Salvage high-dose-rate brachytherapy for recurrent prostate cancer

Каприн, А. Д.; Иванов, С. А.; Карякин, О. Б.; Обухов, А А; Бирюков, В. А.; Borysheva, N.B.; Sanin, D.B.; Lepilina, Olga; Смолкин, А. Л.; Demianovich, Alena; Минаева, Н Г; N, Mikhaĭlovskiĭ

doi:10.17650/1726-9776-2020-16-4-112-119

Cited by 3 publications

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“…«Евразийский онкологический журнал», 2022, том 10, № 1 спасительного локального лечения, после завершения которого в течение 5 лет дальнейшее прогрессирование диагностируется в 15-50% случаев [9,10]. Именно эта категория лиц составляет большую часть пациентов с неметастатическим гормоночувствительным раком простаты, являющихся кандидатами для системной противоопухолевой терапии.…”

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Nonmetastatic Castration-resistant Prostate Cancer: How to Choose the Optimal Treatment Option?

Volkova¹,

Kalinin²,

Turupaev³

2022

Евразийский Онкологический Журнал

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После завершения трех позитивных РКИ подходы к лечению нмКРРПЖ группы высокого риска существенно изменились и включили назначение антиандрогенов второго поколения (АА2) в дополнение к продолжающейся андроген-депривационной терапии у пациентов с ВУПСА ≤10 месяцев. Все изученные АА2 (апалутамид, энзалутамид и даролутамид) продемонстрировали сопоставимую эффективность в отношении БМВ и ОВ, благоприятный профиль безопасности и отсутствие негативного влияния на качество жизни пациентов. Однако уникальная структура молекулы даролутамида обеспечивает возможность снижения риска развития специфичных для данной группы препаратов НЯ, прежде всего – неврологических. Потенциально наиболее безопасным АА2 у пациентов, получающих комедикацию для коррекции сопутствующих заболеваний, является даролутамид. Upon completion of three positive randomized clinical trials (RCTs), the treatment strategies in high-risk patients with nonmetastatic castration-resistant prostate cancer (nmCRPC) have changed significantly and now include administration of second- generation antiandrogens (SGAAs) in addition to continued androgen deprivation therapy (ADT) in patients with (PSADT) ≤ 10 months. All studied SGAAs (apalutamide, enzalutamide and darolutamide) have shown comparable efficacy in terms of metastasis- free survival (MFS) and overall survival (OS), favorable safety profile and no negative effect on patients’ quality of life. However the unique molecular structure of darolutamide makes it possible to decrease the risk of adverse events (AEs) specific for this group of drugs, primarily neurological AEs. Darolutamide is potentially the safest SGAA in patients receiving concomitant treatment for their comorbidities.

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Nonmetastatic Castration-resistant Prostate Cancer: How to Choose the Optimal Treatment Option?

Volkova¹,

Kalinin²,

Turupaev³

2022

Евразийский Онкологический Журнал

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Comparison of salvage high dose-rate brachytherapy and external beam radiotherapy for treatment of prostate cancer local recurrence after radical prostatectomy

2023

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Aim. To compare clinical efficacy of salvage high dose-rate brachytherapy (HDR-BT) and external beam radiotherapy (EBR) in treatment of local recurrence of prostate cancer after radical prostatectomy (RP).Materials and methods. Between January 2017 and December 2020, 60 patients with local recurrence of prostate cancer after RP were treated at the Russian Scientific Center of Roentgenology and Radiology. Two groups were identified: group 1 included 30 patients who underwent salvage external beam radiation therapy (EBRT) according to the classical fractionation regimen; in group 2, within the framework of the scientific protocol, 30 patients underwent 2 fractions of salvage HDR-BT with single boost dose of 15 Gy for total boost dose of 30 Gy. All patients in group 2 underwent pelvic multiparametric magnetic resonance imaging and positron emission tomography-computed tomography with prostatespecific membrane antigen ligands. In the 2nd group, transrectal biopsy of the prostate bed was also performed. Overall and biochemical recurrence-free survival, as well as the profile of early and late radiation complications, were analyzed.Results. Mean age of the patients at the time of salvage radiation therapy was 67.5 years (95 % confidence interval 66.1–69). Median time before development of biochemical relapse after RP was 24 months (interquartile range 13–46 months). Median follow-up period for all patients was 45 months (interquartile range 36–63 months). There were no dropouts in this study. The overall survival rate was 100 % in both groups. Comparative analysis of prostate specific antigen (PSA)-specific recurrence-free survival showed a clear trend toward an increase in the brachytherapy group; however, with the number of observations, statistically significant differences could not be achieved (p = 0.075). Salvage EBRT is more toxic than salvage HDR-BT. Comparative assessment of radiation adverse effects revealed higher frequency of early genitourinary toxicity of grade I and intestinal toxicity of grades I and II in the salvage EBRT group than in the salvage brachytherapy group, as well as late gastrointestinal toxicity of grade I and II.Conclusion. Salvage HDR-BT with 15 Gy × 2 fractions with total boost dose of up to 30 Gy was proved to be a promising treatment for local recurrence of prostate cancer after RP with an acceptable toxicity profile. There was also a trend towards increased PSA-specific recurrence-free survival in the salvage brachytherapy group compared with the salvage EBRT group.

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Iodine-125 brachytherapy and robotic stereotactic radiotherapy — treatment options for patients with localized prostate cancer

et al. 2021

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Introduction. Modern radiological treatment options for patients with localized prostate cancer (PCa) have several advantages and allow achieving high rates of biochemical control.Purpose of the study. To compare immediate, proximate, and long-term results of low-dose Iodine-125 brachytherapy (I-125 BT) and robotic stereotactic radiotherapy (SBRT) in patients with localized low- and intermediate-risk PCa.Materials and methods. The study included 296 patients with localized low- and intermediate-risk PCa. I-125 BT and SBRT were performed in 208 and 88 patients, respectively. All patients with an intermediate-risk PCa were prescribed neoadjuvant androgen-deprivation therapy (NADT) with luteinizing hormone-releasing hormone analogues (LHRH) for 4-6 months. Only radiation treatment was used for low-risk PCa. As a result, two groups and four subgroups of patients were formed depending on the treatment method. The immediate, proximate, and long-term results of radiation treatment methods were studied in groups and subgroups.Results. No complications were recorded during brachytherapy I-125. Radiation cystitis grade 1 and radiation rectitis grade 1 were diagnosed after SBRT in 16.6% and 4.0% of cases, respectively. In the only I-125 BT subgroup, the PSA level during the year decreased from 8.3 to 1.1 ng/ml, in the SBRT subgroup — from 7.5 to 0.8 ng/ml. In the case of combined treatment, PSA decreased from 1.2 to 0.93 ng/ml and from 4.5 to 0.5 ng/ml, respectively. Changes in prostate volume, residual volume, and urinary quality (I-PSS) were comparable in all subgroups. Five-year cancer-specific survival and overall survival in the group of patients after SBRT was 100%, after I-125 BT — more than 90%.Conclusion. Radiation treatment options for patients with localized PCa are safe. Conducting NADT does not significantly reduce the prostate volume and does not affect the indicators of urodynamics. High rates of cancer-specific five-year survival rate testify to the effectiveness of the evaluated treatment options.

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Salvage high-dose-rate brachytherapy for recurrent prostate cancer

Cited by 3 publications

References 5 publications

Nonmetastatic Castration-resistant Prostate Cancer: How to Choose the Optimal Treatment Option?

Nonmetastatic Castration-resistant Prostate Cancer: How to Choose the Optimal Treatment Option?

Comparison of salvage high dose-rate brachytherapy and external beam radiotherapy for treatment of prostate cancer local recurrence after radical prostatectomy

Iodine-125 brachytherapy and robotic stereotactic radiotherapy — treatment options for patients with localized prostate cancer

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