Альманах клинической медицины. 2015; : 46-51
ПУТИ ОПТИМИЗАЦИИ ДИСТАНЦИОННОЙ ЛУЧЕВОЙ ТЕРАПИИ РАКА ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫ
https://doi.org/10.18786/2072-0505-2015-41-46-51Аннотация
Актуальность. Основанием для применения дистанционной гамма-терапии (ДГТ) у пациентов с раком предстательной железы послужили данные об ее эффективности в сочетании с современными планирующими устройствами и более низкая себестоимость по сравнению с использованием линейного медицинского ускорителя.
Цель – оценить влияние применения ДГТ у пациентов с раком предстательной железы с использованием компьютерной программы 3D-планирования Амфора на показатель 5-летней выживаемости в зависимости от основных прогностических критериев эффективности лечения.
Материал и методы. В исследование включены 34 пациента с раком предстательной железы, которые получили низкодозную ДГТ в суммарной очаговой дозе 62–70 Гр. Андрогенная депривация имела место у 73,5% пациентов в течение 6–12 месяцев. Результаты. У пациентов с исходным уровнем простатспецифического антигена в крови < 20 нг/мл показатель 5-летней выживае мости оказался наивысшим и составил 86%. Установлено, что в условиях сочетанного применения с андрогенной депривацией суммарная очаговая доза при низкодозной ДГТ (< 64 Гр; ≥ 64 Гр) не оказывает статистически значимого влияния на показатель 5-летней выживаемости (p = 0,61).
Заключение. Полученные нами результаты – лишь первый шаг на пути установления критериев, позволяющих выбрать способ дистанционной лучевой терапии при раке предстательной железы. Оптимизация определения тактики лечения на основании тщательного анализа исходных данных, в том числе о степени тяжести сопутствующей патологии, сделает использование ДГТ более обоснованным, что будет способствовать снижению себестоимости лечения.
Список литературы
1. Surapaneni A, Schwartz D, Nwokedi E, Rineer J, Rotman M, Schreiber D. Radiation therapy for clinically localized prostate cancer: long-term results of 469 patients from a single institution in the era of dose escalation. J Cancer Res Ther. 2014;10(4):951–6. doi: 10.4103/09731482.138096.
2. Joshi CP, Dhanesar S, Darko J, Kerr A, Vidyasagar PB, Schreiner LJ. Practical and clinical considerations in Cobalt-60 tomotherapy. J Med Phys. 2009;34(3):137–40. doi: 10.4103/09716203.54847.
3. Bagshaw MA, Ray GR, Pistenma DA, Castellino RA, Meares EM. External beam radiation therapy of primary carcinoma of the prostate. Cancer. 1975;36(2):723–8.
4. Cupps RE, Utz DC, Fleming TR, Carson CC, Zincke H, Myers RP. Definitive radiation therapy for prostatic carcinoma: Mayo clinic experience. J Urol. 1980;124(6):855–9.
5. Pilepich MV, Perez CA, Bauer W. Prognostic parameters in radiotherapeutic management of localized carcinoma of the prostate. J Urol. 1980;124(4):485–7.
6. Mahadevan A, Bucholz R, Gaya AM, Kresl JJ, Mantz C, Minnich DJ, Muacevic A, Medbery C 3rd, Yang J, Caglar HB, Davis JN. Best of the Radiosurgery Society® Scientific Meeting 2014: stereotactic radiosurgery/stereotactic body radiotherapy treatment of extracranial and intracranial lesions. Future Oncol. 2014;10(15):2307–10. doi: 10.2217/fon.14.168.
7. Hanks GE, Dunlap K. A comparison of the cost of various treatment methods for early cancer of the prostate. Int J Radiat Oncol Biol Phys. 1986;12(10):1879–81.
8. Perez CA, Michalski J, Ballard S, Drzymala R, Kobeissi BJ, Lockett MA, Wasserman TH. Cost benefit of emerging technology in localized carcinoma of the prostate. Int J Radiat Oncol Biol Phys. 1997;39(4):875–83.
9. Yu JB, Soulos PR, Herrin J, Cramer LD, Potosky AL, Roberts KB, Gross CP. Proton versus intensity-modulated radiotherapy for prostate cancer: patterns of care and early toxicity. J Natl Cancer Inst. 2013;105(1):25–32. doi: 10.1093/jnci/djs463.
10. Hoskin PJ, Rojas AM, Bownes PJ, Lowe GJ, Ostler PJ, Bryant L. Randomised trial of external beam radiotherapy alone or combined with high-dose-rate brachytherapy boost for localised prostate cancer. Radiother Oncol. 2012;103(2):217–22. doi: 10.1016/j.radonc.2012.01.007.
11. Hoffman RM, Barry MJ, Stanford JL, Hamilton AS, Hunt WC, Collins MM. Health outcomes in older men with localized prostate cancer: results from the Prostate Cancer Outcomes Study. Am J Med. 2006;119(5):418–25.
12. Stattin P, Holmberg E, Johansson JE, Holmberg L, Adolfsson J, Hugosson J; National Prostate Cancer Register (NPCR) of Sweden. Outcomes in localized prostate cancer: National Prostate Cancer Register of Sweden follow-up study. J Natl Cancer Inst. 2010;102(13):950–8. doi: 10.1093/jnci/djq154.
13. Fox C, Romeijn HE, Lynch B, Men C, Aleman DM, Dempsey JF. Comparative analysis of 60Co intensity-modulated radiation therapy. Phys Med Biol. 2008;53(12):3175–88. doi: 10.1088/0031-9155/53/12/007.
14. Peeters ST, Heemsbergen WD, Koper PC, van Putten WL, Slot A, Dielwart MF, Bonfrer JM, Incrocci L, Lebesque JV. Dose-response in radiotherapy for localized prostate cancer: results of the Dutch multicenter randomized phase III trial comparing 68 Gy of radiotherapy with 78 Gy. J Clin Oncol. 2006;24(13):1990–6.
15. Zhu Z, Zhang J, Liu Y, Chen M, Guo P, Li K. Efficacy and toxicity of external-beam radiation therapy for localised prostate cancer: a network meta-analysis. Br J Cancer. 2014;110(10):2396–404. doi: 10.1038/bjc.2014.197.
16. Bian SX, Kuban DA, Levy LB, Oh J, Castle KO, Pugh TJ, Choi S, McGuire SE, Nguyen QN, Frank SJ, Nguyen PL, Lee AK, Hoffman KE. Addition of short-term androgen deprivation therapy to dose-escalated radiation therapy improves failure-free survival for select men with intermediate-risk prostate cancer. Ann Oncol. 2012;23(9):2346–52. doi: 10.1093/annonc/mds001.
Almanac of Clinical Medicine. 2015; : 46-51
THE WAY FOR OPTIMIZATION OF DISTANT RADIATION THERAPY IN PROSTATE CANCER
https://doi.org/10.18786/2072-0505-2015-41-46-51Abstract
Background: The rationale for distant gamma therapy (DGT) in prostate cancer patients is the data of its effectiveness in combination with modern planner devices, as well as lower costs, compared to the use of a linear accelerator.
Aim: To access the impact of DGT based on a 3D planning software “Amphora” on the 5-year survival rate depending on the main predictors of treatment efficacy in prostate cancer patients.
Materials and methods: The study included 34 prostate cancer patients who received low-dose DGT (total focal dose of 62 to 70 Gr). Androgen deprivation was used in 73.5% of patients for 6 to 12 months.
Results: The patients with a baseline pros tate-specific antigen level < 20 ng/ml had the highest 5-year survival rate of 86%. There was no significant difference in a 5-year survival that depending on a total focal dose (< 64 Gr; ≥ 64 Gr) of DGT if used in combination with androgen deprivation. Conclusion: This data represents only the first step in establishment of the criteria to choose the type of DGT in prostate cancer patients. The optimization of a treatment strategy based on a thorough analysis of data, including that on comorbidities and their severity, would make the use of DGT more rational that will reduce costs of treatment.
References
1. Surapaneni A, Schwartz D, Nwokedi E, Rineer J, Rotman M, Schreiber D. Radiation therapy for clinically localized prostate cancer: long-term results of 469 patients from a single institution in the era of dose escalation. J Cancer Res Ther. 2014;10(4):951–6. doi: 10.4103/09731482.138096.
2. Joshi CP, Dhanesar S, Darko J, Kerr A, Vidyasagar PB, Schreiner LJ. Practical and clinical considerations in Cobalt-60 tomotherapy. J Med Phys. 2009;34(3):137–40. doi: 10.4103/09716203.54847.
3. Bagshaw MA, Ray GR, Pistenma DA, Castellino RA, Meares EM. External beam radiation therapy of primary carcinoma of the prostate. Cancer. 1975;36(2):723–8.
4. Cupps RE, Utz DC, Fleming TR, Carson CC, Zincke H, Myers RP. Definitive radiation therapy for prostatic carcinoma: Mayo clinic experience. J Urol. 1980;124(6):855–9.
5. Pilepich MV, Perez CA, Bauer W. Prognostic parameters in radiotherapeutic management of localized carcinoma of the prostate. J Urol. 1980;124(4):485–7.
6. Mahadevan A, Bucholz R, Gaya AM, Kresl JJ, Mantz C, Minnich DJ, Muacevic A, Medbery C 3rd, Yang J, Caglar HB, Davis JN. Best of the Radiosurgery Society® Scientific Meeting 2014: stereotactic radiosurgery/stereotactic body radiotherapy treatment of extracranial and intracranial lesions. Future Oncol. 2014;10(15):2307–10. doi: 10.2217/fon.14.168.
7. Hanks GE, Dunlap K. A comparison of the cost of various treatment methods for early cancer of the prostate. Int J Radiat Oncol Biol Phys. 1986;12(10):1879–81.
8. Perez CA, Michalski J, Ballard S, Drzymala R, Kobeissi BJ, Lockett MA, Wasserman TH. Cost benefit of emerging technology in localized carcinoma of the prostate. Int J Radiat Oncol Biol Phys. 1997;39(4):875–83.
9. Yu JB, Soulos PR, Herrin J, Cramer LD, Potosky AL, Roberts KB, Gross CP. Proton versus intensity-modulated radiotherapy for prostate cancer: patterns of care and early toxicity. J Natl Cancer Inst. 2013;105(1):25–32. doi: 10.1093/jnci/djs463.
10. Hoskin PJ, Rojas AM, Bownes PJ, Lowe GJ, Ostler PJ, Bryant L. Randomised trial of external beam radiotherapy alone or combined with high-dose-rate brachytherapy boost for localised prostate cancer. Radiother Oncol. 2012;103(2):217–22. doi: 10.1016/j.radonc.2012.01.007.
11. Hoffman RM, Barry MJ, Stanford JL, Hamilton AS, Hunt WC, Collins MM. Health outcomes in older men with localized prostate cancer: results from the Prostate Cancer Outcomes Study. Am J Med. 2006;119(5):418–25.
12. Stattin P, Holmberg E, Johansson JE, Holmberg L, Adolfsson J, Hugosson J; National Prostate Cancer Register (NPCR) of Sweden. Outcomes in localized prostate cancer: National Prostate Cancer Register of Sweden follow-up study. J Natl Cancer Inst. 2010;102(13):950–8. doi: 10.1093/jnci/djq154.
13. Fox C, Romeijn HE, Lynch B, Men C, Aleman DM, Dempsey JF. Comparative analysis of 60Co intensity-modulated radiation therapy. Phys Med Biol. 2008;53(12):3175–88. doi: 10.1088/0031-9155/53/12/007.
14. Peeters ST, Heemsbergen WD, Koper PC, van Putten WL, Slot A, Dielwart MF, Bonfrer JM, Incrocci L, Lebesque JV. Dose-response in radiotherapy for localized prostate cancer: results of the Dutch multicenter randomized phase III trial comparing 68 Gy of radiotherapy with 78 Gy. J Clin Oncol. 2006;24(13):1990–6.
15. Zhu Z, Zhang J, Liu Y, Chen M, Guo P, Li K. Efficacy and toxicity of external-beam radiation therapy for localised prostate cancer: a network meta-analysis. Br J Cancer. 2014;110(10):2396–404. doi: 10.1038/bjc.2014.197.
16. Bian SX, Kuban DA, Levy LB, Oh J, Castle KO, Pugh TJ, Choi S, McGuire SE, Nguyen QN, Frank SJ, Nguyen PL, Lee AK, Hoffman KE. Addition of short-term androgen deprivation therapy to dose-escalated radiation therapy improves failure-free survival for select men with intermediate-risk prostate cancer. Ann Oncol. 2012;23(9):2346–52. doi: 10.1093/annonc/mds001.
