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Combined chemohormonalradiation treatment of highand very-high-risk non-metastatic prostate cancer

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Title Combined chemohormonalradiation treatment of highand very-high-risk non-metastatic prostate cancer
Комплексное гормонохимиолучевое лечение больных неметастатическим раком предстательной железы группы высокого и очень высокого риска прогрессирования
 
Creator A. Kaprin D.; A.F. Tsyb Medical Radiological Research Center – branch of the National Medical Research Radiological Center
A. Troyanov V.; A.F. Tsyb Medical Radiological Research Center – branch of the National Medical Research Radiological Center
S. Ivanov A.; A.F. Tsyb Medical Radiological Research Center – branch of the National Medical Research Radiological Center
O. Karyakin V.; A.F. Tsyb Medical Radiological Research Center – branch of the National Medical Research Radiological Center
А. Каприн Д.; Медицинский радиологический научный центр им А.Ф. Цыба – филиал ФГБУ «Национальный медицинский исследовательский радиологический центр»
А. Троянов В.; Медицинский радиологический научный центр им А.Ф. Цыба – филиал ФГБУ «Национальный медицинский исследовательский радиологический центр»
С. Иванов А.; Медицинский радиологический научный центр им А.Ф. Цыба – филиал ФГБУ «Национальный медицинский исследовательский радиологический центр»
О. Карякин Б.; Медицинский радиологический научный центр им А.Ф. Цыба – филиал ФГБУ «Национальный медицинский исследовательский радиологический центр»
 
Subject prostate cancer; non-metastatic cancer; high-risk of progression; combination treatment; chemohormonalradiation treatment
рак предстательной железы; неметастатический рак; высокий риск прогрессирования; комплексное лечение; гормонохимиолучевое лечение
 
Description Introduction. Treatment of highand very-high-risk prostate cancer appears to be extremely difficult. External beam radiation therapy combined with long-term androgen deprivation therapy (ADT) plays the main role, though low treatment effectiveness compared to one of intermediateand low-risk groups pushes towards finding new treatment options and modalities.Objective: to enlighten data from modern publications and reviews concerning combined treatment uncluding (or not) chemotherapy and different types of radiation therapy.Risk stratification. Several organizations (NCCN, NICE, ESMO, AUA, EAU and others) offer risk stratification systems. The NCCN system includes the very-high-risk group (Т3b–T4). Nowadays high-risk is set (EAU) when stages ≥ T2c or prostatic specific antigen > 20 ng/ml or Gleason score 8–10 appear.External beam radiation therapy. Recommended dose is ≥ 74 Gy not depending on risk group. Low overall 10-years survival rate makes searching for new effective treatments inevitable.ADT. Long-term regimens (2–3 years) of ADT in high-risk prostate cancer is undoubtable and neccecary. Biochemical progression-free survival can be achieved by using luteinizing hormone-releasing hormone antagonists in long-term regimens.Brachytherapy. Brachytherapy alone and its combination with external beam radiation therapy show high effectiveness concerning progressionfree survival. In high-risk group survival rates are significantly lower. Improvement can be achieved by using adjuvant long-term ADT and other systemic therapy. Nowadays the results of such clinical trials are not available.Chemotherapy. Chemotherapy as part of combination treatment of non-metastatic hormonal-sensitive high-risk prostate cancer is proved to be effective (increasing progression-free and overall survival), but still rarely used treatment option.Conclusion. Reviews, meta-analyses and phase III clinical trials results show improvement of progression-free survival (and some – overall survival) when using a multimodal approach with chemotherapy. Combination treatment of taxane-base chemotherapy, luteinizing hormonereleasing hormone antagonists as ADT and brachytherapy alone or with external beam radiation therapy seems to be extremely perspective and needing further investigation. 
Введение. Лечение больных раком предстательной железы (РПЖ) группы высокого и очень высокого риска прогрессирования представляет большую сложность. Лучевая терапия в сочетании с длительной гормональной терапией (ГТ) играет ключевую роль, однако низкая эффективность лечения по сравнению с таковой в группе пациентов промежуточного и низкого риска прогрессирования вынуждает искать новые лечебные алгоритмы и подходы.Цель работы – анализ существующих публикаций и обзоров касательно комплексного лечения как с включением химиотерапии, так и без него, а также различных видов лучевой терапии.Оценка риска прогрессирования. Системы классификации и оценки риска прогрессирования предложены различными организациями (NCCN, NICE, ESMO, AUA, EAU и др.). Система классификации NCCN включает группу очень высокого риска (Т3b–4). В настоящее время принадлежность к группе высокого риска (EAU) определяется при стадии ≥ T2c, или при уровне простатического специфического антигена > 20 нг/мл, или при сумме баллов по шкале Глисона 8–10.Лучевая терапия. Рекомендованная доза облучения составляет ≥ 74 Гр вне зависимости от группы риска. Низкий уровень 10-летней общей выживаемости при РПЖ высокого риска прогрессирования вынуждает искать более эффективные подходы терапии. ГТ. Применение режимов длительной (2–3 года) ГТ при РПЖ высокого риска прогрессирования не вызывает сомнений и является обязательным. Увеличение выживаемости без биохимического рецидива возможно при использовании антагонистов лютеинизирующего гормона рилизинг-гормона в долгосрочных режимах.Внутритканевая лучевая терапия. Брахитерапия, как и сочетание ее с дистанционной лучевой терапией, показывает высокие результаты в отношении безрецидивной выживаемости. В группе высокого риска отмечается значительно более низкая выживаемость, поэтому возможно улучшение эффективности лечения при использовании длительной адъювантной ГТ и иной системной терапии. В настоящее время результаты подобных исследований не опубликованы.Химиотерапия. Химиотерапия как часть комплексного лечения неметастатического гормоночувствительного РПЖ высокого и очень высокого риска прогрессирования является доказанно эффективным (увеличивая безрецидивную и общую выживаемость пациентов), но еще мало распространенным видом лечения.Заключение. Обзоры, метаанализы и результаты рандомизированных исследований III фазы сообщают о преимуществах в отношении безрецидивной выживаемости при использовании мультимодального подхода с включением химиотерапии. Комбинация химиотерапии на основе таксанов, ГТ в виде антагонистов лютеинизирующего гормона рилизинг-гормона и лучевой терапии в виде брахитерапии или сочетанной терапии видится крайне перспективной и требующей дальнейшего изучения. 
 
Publisher "PH "ABV-Press"", LLC
 
Contributor —
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Date 2017-04-04
 
Type info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
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Format application/pdf
 
Identifier http://oncourology.abvpress.ru/oncur/article/view/650
10.17650/1726-9776-2017-13-1-101-111
 
Source Cancer Urology; Том 13, № 1 (2017); 101-111
Онкоурология; Том 13, № 1 (2017); 101-111
1996-1812
1726-9776
10.17650/1726-9776-2017-13-1
 
Language rus
 
Relation http://oncourology.abvpress.ru/oncur/article/view/650/628
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