Skip to main content
SpringerLink
Log in

Strahlentherapie des Prostatakarzinoms in der neuen S3-Leitlinie

Teil 2: Postoperative Strahlentherapie und Brachytherapie

Radiation therapy for prostate cancer in the new S3 guideline

Part 2: postoperative radiation therapy and brachytherapy

  • Leitthema
  • Published:
Der Urologe Aims and scope Submit manuscript

Zusammenfassung

Der postoperativen adjuvanten Strahlentherapie kommt durch das Vorliegen dreier randomisierter Studien im Stadium pT3R1 besondere Bedeutung zu, da hier eine Überlebensverlängerung gegenüber der „Wait-and-see-Strategie“ nachgewiesen wurde. Als Alternative steht die Bestrahlung bei persistierendem oder ansteigendem PSA-Wert nach radikaler Prostatektomie zur Verfügung. In diesem Fall jedoch sollte die Salvagestrahlentherapie so früh wie möglich erfolgen, am besten, wenn der PSA-Wert <0,5 ng/ml ist. Die Nebenwirkungen der perkutanen Strahlentherapie mit modernen Techniken in diesem Stadium sind sehr gering, schwere Spätfolgen Grad III oder IV treten in <3% der Fälle auf. Die LDR-Brachytherapie als Monotherapie ist eine primäre Therapieoption des „Low-risk-Tumors“. Bei Patienten mit „Intermediate-risk-Tumoren“ ist die Datenlage kontrovers und noch nicht abschließend beurteilbar. Bei „High-risk-Tumoren“ sollte die LDR-Brachytherapie nicht eingesetzt werden. Auch die High-dose-rate- (HDR-)Brachytherapie“ in Verbindung mit einer perkutanen Strahlentherapie ist als Beispiel einer typischen Dosiseskalation eine primäre Option bei „Intermediate-risk-“ und „High-risk-Prostatakarzinom“. Die Notwendigkeit einer zusätzlichen Hormontherapie bei der HDR-Brachytherapie ist unklar. Eine HDR-Monotherapie kann nur in Studien empfohlen werden.

Abstract

Postoperative adjuvant radiation therapy has achieved special significance based on the results of three randomized studies on stage pT3R1 prostate cancer which provided evidence for prolonged survival in comparison to the “wait and see” strategy. When PSA levels persist or increase after radical prostatectomy, irradiation represents an alternative. In this instance, salvage radiotherapy should be initiated as early as possible, most suitably when the PSA level is <0.5 ng/ml. Side effects of percutaneous radiotherapy using modern techniques are minimal in this stage; severe grade 3 or 4 late sequelae occur in <3% of cases. Low dose rate (LDR) brachytherapy as monotherapy is a primary treatment option for low-risk tumors. In patients with intermediate-risk tumors, data are controversial and cannot be assessed conclusively. LDR brachytherapy should not be administered in high-risk tumors. High dose rate (HDR) brachytherapy combined with percutaneous radiotherapy as an example of a typical dose escalation approach is a primary option for intermediate- and high-risk prostate cancer. Whether additional hormone therapy is needed with HDR brachytherapy is unclear. HDR monotherapy can only be recommended in the clinical trial setting.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Blasko JC, Grimm PD, Sylsvester JE, Cavanagh W (2000) The role of external beam radiotherapy with I-125/Pd-103 brachytherapy for prostate carcinoma. Radiother Oncol 57(3):273–278

    Article  CAS  PubMed  Google Scholar 

  2. Bolla M, Poppel H van, Collette L et al (2005) Postoperative radiotherapy after radical prostatectomy: a randomised controlled trial (EORTC trial 22911). Lancet 366(9485):572–578

    Article  PubMed  Google Scholar 

  3. Bottke D, Reijke TM de, Barkowiak D, Wiegel T (2009) Salvage radiotherapy in patients with persisting/rising PSA after radical prostatectomy for prostate cancer. Eur J Cancer 45(Suppl 1):148–157

    Article  PubMed  Google Scholar 

  4. Catton C, Gospodarowicz M, Warde P et al (2001) Adjuvant and salvage radiation therapy after radical prostatectomy for adenocarcinoma of the prostate. Radiother Oncol 59(1):51–60

    Article  CAS  PubMed  Google Scholar 

  5. Collette L, Poppel H van, Bolla M et al (2005) Patients at high risk of progression after radical prostatectomy: do they all benefit from immediate post-operative irradiation? (EORTC trial 22911). Eur J Cancer 41(17):2662–2672

    Article  PubMed  Google Scholar 

  6. Corner C, Rojas AM, Bryant L et al (2008) A Phase II study of high-dose-rate afterloading brachytherapy as monotherapy for the treatment of localized prostate cancer. Int J Radiat Oncol Biol Phys 72(2):441–446

    PubMed  Google Scholar 

  7. Deger S, Boehmer D, Roigas J et al (2005) High dose rate (HDR) brachytherapy with conformal radiation therapy for localized prostate cancer. Eur Urol 47(4):441–448

    Article  PubMed  Google Scholar 

  8. Demanes DJ, Rodriguez RR, Schour L et al (2005) High-dose-rate intensitymodulated brachytherapy with external beam radiotherapy for prostate cancer: California endocurietherapy’s 10-year results. Int J Radiat Oncol Biol Phys 61(5):1306–1316

    PubMed  Google Scholar 

  9. Galalae RM, Martinez A, Mate T et al (2004) Long-term outcome by risk factors using conformal high-dose-rate brachytherapy (HDR-BT) boost with or without neoadjuvant androgen suppression for localized prostate cancer. Int J Radiat Oncol Biol Phys 58(4):1048–1055

    PubMed  Google Scholar 

  10. Galalae RM, Martinez A, Nuernberg N et al (2006) Hypofractionated conformal HDR brachytherapy in hormone naive men with localized prostate cancer. Is escalation to very high biologically equivalent dose beneficial in all prognostic risk groups? Strahlenther Onkol 182(3):135–141

    Article  PubMed  Google Scholar 

  11. Ganswindt U, Stenzl A, Bamberg M, Belka C (2008) Adjuvant radiotherapy for patients with locally advanced prostate cancer-a new standard? Eur Urol 54(3):528–542

    Article  PubMed  Google Scholar 

  12. Garg MK, Tekyi-Mensah S, Bolton S et al (1998) Impact of postprostatectomy prostate-specific antigen nadir on outcomes following salvage radiotherapy. Urology 51(6):998–1002

    Article  CAS  PubMed  Google Scholar 

  13. Hoskin PJ, Motohashi K, Bownes P et al (2007) High dose rate brachytherapy in combination with external beam radiotherapy in the radical treatment of prostate cancer: initial results of a randomised phase three trial. Radiother Oncol 84(2):114–120

    Article  PubMed  Google Scholar 

  14. Khaksar SJ, Langley SE, Lovell D, Laing RW (2006) Interstitial low dose rate brachytherapy for prostate cancer–a focus on intermediate- and high-risk disease. Clin Oncol (R Coll Radiol) 18(7):513–518

    Google Scholar 

  15. Kovacs G, Potter R, Loch T et al (2005) GEC/ESTRO-EAU recommendations on temporary brachytherapy using stepping sources for localised prostate cancer. Radiother Oncol 74(2):137–148

    Article  PubMed  Google Scholar 

  16. Loeb S, Roehl KA, Viprakasit DP, Catalona WJ (2008) Long-term rates of undetectable PSA with initial observation and delayed salvage radiotherapy after radical prostatectomy. Eur Urol 54(1):88–94

    Article  PubMed  Google Scholar 

  17. Martin T, Baltas D, Kurek R et al (2004) 3-D conformal HDR brachytherapy as monotherapy for localized prostate cancer. A pilot study. Strahlenther Onkol 180(4):225–232

    Article  PubMed  Google Scholar 

  18. Martinez AA, Pataki I, Edmundson G et al (2001) Phase II prospective study of the use of conformal high-dose-rate brachytherapy as monotherapy for the treatment of favorable stage prostate cancer: a feasibility report. Int J Radiat Oncol Biol Phys 49(1):61–69

    CAS  PubMed  Google Scholar 

  19. Merrick GS, Butler WM, Galbreath RW et al (2003) Does hormonal manipulation in conjunction with permanent interstitial brachytherapy, with or without supplemental external beam irradiation, improve the biochemical outcome for men with intermediate or high-risk prostate cancer? BJU Int 91(1):23–29

    Article  CAS  PubMed  Google Scholar 

  20. Morgan SC, Waldron TS, Eapen L et al (2008) Adjuvant radiotherapy following radical prostatectomy for pathologic T3 or margin-positive prostate cancer: a systematic review and meta-analysis. Radiother Oncol 88(1):1–9

    Article  PubMed  Google Scholar 

  21. Nilsson S, Norlen BJ, Widmark A (2004) A systematic overview of radiation therapy effects in prostate cancer. Acta Oncol 43(4):316–381

    Article  PubMed  Google Scholar 

  22. Pasquier D, Ballereau C (2008) Adjuvant and salvage radiotherapy after prostatectomy for prostate cancer: a literature review. Int J Radiat Oncol Biol Phys 72(4):972–979

    PubMed  Google Scholar 

  23. Potters L, Torre T, Ashley R, Leibel S (2000) Examining the role of neoadjuvant androgen deprivation in patients undergoing prostate brachytherapy. J Clin Oncol 18(6):1187–1192

    CAS  PubMed  Google Scholar 

  24. Sathya JR, Davis IR, Julian JA et al (2005) Randomized trial comparing iridium implant plus external-beam radiation therapy with external-beam radiation therapy alone in node-negative locally advanced cancer of the prostate. J Clin Oncol 23(6):1192–1199

    Article  PubMed  Google Scholar 

  25. Sautter-Bihl ML, Sedlmayer F, Wiegel T (2009) Postoperative radiotherapy for advanced prostate cancer:improved local control translates into increased survival. Strahlenther Onkol 185(8):485–487

    Article  PubMed  Google Scholar 

  26. Sharkey J, Cantor A, Solc Z et al (2005) 103Pd brachytherapy versus radical prostatectomy in patients with clinically localized prostate cancer: a 12-year experience from a single group practice. Brachytherapy 4(1):34–44

    Article  PubMed  Google Scholar 

  27. Stephenson AJ, Scardino PT, Katton MW et al (2007) Predicting the outcome of slavage radiation therapy for recurrent prostate cancer after radical prostatectomy. J Clin Oncol 25(15):2035–2034

    Article  PubMed  Google Scholar 

  28. Sylvester JE, Blasko JC, Grimm PD et al (2003) Ten-year biochemical relapse-free survival after external beam radiation and brachytherapy for localized prostate cancer: the Seattle experience. Int J Radiat Oncol Biol Phys 57(4):944–952

    PubMed  Google Scholar 

  29. Thompson IM, Tangen CM, Paradelo J et al (2009) Adjuvant radiotherapy for pathological T3N0M0 prostate cancer significantly reduces risk of metastases and improves survival: long-term followup of a randomized clinical trial. J Urol 181(3):956–962

    Article  PubMed  Google Scholar 

  30. Thompson IM Jr, Tangen CM, Paradelo J et al (2006) Adjuvant radiotherapy for pathologically advanced prostate cancer: a randomized clinical trial. JAMA 296(19):2329–2335

    Article  CAS  PubMed  Google Scholar 

  31. Trock BJ, Han M, Freedland SJ et al (2008) Prostate cancer-specific survival following salvage radiotherapy vs observation in men with biochemical recurrence after radical prostatectomy. JAMA 299(23):2760–2769

    Article  CAS  PubMed  Google Scholar 

  32. Van der Kwast TH, Bolla M, Van Poppel H et al (2007) EORTC 22911. Identification of patients with prostate cancer who benefit from immediate postoperative radiotherapy: EORTC 22911. J Clin Oncol 25(27):4178–4186

    Article  Google Scholar 

  33. Wiegel T, Bottke D, Steiner U et al (2009) Phase III postoperative adjuvant radiotherapy after radical prostatectomy compared with radical prostatectomy alone in pT3 prostate cancer with postoperative undetectable prostate-specific antigen: ARO 96–02/AUO AP 09/95. J Clin Oncol 27(18):2924–2930

    Article  PubMed  Google Scholar 

  34. Wiegel T, Lohm G, Bottke D et al (2009) Achieving an undetectable PSA after radiotherapy for biochemical progression after radical prostatectomy is an independent predictor of biochemical outcome-results of a retrospective study. Int J Radiat Oncol Biol Phys 73(4):1009–1016

    PubMed  Google Scholar 

  35. Zelefsky MJ, Wallner KE, Ling CC et al (1999) Comparison of the 5-year outcome and morbidity of threedimensional conformal radiotherapy versus transperineal permanent iodine-125 implantation for early-stage prostatic cancer. J Clin Oncol 17(2):517–522

    CAS  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Strahlentherapie, Klinikum Bremen-Mitte, St.-Jürgen-Straße 1, 28205, Bremen, Deutschland

    T. Martin

  2. Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Mannheim, Mannheim, Deutschland

    F. Wenz

  3. Charité-Universitätsmedizin Berlin, Campus Mitte, Berlin, Deutschland

    D. Böhmer

  4. Klinik für Radiotherapie, Universität Salzburg, Salzburg, Österreich

    F. Sedlmayer

  5. Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Deutschland

    W. Hinkelbein

  6. Urologische Gemeinschaftspraxis, Berlin, Deutschland

    T.O. Henkel

  7. Urologische Klinik und Poliklinik, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Deutschland

    K. Miller

  8. Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Ulm, Ulm, Deutschland

    T. Wiegel

Authors
  1. T. Martin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Wenz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. Böhmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. F. Sedlmayer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. W. Hinkelbein
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. T.O. Henkel
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. K. Miller
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. T. Wiegel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. Martin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Martin, T., Wenz, F., Böhmer, D. et al. Strahlentherapie des Prostatakarzinoms in der neuen S3-Leitlinie. Urologe 49, 216–220 (2010). https://doi.org/10.1007/s00120-010-2242-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00120-010-2242-7

Schlüsselwörter

Keywords

Search

Navigation