Диагностика и лечение опухолей мочеполовой системы. Рак предстательной железыВведение В последнее время активно ведутся разработка и внедрение в клиническую практику методов радио-терапии в лечении злокачественных заболеваний. С развитием новых технологий в лечении рака пред-стательной железы (РПЖ) методу радиотерапии отда-ют все большее предпочтение. Тем не менее, по дан-ным мировой литературы, биохимический рецидив после дистанционной радиотерапии (ДРТ), брахите-рапии в монорежиме и в сочетании с ДРТ при РПЖ достигает 40 % [1][2][3][4]. В 20-30 % случаев биохимиче-ский рецидив связан с локальным прогрессированием (локальные рецидивы), что говорит о возможности рассмотрения вопроса проведения спасительной (сальважной) терапии [5]. Однако лишь небольшая часть (0,9-2,0 %) этих случаев фактически поддается контролю с помощью спасительной радикальной про-статэктомии, тогда как большинство больных в конеч-ном итоге получают андрогендепривационную тера-пию, вне зависимости от степени распространенности опухолевого процесса [6,7].Назначение андрогендепривационной терапии, как правило, является методом выбора при лечении таких больных. Тем не менее стабильный контроль РПЖ не может быть полностью достигнут только при-менением андрогендепривационной терапии в связи с развитием в конечном итоге кастрационно-рези-стентной фазы заболевания. В таком случае пациенты умирают в течение 1-2 лет с начала признаков про-грессирования заболевания [8]. Однако андрогенде-привационная терапия у большинства больных РПЖ эффективна и может проводиться при любых формах заболевания [5,6]
Introduction. One of the main problems of modem on-courology is treatment for prostate cancer of intermediate and high risk of progression. Modern radiotherapy in this category of patients has an advantage over surgical methods of treatment. One way to improve the effectiveness of radiotherapy is to escalate the dose in the prostate gland. For this purpose a combination of brachytherapy and remote radiotherapy is used. This combination allows increasing the dose of radiation, thereby providing better local control, reducing complications from neighboring organs. Purpose of the study. To conduct a comparative analysis of efficacy and safety of radical treatment of patients with prostate cancer at medium and high risk of progression using a combination of high and low dose rate brachytherapy with external beam radiotherapy. Materials and methods. 107 patients with prostate cancer of the group of medium and high risk of progression combined treatment (brachytherapy with external beam radiotherapy) was conducted. 53 patients underwent combined treatment (HDR-brachytherapy and external beam radiotherapy). 54 patients underwent combined treatment (LDR-brachytherapy and external beam radiotherapy). The observation period was 5 years. Conclusion. In a comparative analysis in groups of combined radiotherapy with the use of high-dose and low-dose-rate brachytherapy, the same effectiveness of immediate and long-term results of treatment was demonstrated. A significant reduction in early and late toxic reactions in patients with high-power brachytherapy has been demonstrated.
PURPOSE:To compare the outcome of high-dose-rate interstitial brachytherapy (HDR-BT) and low-dose-ratebrachytherapy (LDR-BT) as monotherapy for localized prostate cancer of low and intermediate risks progression. METHODS AND MATERIALS: The study included 165 patients with localized prostate cancer in low and intermediate progression risk groups. We compared 65 patients treated with HDR-BT and 100 patients with LDR-BT as monotherapy. LDR-BT treated advanced disease with more hormonal therapy than HDR-BT. All patients were in low and intermediate risk groups for prostate cancer progression. HDR-BT as monotherapy was delivered in 2 fractions of 15 Gy, two weeks apart. LDR-BT was performed in a standard mode of 145 Gy. The median observation was 32 months. All patients gave written informed consent. RESULTS: Overall biochemical free survival rate (BFSR) is 95,8%. There are 7 people having a growing prostatic specific antigen (PSA) while the case follow-up (in the group HDR-BT - 2 patients, LDR - 5 patients). Two recurrence cases with metastases in lymph nodes and bones were brought out as a result of 68Ga-PSMA PET examination in the group of HDR-BT. In 4 cases out of 5 LDR-BT, a local recurrence was detected (p=0,085). All cases of relapse were found in patients at intermediate risk (p = 0,041). LDR-BT showed a higher incidence of genitourinary (GU) toxicity grade >2 than that of HDR-BT in the acute phase and grade 1 toxicity in late phase. Accumulated incidence of late grade >2 GU and GU toxicity was equivalent between HDR-BT and LDR-BT. CONCLUSION: HDR-BT monotherapy showed an equivalent outcome to that of LDR-BT for low and intermediate risk patients. LDR-BT showed equivalent incidence of grade >2 late GU toxicities and higher grade >2 acute GU toxicity as that of HDR-BT as a monotherapy.
The technology of direct dosimetry was examined during a session of automated high-power interstitial gamma therapy for prostate cancer with a source of iridium-192 using a MKD-04 scintillation multi-detector dosimeter developed at the JSC ROSATOM. Miniature detectors of up to 5 pieces allow simultaneous measurements in areas of medical interest - the urethra and the rectum at different distances from the intrastats. The technology of direct dosimetry with rigid fixation of detectors is aimed at increasing quality assurance and reducing the frequency of complications. The dosimeter MKD-04 can be used for all types of automated brachytherapy, as well as in bundles of gamma-therapeutic devices to monitor the dose prescribed and actually received by the patient.
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