Skip to main content
SpringerLink
Log in

High-dose-rate-Brachytherapie beim Risikoprostatakarzinom

High-dose rate brachytherapy for high-risk prostate cancer

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

Zusammenfassung

Beim Prostatakarzinom ist zur Einschätzung des Therapieerfolgs hinsichtlich der rezidivfreien Zeit die Gruppierung in Niedrig-, Intermediär- und Hochrisikokarzinome sinnvoll. Die Trias PSA ≥10, Gleason-Score ≥7 und die klinische Tumorkategorie cT3 (extrakapsuläres Tumorwachstum) sind bei der Einteilung hilfreich und einfach.

Das Phänomen des posttherapeutischen biochemischen Rezidivs könnte eine Folge der zzt. noch zu ungenauen Bildgebung in der Erkennung von Lymphknoten- oder Knochenmetastasen sein, sodass bereits zum Diagnosezeitpunkt eine Metastasierung nicht erkannt und eine lokale Therapie eingeleitet wird. Andererseits sind Karzinome der Hochrisikogruppe durch biologische Tumoreigenschaften gekennzeichnet, die auch sekundär zu einer fortschreitenden Erkrankung führen. Hierbei ist eine risikoadaptierte Therapie von immenser Wichtigkeit. In der Strahlentherapie spielt die applizierte Strahlendosis eine wichtige Rolle. Das Auftreten des biochemischen Lokalrezidivs korreliert mit den Risikofaktoren und der Strahlendosis. Vor diesem Hintergrund kann bei einem selektionierten Patientengut eine initiale 3D-konformale perkutane Strahlentherapie und HDR-Brachytherapie einen Vorteil bringen.

Erste eigene Erfahrungen zeigen, dass die HDR-Brachytherapie in Kombination mit der Teletherapie beim Risikoprostatakarzinom eine nebenwirkungsarme Therapieform ist. Bezüglich der PSA-rezidivfreien Zeit, der Lebensqualität, Miktion und erektiler Funktion zeigt die Untersuchung bei den ersten 42 Patienten erfolgversprechende Ergebnisse.

Abstract

To estimate disease-free survival it is necessary to allocate patients into tumor risk groups: locally advanced prostate carcinoma with extracapsular spread or localized prostate carcinoma of tumor stage T2c or one of the risk factors PSA >20 or Gleason ≥8 apply for the high-risk group. Intermediate-risk carcinomas are those belonging to tumor stage T2b or with PSA >10–20 or Gleason 7. Particulary for patients with intermediate and high-risk disease early PSA relapse is of major interest.

This phenomenon could be a consequence of current inadequate imaging of lymph node or bone metastasis or as a consequence subclinical metastatic spread remains undetectable during radical treatment. However, tumor biology itself could lead to the progression of the disease in the high-risk group. As a consequence, risk-adapted therapy is very important in these cases. The applied radiation dose plays an important role in radiotherapy.

Several publications have shown that the biochemical relapse correlates with the generally accepted risk factors and the radiation dose. Regarding this, high-quality treatment planning and HDR brachytherapy combined with EBRT (external beam radiation therapy) leads to good treatment results in selected groups. So far in our own experience, HDR brachytherapy in combination with EBRT is a successful form of treatment with few acute and late side effects in the first 42 patients examined. First results concerning to PSA relapse-free time, quality of life, miction, and erectile function are promising.

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

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6

Literatur

  1. Bolla M, van Poppel H, 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 

  2. Brenner DJ, Hall EJ (1999) Fractionation and protraction for radiotherapy of prostate carcinoma. Int J Radiat Oncol Biol Phys 43(5): 1095–1101

    Article  PubMed  Google Scholar 

  3. Cox JD (1997) Clinical science and patient care: lessons from cooperative randomized clinical trials. Int J Radiat Oncol Biol Phys 39(2): 273–274

    Article  PubMed  Google Scholar 

  4. D’Amico AV, Renshaw AA, Cote K et al. (1998) Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. Jama 280(11): 969–974

    Article  PubMed  Google Scholar 

  5. Deger S, Böhmer D, Schink T et al. (2002) High dose rate brachytherapy of localized prostate cancer. Eur Urol 41(4): 420–426

    Article  PubMed  Google Scholar 

  6. Dinges S, Deger S, Koswig S et al. (1998) High-dose rate interstitial with external beam irradiation for localized prostate cancer--results of a prospective trial. Radiother Oncol 48(2): 197–202

    Article  PubMed  Google Scholar 

  7. Donnelly BJ, Pedersen JE, Porter AT et al. (1991) Iridium-192 brachytherapy in the treatment of cancer of the prostate. Urol Clin North Am 18(3): 481–483

    PubMed  Google Scholar 

  8. Fowler J, Chappell R, Ritter M (2001) Is alpha/beta for prostate tumors really low? Int J Radiat Oncol Biol Phys 50(4): 1021–1031

    Article  PubMed  Google Scholar 

  9. 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 

  10. Gleave ME, Goldenberg SL, Chin JL et al. (2001) Randomized comparative study of 3 versus 8-month neoadjuvant hormonal therapy before radical prostatectomy: biochemical and pathological effects. J Urol 166(2): 500–507

    Article  PubMed  Google Scholar 

  11. Hanks GE (2002) Dose response in prostate cancer with 8–12 years‘ follow-uInt. J Radiat Oncol Biol Phys 54(2): 427–435

    Article  Google Scholar 

  12. Hocht S, Wiegel T, Schostak M et al. (2002) Adjuvant and salvage radiotherapy after radical prostatectomy. Onkologie 25(3): 201–206

    Article  PubMed  Google Scholar 

  13. Hocht S, Hinkelbein W (2005) Postoperative radiotherapy for prostate cancer. Lancet 366(9485): 524–525

    Article  PubMed  Google Scholar 

  14. Holmberg L, Bill-Axelson A, Helgesen F et al. (2002) A randomized trial comparing radical prostatectomy with watchful waiting in early prostate cancer. N Engl J Med 347(11): 781–789

    Article  PubMed  Google Scholar 

  15. Klotz LH (2005) Active surveillance for good risk prostate cancer: rationale, method, and results. Can J Urol 12 [Suppl 2]: 21–24

    PubMed  Google Scholar 

  16. Kovacs G, Galalae R, Wirth B, Kimming BM (1995) Improvement of interstitial brachytherapy for localized prostate neoplasms with a new implantation technique. Strahlenther Onkol 171(12): 685–688

    PubMed  Google Scholar 

  17. Kovacs G, Galalae R, Loch T et al. (1999) Prostate preservation by combined external beam and HDR brachytherapy in nodal negative prostate cancer. Strahlenther Onkol 175 [Suppl 2]: 87–88

    PubMed  Google Scholar 

  18. Kupelian PA, Elshaikh M, Reddy CA et al. (2002) Comparison of the efficacy of local therapies for localized prostate cancer in the prostate-specific antigen era: a large single-institution experience with radical prostatectomy and external-beam radiotherapy. J Clin Oncol 20(16): 3376–3385

    Article  PubMed  Google Scholar 

  19. Martinez AA, Kestin LL,Stromberg JS et al. (2000) Interim report of image-guided conformal high-dose-rate brachytherapy for patients with unfavorable prostate cancer: the William Beaumont phase II dose-escalating trial. Int J Radiat Oncol Biol Phys 47(2): 343–352

    Article  PubMed  Google Scholar 

  20. Martinez AA, Gonzalez JA, Chung AK et al. (2000) A comparison of external beam radiation therapy versus radical prostatectomy for patients with low risk prostate carcinoma diagnosed, staged, and treated at a single institution. Cancer 88(2): 425–432

    Article  PubMed  Google Scholar 

  21. Mate TP, Gribble M, Van Hollebeke L et al. (1998) High dose-rate afterloading 192Iridium prostate brachytherapy: feasibility report. Int J Radiat Oncol Biol Phys 41(3): 525–533

    Article  PubMed  Google Scholar 

  22. Messing EM, Manola J, Sarosdy M et al. (1999) Immediate hormonal therapy compared with observation after radical prostatectomy and pelvic lymphadenectomy in men with node-positive prostate cancer. N Engl J Med 341(24): 1781–1788

    Article  PubMed  Google Scholar 

  23. Moul JW, Wu H, Sun L et al. (2004) Early versus delayed hormonal therapy for prostate specific antigen only recurrence of prostate cancer after radical prostatectomy. J Urol 171(3): 1141–1147

    Article  PubMed  Google Scholar 

  24. Parker C (2004) Active surveillance of early prostate cancer: rationale, initial results and future developments. Prostate Cancer Prostatic Dis 7(3): 184–187

    Article  PubMed  Google Scholar 

  25. Pilepich MV, Caplan R, Byhardt RW et al. (1997) Phase III trial of androgen suppression using goserelin in unfavorable-prognosis carcinoma of the prostate treated with definitive radiotherapy: report of Radiation Therapy Oncology Group Protocol 85–31. J Clin Oncol 15(3): 1013–1021

    PubMed  Google Scholar 

  26. Pilepich MV, Caplan R, Byhardt RW et al. (2005) Androgen suppression adjuvant to definitive radiotherapy in prostate carcinoma – long-term results of phase III RTOG 85-31. Int J Radiat Oncol Biol Phys 61(5): 1285–1290

    Article  PubMed  Google Scholar 

  27. Pollack A, Starkschall G, Antolak JA 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(5): 1097–1105

    Article  PubMed  Google Scholar 

  28. Porter AT, Forman JD (1993) Prostate brachytherapy. An overview. Cancer 71 [3 Suppl]: 953–958

    PubMed  Google Scholar 

  29. Prestidge BR, Prete JJ Bice WS et al. (1998) A survey of current clinical practice of permanent prostate brachytherapy in the United States. Int J Radiat Oncol Biol Phys 40(2): 461–465

    Article  PubMed  Google Scholar 

  30. Schwarzer JU, Hofmann R, Kneschaurek P et al. (1992) High-dose-rate brachytherapy of prostatic carcinoma with iridium 192. Strahlenther Onkol 168(1): 17–22

    PubMed  Google Scholar 

  31. Seay TM, Blute ML, Zincke H (1998) Long-term outcome in patients with pTxN+ adenocarcinoma of prostate treated with radical prostatectomy and early androgen ablation. J Urol 159(2): 357–364

    Article  PubMed  Google Scholar 

  32. Steineck G, Helgesen F, Adolfsson J et al. (2002) Quality of life after radical prostatectomy or watchful waiting. N Engl J Med 347(11): 790–796

    Article  PubMed  Google Scholar 

  33. Stock RG, Stone NN, Tabert A et al. (1998) A dose-response study for I-125 prostate implants. Int J Radiat Oncol Biol Phys 41(1): 101–108

    Article  PubMed  Google Scholar 

  34. Zelefsky MJ, Leibel SA (1998) Dose escalation with three-dimensional conformal radiation therapy affects the outcome in prostate cancer. Int J Radiat Oncol Biol Phys 41(3): 491–500

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

Author information

Authors and Affiliations

  1. Urologische Klinik und Poliklinik, Universitätsklinikum, Hufelandstraße 55, 45122, Essen

    M. Schenck, T. Jaeger, C. Boergermann & H. Ruebben

  2. Klinik für Strahlentherapie, Universitätsklinikum, Essen

    K. Krause, J. Friedrich & M. Stuschke

  3. Klinische Strahlenphysik, Universitätsklinikum, Essen

    R. Schwandtner, I. Haase & D. Fluehs

  4. Interdisziplinäre Radio-Uroonkologie, Universitätsklinikum, Essen

    M. Schenck, K. Krause, D. Fluehs, J. Friedrich, T. Jaeger, C. Boergermann, H. Ruebben & M. Stuschke

Authors
  1. M. Schenck
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K. Krause
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. Schwandtner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. I. Haase
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. Fluehs
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Friedrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. T. Jaeger
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. C. Boergermann
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. H. Ruebben
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. M. Stuschke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Schenck.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schenck, M., Krause, K., Schwandtner, R. et al. High-dose-rate-Brachytherapie beim Risikoprostatakarzinom. Urologe 45, 715–722 (2006). https://doi.org/10.1007/s00120-006-1083-x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00120-006-1083-x

Schlüsselwörter

Keywords

Search

Navigation