate (LDR) and high-dose rate (HDR) brachytherapy are primary treatment options for patients with low and high risk factors and localized disease. An elaborate management of treatment-related toxicities is mandatory and may provide persistent symptom relief. A comprehensive assessment of radiation side effects and treatment concepts is provided. The development of secondary cancers after radiotherapy represents a most severe side effect for which an assessment of available data is presented.

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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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Correspondence to D. Böhmer.

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Der Artikel „Perkutane Strahlentherapie in der Behandlung des Prostatakarzinoms“ erschien in Ausgabe 11/2012 von Der Urologe.

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Böhmer, D. Strahlentherapie des fortgeschrittenen und rezidivierenden Prostatakarzinoms. Urologe 51, 1759–1771 (2012). https://doi.org/10.1007/s00120-012-3030-3

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