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Moderne Strahlentherapie des primären Prostatakarzinoms

Modern radiotherapy of primary prostate cancer

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best practice onkologie Aims and scope

Zusammenfassung

Das Prostatakarzinom (PCa) ist die häufigste Tumorerkrankung des Mannes. Während Patienten mit niedrigem Risikoprofil aktiv überwacht werden können, bieten die Strahlentherapie und Operation Patienten mit intermediärem und hohem Risiko gleichwertige Therapieoptionen. Die moderne Strahlentherapie ermöglicht eine reduzierte Behandlungszeit von 2–4 Wochen mittels moderater Hypofraktionierung oder stereotaktischer Strahlentherapie (SBRT), eine geringe Rate an Nebenwirkungen und eine personalisierte, auf die individuelle Anatomie und Tumorgeometrie angepasste Behandlung. Dabei können Informationen aus der multiparametrischen Magnetresonanztomographie (mpMRT) und Positronenemissionstomographie mit Tracern gegen das prostataspezifische Membranantigen (PSMA-PET) berücksichtigt werden. Mittels fokaler Dosiseskalation kann die Bestrahlungsdosis auf die Tumorareale in der Prostata erhöht werden, ohne umliegende Organe mehr zu belasten. Die HypoFocal-SBRT-Studie, eine durch die Dekade gegen Krebs geförderte multizentrische Phase-III-Studie, untersucht den möglichen Vorteil einer SBRT in 5 Fraktionen mit Dosiseskalation im Bereich der durch die mpMRT und PSMA-PET definierten intraprostatischen Tumorläsionen. Ziel dieser Studie ist es, das rezidivfreie Überleben für Patienten mit lokalisiertem PCa von intermediärem und hohem Risikoprofil weiter zu verbessern und gleichzeitig eine Reduktion der Therapiedauer zu ermöglichen.

Abstract

Prostate cancer (PCa) is the most frequent malignant disease in men. While patients with a low risk profile can be actively monitored (watchful waiting), radiotherapy and surgery are equivalent therapeutic options for patients with an intermediate or high risk profile. Modern radiotherapy allows a reduction in treatment time to 2–4 weeks via hypofractionation or stereotactic body radiotherapy (SBRT), is associated with a low rate of adverse events, and enables personalized treatment adapted to the individual anatomy and tumor geometry. Information from multiparametric MRI (mpMRI) and positron-emission tomography with tracers targeting the prostate-specific membrane antigen (PSMA-PET) can be considered during treatment planning. Using focal dose escalation, the radiation dose to the tumor in the prostate can be increased, without further exposure of proximal organs. The HypoFocal-SBRT study, a multicentric phase III trial funded by the National Decade Against Cancer, is investigating the possible benefit of SBRT in five fractions with dose escalation to the intraprostatic tumor lesions defined by mpMRT and PSMA-PET. The aim of this study is to further improve the recurrence-free survival of patients with localized PCa of intermediate and high risk profile while simultaneously reducing the treatment time.

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Author information

Authors and Affiliations

  1. Klinik für Strahlenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Robert-Koch-Straße 3, 79106, Freiburg, Deutschland

    Simon K. B. Spohn, Constantinos Zamboglou & Anca L. Grosu

  2. Partner Standort Freiburg, Deutsches Krebsforschungszentrum (DKFZ), Deutsches Konsortium für Translationale Krebsforschung (DKTK), Freiburg, Deutschland

    Simon K. B. Spohn, Constantinos Zamboglou & Anca L. Grosu

  3. Berta-Ottenstein-Programm, Medizinische Fakultät, Universität Freiburg, Freiburg, Deutschland

    Simon K. B. Spohn & Constantinos Zamboglou

  4. German Oncology Center, Europäische Universität Zypern, Limassol, Zypern

    Constantinos Zamboglou

Authors
  1. Simon K. B. Spohn
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  2. Constantinos Zamboglou
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  3. Anca L. Grosu
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Correspondence to Simon K. B. Spohn.

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Interessenkonflikt

Die HypoFocal-SBRT Studie wird auch das Bundesministerium für Bildung und Forschung (BMBF) gefördert. S.K.B. Spohn, C. Zamboglou und A.L. Grosu geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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David Krug, Kiel

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Spohn, S.K.B., Zamboglou, C. & Grosu, A.L. Moderne Strahlentherapie des primären Prostatakarzinoms. best practice onkologie 18, 130–137 (2023). https://doi.org/10.1007/s11654-023-00473-0

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  • DOI: https://doi.org/10.1007/s11654-023-00473-0

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