DOI: https://doi.org/10.22263/2312-4156.2020.3.79
Goldytski S.O.1, Krasny S.A.2, Demeshko P.D.2, Lud N.G.1
Comparative analysis of treatment outcomes in patients with intermediate-risk prostate cancer
1Vitebsk State Order of Peoples’ Friendship Medical University, Vitebsk, Republic of Belarus
2N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Republic of Belarus
Vestnik VGMU. 2020;19(3):79-86.
Abstract.
Objectives. To conduct a retrospective comparison of long-term oncological outcomes in patients with intermediate-risk prostate cancer after radical prostatectomy, combined radiotherapy and high-dose rate brachytherapy in mono mode.
Material and methods. From 2008 to 2011 in the N. N. Alexandrov National Cancer Centre of Belarus 120 intermediate-risk prostate cancer patients were radically treated, of which 114 were further followed up after treatment. Patients were divided into 3 groups depending on the type of treatment. Stratification to the intermediate-risk group was performed in accordance with the NCCN criteria. The follow-up period lasted for 8 years. High-dose rate brachytherapy and combined radiotherapy were provided using specialized equipment, radical prostatectomy was performed according to the standard open-access technique. As net results, the event-free survival, cancer specific survival, and overall patients’ survival were evaluated.
Results. As a result of the retrospective analysis, the eight-year event-free survival, cancer specific survival turned out to be comparable for all types of treatment. The eight-year overall survival rate made up 90.5%.
Conclusions. The studied treatment methods are characterized by good long-term oncological outcomes in patients with intermediate-risk prostate cancer. Taking into account good tolerance and safety of high-dose rate brachytherapy and combined radiotherapy, as well as the oncological results obtained, these methods can be recommended as radical treatment and an alternative to radical prostatectomy in patients suffering from prostate cancer of the intermediate-risk progression group.
Key words: prostate cancer, high-dose rate brachytherapy, combined radiation therapy, radical prostatectomy, radiation therapy, intermediate risk of progression.
References
1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015 Mar;136(5):E359-86. doi: http://dx.doi.org/10.1002/ijc.29210
2. Brierley JD, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumors. 8th ed. [USA]: Wiley-Blackwell; 2017. 272 p.
3. Cooperberg MR, Pasta DJ, Elkin EP, Litwin MS, Latini DM, Chane JD, et al. The University of California, San Francisco Cancer of the Prostate Risk Assessment score: a straightforward and reliable preoperative predictor of disease recurrence after radical prostatectomy. J Urol. 2005 Jun;173(6):1938-42. doi: http://dx.doi.org/10.1097/01.ju.0000158155.33890.e7
4. Cimino S, Reale G, Castelli T, Favilla V, Giardina R, Russo GI, et al. Comparison between Briganti, Partin and MSKCC tools in predicting positive lymph nodes in prostate cancer: a systematic review and meta-analysis. Scand J Urol. 2017 Oct;51(5):345-350. doi: http://dx.doi.org/10.1080/21681805.2017.1332680
5. Lam TBL, MacLennan S, Willemse P-PM, Mason MD, Plass K, Shepherd R, et al. EAU-EANM-ESTRO-ESUR-SIOG Prostate Cancer Guideline Panel Consensus Statements for Deferred Treatment with Curative Intent for Localized Prostate Cancer from an International Collaborative Study (DETECTIVE Study). Eur Urol. 2019 Dec;76(6):790-813. doi: http://dx.doi.org/10.1016/j.eururo.2019.09.020
6. Bekelman JE, Rumble RB, Chen RC, Pisansky TM, Finelli A, Feifer A, et al. Clinically Localized Prostate Cancer: ASCO Clinical Practice Guideline Endorsement of an American Urological Association/ American Society for Radiation Oncology/ Society of Urologic Oncology Guideline. J Clin Oncol. 2018 Nov 10;36(32):3251-3258. doi: http://dx.doi.org/10.1200/JCO.18.00606
7. 10-Year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer / F. C. Hamdy [et al.] / N. Engl. J. Med. – 2016 Oct. – Vol. 375, N 15. – P. 1415–1424.
8. Bill-Axelson A, Holmberg L, Ruutu M, Garmo H, Stark JR, Busch C, et al. Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med. 2011 May;364(18):1708-17. doi: http://dx.doi.org/10.1056/NEJMoa1011967
9. Boorjian SA, Karnes RJ, Rangel LJ, Bergstralh EJ, Blute ML. Clinic validation of the D'amico risk group classification for predicting survival following radical prostatectomy. J Urol. 2008 Apr;179(4):1354-60; discussion 1360-1. doi: http://dx.doi.org/10.1016/j.juro.2007.11.061
10. Kupelian PA, Ciezki J, Reddy CA, Klein EA, Mahadevan A. Effect of increasing radiation doses on local and distant failures in patients with localized prostate cancer. Int J Radiat Oncol Biol Phys. 2008 May;71(1):16-22. doi: http://dx.doi.org/10.1016/j.ijrobp.2007.09.020
11. Heemsbergen WD, Al-Mamgani A, Slot A, Dielwart MFH, Lebesque JV. Long-term results of the Dutch randomized prostate cancer trial: impact of dose-escalation on local, biochemical, clinical failure, and survival. Radiother Oncol. 2014 Jan;110(1):104-9. doi: http://dx.doi.org/10.1016/j.radonc.2013.09.026
12. Michalski JM, Moughan J, Purdy J, Bosch W, Bruner DW, Bahary J-P, et al. Effect of Standard vs Dose-Escalated Radiation Therapy for Patients with Intermediate-Risk Prostate Cancer: The NRG Oncology RTOG 0126 Randomized Clinical Trial. JAMA Oncol. 2018 Jun;4(6):e180039. doi: http://dx.doi.org/10.1001/jamaoncol.2018.0039
13. Hoskin PJ, Colombo A, Henry A, Niehoff P, Hellebust TP, Siebert F-A, et al. GEC/ESTRO recommendations on high dose rate afterloading brachytherapy for localized prostate cancer: an update. Radiother Oncol. 2013 Jun;107(3):325-32. doi: http://dx.doi.org/10.1016/j.radonc.2013.05.002
14. Miralbell R, Roberts SA, Zubizarreta E, Hendry JH. Dose-fractionation sensitivity of prostate cancer deduced from radiotherapy outcomes of 5,969 patients in seven international institutional datasets: alpha/beta = 1.4 (0.9-2.2) Gy. Int J Radiat Oncol Biol Phys. 2012 Jan;82(1):e17-24. doi: http://dx.doi.org/10.1016/j.ijrobp.2010.10.075
15. Brenner DJ, Martinez AA, Edmundson GK, Mitchell C, Thames HD, Armour EP. Direct evidence that prostate tumors show high sensitivity to fractionation (low alpha/beta ratio), similar to late-responding normal tissue. Int J Radiat Oncol Biol Phys. 2002 Jan;52(1):6-13. doi: http://dx.doi.org/10.1016/s0360-3016(01)02664-5
16. Hoskin PJ, Rojas AM, Bownes PJ, Lowe GJ, Ostler PJ, Bryant L. Randomized trial of external beam radiotherapy alone or combined with high-dose-rate brachytherapy boost for localized prostate cancer. Radiother Oncol. 2012 May;103(2):217-22. doi: http://dx.doi.org/10.1016/j.radonc.2012.01.007
17. Zaorsky NG, Doyle L, Yamoah K, Andrel JA, Trabulsi EJ, Hurwitz MD, et al. High dose rate brachytherapy boost for prostate cancer: a systematic review. Cancer Treat Rev. 2014 Apr;40(3):414-25. doi: http://dx.doi.org/10.1016/j.ctrv.2013.10.006
18. Weed D, Kestin L, Martinez A, Gustafson G, Vicini F. A comparison of external beam radiation combined with HDR IR-192 boost brachytherapy vs radical prostatectomy for patients with intermediate to high risk prostate cancer. Int J Radiat Oncol Biol Phys. 2002 Oct;54(2):187. doi: http://dx.doi.org/10.1016/S0360-3016(02)03380-1
19. Roach M, Hanks G, Thames JrH, Schellhammer P, Shipley WU, Sokol GH, et al. Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: Recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys. 2006 Jul;65(4):965-74. doi: http://dx.doi.org/10.1016/j.ijrobp.2006.04.029
20. Demanes DJ, Martinez AA, Ghilezan M, Hill DR, Schour L, Brandt D, et al. High-dose-rate monotherapy: safe and effective brachytherapy for patients with localized prostate cancer. Int J Radiat Oncol Biol Phys. 2011 Dec;81(5):1286-92. doi: http://dx.doi.org/10.1016/j.ijrobp.2010.10.015
21. Yoshioka Y. Current status and perspectives of brachytherapy for prostate cancer. Int J Clin Oncol. 2009 Feb;14(1):31-6. doi: http://dx.doi.org/10.1007/s10147-008-0866-z
Information about authors:
Goldytski S.O. – senior lecturer of the Chair of Hospital Surgery with the courses of Urology & Pediatric Surgery, Vitebsk State Order of Peoples’ Friendship Medical University,
ORCID: https://orcid.org/0000-0002-3066-3185
Krasny S.A. – Doctor of Medical Sciences, professor, corresponding member of the National Academy of Sciences of Belarus, deputy director for scientific work of the N.N. Alexandrov National Cancer Centre of Belarus,
ORCID: https://orcid.org/0000-0003-3244-5664
Demeshko P.D. – Doctor of Medical Sciences, head of the Department of Radiation and Complex Therapy, chairman of the Council of Young Scientists of the N.N. Alexandrov National Cancer Centre of Belarus,
ORCID: https://orcid.org/0000-0002-1324-3656
Lud N.G. – Doctor of Medical Sciences, professor, head of the Chair of Oncology with the courses of Radiodiagnosis & Radiotherapy and the course of the Faculty for Advanced Training & Retraining, Vitebsk State Order of Peoples’ Friendship Medical University,
ORCID: https://orcid.org/0000-0002-1975-3163
Correspondence address: Republic of Belarus, 210009, Vitebsk, 27 Frunze ave., Vitebsk State Order of Peoples’ Friendship Medical University, Chair of Oncology with the courses of Radiodiagnosis & Radiotherapy and the course of the Faculty for Advanced Training & Retraining. E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Sergei O. Goldytski.
