tumorsMalignant tumoursMalignant tumours2224-50572587-6813Rosoncoweb10.18027/2224-5057-2020-10-3-26-33tumors-804Research ArticleСОБСТВЕННЫЕ ИССЛЕДОВАНИЯ. ВОПРОСЫ ЛУЧЕВОЙ ТЕРАПИИOWN RESEARCH. RADIATION THERAPY ISSUESСравнительная оценка отдаленных результатов дистанционной и сочетанной лучевой терапии у больных раком предстательной железы высокого рискаComparative analysis of long-term results of external beam and combined radiotherapy in high-risk prostate cancer patientsПотаповаА. В.PotapovaA.  V.

Анна В. Потапова, аспирант

Москва

Anna V. Potapova, Postgraduate Student 

Moscow

dr.anna-potapova@mail.ruГладилинаИ. А.GladilinaI.  A.

Ирина А. Гладилина, д. м. н., старший научный сотрудник отделения радиотерапии, ФГБУ «НМИЦ онкологии им. Н. Н. Блохина» Минздрава России, профессор кафедры онкологии и лучевой терапии лечебного факультета, ФГБОУ ВО «РНИМУ им. Н. И. Пирогова» Министерства здравоохранения Российской Федерации

Москва

Irina A. Gladilina, MD, PhD, DSc, Senior Researcher, Radiotherapy Department, N. N. Blokhin National Medical Research Center of Oncology, Professor Department of Oncology and Radiotherapy of Faculty of General Medicine, Pirogov Russian National Research Medical University 

Moscow

ПетровскийА. В.PetrovskyA.  V.

Александр В. Петровский, к. м. н., заместитель директора по образовательной деятельности, ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н. Н. Блохина» Минздрава России, доцент кафедры онкологии Института Клинической Медицины ФГАОУ ВО «Первый МГМУ им. И. М. Сеченова» Минздрава России (Сеченовский Университет)

Москва

Alexander V. Petrovsky, MD, PhD, Deputy Director for Education, N. N. Blokhin National Medical Research Center of Oncology, Associate Professor, Department of Oncology, Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University

Moscow

РотобельскаяЛ. Е.RotobelskayaL.  E.

Лидия Е. Ротобельская, научный сотрудник группы медицинской кибернетики радиационного отделения 

Москва

Lidiya E. Rotobelskaya, Research Associate, Medical Cybernetics Group, Radiology Unit 

Moscow

ШабановМ. А.ShabanovM.  A.

Михаил А. Шабанов, д. м. н., профессор, ведущий научный сотрудник отделения патологической анатомии человека 

Москва

Mikhail A. Shabanov, MD, PhD, DSc, Prof., Leading Research, Department of Human Pathological Anatomy 

Moscow

ЧерняевВ. А.ChernyaevV.  A.

Виталий А. Черняев, к. м. н., врач-онколог 2‑го онкологического отделения 

Москва

Vitaliy A. Chernyaev, MD, PhD, Oncologist of the 2nd Oncology Department 

Moscow

ШолоховВ. Н.SholokhovV.  N.

Владимир Н. Шолохов, д. м. н., профессор, ведущий научный сотрудник отделения ультразвуковой диагностики 

Москва

Vladimir N. Sholokhov, MD, PhD, DSc, Prof., Leading Research Associate, Ultrasonography Unit 

Moscow

ТкачевС. И.TkachevS.  I.

Сергей И. Ткачев, д. м. н., профессор, ведущий научный сотрудник отделения радиотерапии 

Москва

Sergei I. Tkachev, MD, PhD, DSc, Prof., Leading Research Associate, Radiotherapy Department 

Moscow

ФГБУ «НМИЦ онкологии им. Н.Н. Блохина» Минздрава РоссииРоссияN. N. Blokhin National Medical Research Center of OncologyRussian FederationФГБУ «НМИЦ онкологии им. Н.Н. Блохина» Минздрава России; ФГБОУ ВО «РНИМУ им. Н.И. Пирогова» Минздрава РоссииРоссияN. N. Blokhin National Medical Research Center of Oncology; Pirogov Russian National Research Medical UniversityRussian FederationФГБУ «НМИЦ онкологии им. Н.Н. Блохина» Минздрава России; ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» Минздрава России (Сеченовский Университет)РоссияN. N. Blokhin National Medical Research Center of Oncology; I. M. Sechenov First Moscow State Medical UniversityRussian FederationГБУЗ «Городская клиническая онкологическая больница № 1»РоссияCity Clinical Oncological Hospital № 1Russian Federation2020040320211032633Copyright © Потапова А.В., Гладилина И.А., Петровский А.В., Ротобельская Л.Е., Шабанов М.А., Черняев В.А., Шолохов В.Н., Ткачев С.И., 20212021Потапова А.В., Гладилина И.А., Петровский А.В., Ротобельская Л.Е., Шабанов М.А., Черняев В.А., Шолохов В.Н., Ткачев С.И.Potapova A.V., Gladilina I.A., Petrovsky A.V., Rotobelskaya L.E., Shabanov M.A., Chernyaev V.A., Sholokhov V.N., Tkachev S.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.malignanttumors.org/jour/article/view/804

Рак предстательной железы (РПЖ) высокого риска представляет собой одну из ключевых проблем онкоурологии. Лучевая терапия (ЛТ) наряду с хирургическим лечением является неотъемлемым компонентом комплексного лечения больных РПЖ высокого риска. Для улучшения отдаленных онкологических результатов у больных РПЖ высокого риска целесообразно проведение ЛТ с эскалацией дозы, что в настоящее время проводится с использованием методик дистанционного и контактного облучения. В исследование были включены 109 пациентов с РПЖ высокого риска, которым была проведена либо дистанционная ЛТ до СД 76 Гр, либо сочетанная ЛТ (дистанционная + внутритканевая ЛТ) с использованием источников 125I на фоне длительной андрогенной депривационной терапии (АДТ). Сравнительный анализ отдаленных результатов лечения больных РПЖ высокого риска выявил улучшение показателей 5‑летней безрецидивной выживаемости в группе сочетанной ЛТ по сравнению с больными после дистанционной ЛТ. В группе сочетанной ЛТ отмечается снижение острых постлучевых ректитов на 33 % после сочетанной ЛТ по сравнению с группой дистанционной ЛТ: 13,2 % и 46,4 %, соответственно (р < 0,01).

Prostate cancer (PCa) of high risk is one of the crucial problems in urological oncology. Radiation therapy (RT), along with radical prostatectomy, is an important component of the complex treatment of patients with high‑risk PCa. To improve the long‑term oncological results of RT dose escalation is advocated. Currently, dose escalation can be reached via external beam irradiation and interstitial RT techniques. The study included 109 patients with high‑risk PCa who underwent either external beam RT up to 76 Gy, or combined RT (external beam + interstitial RT) using 125I sources with long‑term androgen deprivation therapy. Comparative analysis of long‑term results of patients with high‑risk PCa treatment showed an improvement in 5‑year disease‑free survival rates after combined RT compared with external beam RT. Acute rectal toxicity was decreased in combined RT group compared to patients after external beam RT: 13.2 % and 46.4 %, respectively (p < 0.01).

рак предстательной железыдистанционная конформная лучевая терапиясочетанная лучевая терапиябрахитерапияprostate cancerexternal beam conformal radiation therapycombined radiation therapybrachytherapyReferencesDearnaley D. Escalated-dose versus standard-dose conformal radiotherapy in prostate cancer: first results from the MRC RT01 randomised controlled trial / Dearnaley D.P., Sydes M.R., Graham J.D., Aird E.G., et al. // Lancet Oncol. – 2007 – V. 8 (6) – P. 475–487.Dearnaley D. Escalated-dose versus standard-dose conformal radiotherapy in prostate cancer: first results from the MRC RT01 randomised controlled trial / Dearnaley D.P., Sydes M.R., Graham J.D., Aird E.G., et al. // Lancet Oncol. – 2007 – V. 8 (6) – P. 475–487.Kuban D. Long-term failure patterns and survival in a randomized dose-escalation trial for prostate cancer. Who dies of disease? / Kuban D.A., Levy L.B., Cheung M.R., Lee A.K., et al. // Int. J Radiat. Oncol. Biol. Phys. – 2011 – V. 79 (5) – P. 1310-1317.Kuban D. Long-term failure patterns and survival in a randomized dose-escalation trial for prostate cancer. Who dies of disease? / Kuban D.A., Levy L.B., Cheung M.R., Lee A.K., et al. // Int. J Radiat. Oncol. Biol. Phys. – 2011 – V. 79 (5) – P. 1310-1317.Michalski J. Effect of Standard vs Dose-Escalated Radiation Therapy for Patients With Intermediate-Risk Prostate Cancer: The NRG Oncology RTOG 0126 Randomized Clinical Trial / Michalski J.M., Moughan J., Purdy J., et al. // JAMA Oncol. – 2018 – V. 4 (6) – P. 180039.Michalski J. Effect of Standard vs Dose-Escalated Radiation Therapy for Patients With Intermediate-Risk Prostate Cancer: The NRG Oncology RTOG 0126 Randomized Clinical Trial / Michalski J.M., Moughan J., Purdy J., et al. // JAMA Oncol. – 2018 – V. 4 (6) – P. 180039.Peeters S. 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 / Peeters S.T., Heemsbergen W.D., Koper P.C., van Putten W.L., et al. // J Clin. Oncol. – 2006 – V. 24 (13) – V. 1990-1996.Peeters S. 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 / Peeters S.T., Heemsbergen W.D., Koper P.C., van Putten W.L., et al. // J Clin. Oncol. – 2006 – V. 24 (13) – V. 1990-1996.Sathya J. Randomized trial comparing iridium implant plus external-beam radiation therapy with external-beam radiation therapy alone in node-negative locally advanced cancer of the prostate / Sathya J.R., Davis I.R., Julian J.A., et al. // J Clin. Oncol. - 2005 – V. 23 (6) – P. 1192-1199.Sathya J. Randomized trial comparing iridium implant plus external-beam radiation therapy with external-beam radiation therapy alone in node-negative locally advanced cancer of the prostate / Sathya J.R., Davis I.R., Julian J.A., et al. // J Clin. Oncol. - 2005 – V. 23 (6) – P. 1192-1199.Zietman A. Randomized trial comparing conventional-dose with high-dose conformal radiation therapy in early-stage adenocarcinoma of the prostate: long-term results from proton radiation oncology group/american college of radiology 95-09 / Zietman A.L., Bae K., Slater J.D., Shipley W.U., et al. // J Clin. Oncol. – 2010 – V. 28 (7) – P. 1106-1111.Zietman A. Randomized trial comparing conventional-dose with high-dose conformal radiation therapy in early-stage adenocarcinoma of the prostate: long-term results from proton radiation oncology group/american college of radiology 95-09 / Zietman A.L., Bae K., Slater J.D., Shipley W.U., et al. // J Clin. Oncol. – 2010 – V. 28 (7) – P. 1106-1111.Shilkrut M. The addition of low-dose-rate brachytherapy and androgen-deprivation therapy decreases biochemical failure and prostate cancer death compared with dose-escalated external-beam radiation therapy for high-risk prostate cancer / Shilkrut M., Merrick G.S., McLaughlin P.W., et al. // Cancer – 2013 – V. 119 (3) – P. 681-690.Shilkrut M. The addition of low-dose-rate brachytherapy and androgen-deprivation therapy decreases biochemical failure and prostate cancer death compared with dose-escalated external-beam radiation therapy for high-risk prostate cancer / Shilkrut M., Merrick G.S., McLaughlin P.W., et al. // Cancer – 2013 – V. 119 (3) – P. 681-690.Taira A. Long-term outcomes of prostate cancer patients with Gleason pattern 5 treated with combined brachytherapy and external beam radiotherapy / Taira A.V., Merrick G.S., Galbreath R.W., et al. // Brachytherapy – 2013 – V. 12 (5) – P. 408-414.Taira A. Long-term outcomes of prostate cancer patients with Gleason pattern 5 treated with combined brachytherapy and external beam radiotherapy / Taira A.V., Merrick G.S., Galbreath R.W., et al. // Brachytherapy – 2013 – V. 12 (5) – P. 408-414.Liss A. Combination therapy improves prostate cancer survival for patients with potentially lethal prostate cancer: The impact of Gleason pattern 5 / Liss A.L., Abu-Isa E.I., Jawad M.S., et al. // Brachytherapy – 2015 – V. 14 (4) – P. 502-510Liss A. Combination therapy improves prostate cancer survival for patients with potentially lethal prostate cancer: The impact of Gleason pattern 5 / Liss A.L., Abu-Isa E.I., Jawad M.S., et al. // Brachytherapy – 2015 – V. 14 (4) – P. 502-510Hoskin P. Randomised trial of external beam radiotherapy alone or combined with high-dose-rate brachytherapy boost for localised prostate cancer / Hoskin P.J., Rojas A.M., Bownes P.J., et al. // Radiother. Oncol. – 2012 – V. 103 (2) – P. 217-222.Hoskin P. Randomised trial of external beam radiotherapy alone or combined with high-dose-rate brachytherapy boost for localised prostate cancer / Hoskin P.J., Rojas A.M., Bownes P.J., et al. // Radiother. Oncol. – 2012 – V. 103 (2) – P. 217-222.Morris W. Is ASCENDE-RT still pertinent? Is LDR-PB obsolete? / W. James Morris, Scott Tyldesley, Sree Rodda, Ross Halperin et al. // URL: https://www.prostatebrachytherapy.org.uk/2016-presentations/J-Morris%20170516.pdf – 2016Morris W. Is ASCENDE-RT still pertinent? Is LDR-PB obsolete? / W. James Morris, Scott Tyldesley, Sree Rodda, Ross Halperin et al. // URL: https://www.prostatebrachytherapy.org.uk/2016-presentations/J-Morris%20170516.pdf – 2016Morris W. Androgen suppression Combined with elective nodal and dose escalated radiation therapy (the ASCENDE-RT Trial): an analysis of survival endpoints for a randomized trial comparing a low-dose-rate Brachytherapy boost to a dose-escalated external beam boost for high- and intermediate-risk prostate cancer / Morris W.J., Tyldesley S., Rodda S., Halperin R., Pai H., McKenzie M., et al. // Int. J Radiat. Oncol. Biol. Phys. – 2017 – V. 98 (2) – P. 275-285.Morris W. Androgen suppression Combined with elective nodal and dose escalated radiation therapy (the ASCENDE-RT Trial): an analysis of survival endpoints for a randomized trial comparing a low-dose-rate Brachytherapy boost to a dose-escalated external beam boost for high- and intermediate-risk prostate cancer / Morris W.J., Tyldesley S., Rodda S., Halperin R., Pai H., McKenzie M., et al. // Int. J Radiat. Oncol. Biol. Phys. – 2017 – V. 98 (2) – P. 275-285.Rodda S. ASCENDE-RT: An Analysis of Treatment-Related Morbidity for a Randomized Trial Comparing a LowDose-Rate Brachytherapy Boost with a Dose-Escalated External Beam Boost for High- and Intermediate-Risk Prostate Cancer / Rodda S., Tyldesley S., Morris W.J., Keyes M., et al. // Int. J Radiat. Oncol. Biol. Phys. – 2017 – V. 98 (2) – P. 286-295.Rodda S. ASCENDE-RT: An Analysis of Treatment-Related Morbidity for a Randomized Trial Comparing a LowDose-Rate Brachytherapy Boost with a Dose-Escalated External Beam Boost for High- and Intermediate-Risk Prostate Cancer / Rodda S., Tyldesley S., Morris W.J., Keyes M., et al. // Int. J Radiat. Oncol. Biol. Phys. – 2017 – V. 98 (2) – P. 286-295.Chan E. Decline in acute urinary toxicity: A long-term study in 2011 patients with prostate brachytherapy within a provincial institution / Chan E.K., Keyes M., Pickles T., et al. // Brachytherapy – 2014 – V. 13 (1) – P. 46-52.Chan E. Decline in acute urinary toxicity: A long-term study in 2011 patients with prostate brachytherapy within a provincial institution / Chan E.K., Keyes M., Pickles T., et al. // Brachytherapy – 2014 – V. 13 (1) – P. 46-52.Cancer Stat Facts: Prostate Cancer. SEER, 2018. https://seer.cancer.gov/statfacts/html/prost.html.Cancer Stat Facts: Prostate Cancer. SEER, 2018. https://seer.cancer.gov/statfacts/html/prost.html.Draisma G. Lead time and overdiagnosis in prostate-specific antigen screening: importance of methods and context / Draisma G., Etzioni R., Tsodikov A., Mariotto A., Wever E., Gulati R., Feuer E. // J. Natl. Cancer Inst. – 2009 – V. 101 (6) – P. 374-383.Draisma G. Lead time and overdiagnosis in prostate-specific antigen screening: importance of methods and context / Draisma G., Etzioni R., Tsodikov A., Mariotto A., Wever E., Gulati R., Feuer E. // J. Natl. Cancer Inst. – 2009 – V. 101 (6) – P. 374-383.Bolla M. External irradiation with or without long-term androgen suppression for prostate cancer with high metastatic risk: 10-year results of an EORTC randomised study / Michel Bolla, Geertjan Van Tienhoven, Padraig Warde et al. // Lancet Oncol. – 2010 – V. 11 (11) – P. 1066–1073.Bolla M. External irradiation with or without long-term androgen suppression for prostate cancer with high metastatic risk: 10-year results of an EORTC randomised study / Michel Bolla, Geertjan Van Tienhoven, Padraig Warde et al. // Lancet Oncol. – 2010 – V. 11 (11) – P. 1066–1073.EAU Guidelines. Edn. presented at the EAU Annual Congress Barcelona 2019. ISBN 978-94-92671-04-2.EAU Guidelines. Edn. presented at the EAU Annual Congress Barcelona 2019. ISBN 978-94-92671-04-2.Pilepich M. Androgen suppression adjuvant to definitive radiotherapy in prostate carcinoma – long-term results of phase III RTOG 85-31 / Pilepich M.V., Winter K., Lawton C.A., Krisch R.E., et al. // Int. J Radiat. Oncol. Biol. Phys. – 2005 – V. 61 (5) – P. 1285-1290.Pilepich M. Androgen suppression adjuvant to definitive radiotherapy in prostate carcinoma – long-term results of phase III RTOG 85-31 / Pilepich M.V., Winter K., Lawton C.A., Krisch R.E., et al. // Int. J Radiat. Oncol. Biol. Phys. – 2005 – V. 61 (5) – P. 1285-1290.Vogelius I. Meta-analysis of the alpha/beta ratio for prostate cancer in the presence of an overall time factor: Bad news, good news, or no news? / Vogelius I.R., Bentzen S.M. // Int. J Radiat. Oncol. Biol. Phys. – 2013 – V. 85 (1) – P. 89-94.Vogelius I. Meta-analysis of the alpha/beta ratio for prostate cancer in the presence of an overall time factor: Bad news, good news, or no news? / Vogelius I.R., Bentzen S.M. // Int. J Radiat. Oncol. Biol. Phys. – 2013 – V. 85 (1) – P. 89-94.

The authors declare that there are no conflicts of interest present.