Cáncer localizado de próstata
Experiencia de diez años con radioterapia conformal tridimensional
Palabras clave:
NEOPLASMAS DE PROSTATA, RADIOTERAPIA CONFORMAL
Resumen
Se analizaron 560 pacientes consecutivos con cáncer localizado de próstata tratados con radioterapia conformal tridimensional entre 1993 y 2001. La sobrevida global actuarial a los nueve años fue de 71%, y la sobrevida causa específica de 88%. La mortalidad cruda por cáncer de próstata fue de 4,8% mientras que la mortalidad por otras causas fue de 8,3%. La sobrevida libre de recaída bioquímica en función del grupo de riesgo fue de 83%, 68% y 41% a los nueve años, respectivamente para los grupos de riesgo bajo, intermedio y alto en 504 pacientes (p<0,05). La dosis mayor o igual a 72 Gy mejora el control bioquímico a los siete años en todos los grupos de riesgo aunque sólo es estadísticamente significativa en el grupo de riesgo alto (p<0,006). El modelo de Cox reveló que solamente el grupo de riesgo, la dosis total como variable continua y el antígeno prostático específico inicial como variable categórica fueron significativos. Cuando el modelo de Cox fue aplicado a los 188 pacientes de riesgo alto, el uso de la hormonoterapia de inducción o concomitante, o ambas, y la edad, resultaron además significativos. La tasa actuarial de complicaciones severas a diez años grados 3 y 4 (no hubo complicaciones grado 5) fue de 1,2% para las urinarias y de 1,4% para las digestivas. La radioterapia conformal tridimensional a altas dosis es un tratamiento efectivo y de baja morbilidad para el tratamiento del cáncer localizado de próstata.
Citas
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29) Kuban DA, Thames HD, Levy LB, Horwitz EM, Kupelian PA, Martinez AA, et al. Long-term multi-institutional analysis of stage T1–T2 prostate cancer treated with radiotherapy in the PSA era. Int J Radiat Oncol Biol Phys 2003; 57: 915-28.
30) Kupelian PA, Elshaikh M, Reddy CA, Zippe C, Klein EA. Comparison of the efficacy of local therapies for localized prostate cancer in the prostate-specific antigen era: a large single-institution experience with radical prostatectomy and external-beam radiotherapy JCO 2002; 20: 3376-85.
2) Mettlin CJ, Murphy GP. Why is the prostate cancer death rate declining in the United States? Cancer 1998; 82: 249-25.
3) Catalona WJ. Surgical management of prostate cancer. Contemporary results with anatomic radical prostatectomy. Cancer 1995; 75: 1903-8.
4) Kupelian PA, Potters L, Khuntia D, Ciezki JP, Reddy C, Reuther A, et al. Radical prostatectomy, external beam radiotherapy <72 Gy, external beam radiotherapy =72 Gy, permanent seed implantation, or combined seeds/external beam radiotherapy for stage T1–T2 prostate cancer. Int J Rad Oncol Biol Phys 2004; 58: 25-33.
5) Chodak GW, Thisted RA, Gerber GS, Johansson JE, Adolfsson J, Jones GW. Results of conservative management of clinically localized prostate cancer. N Engl J Med 1994; 330: 242-8.
6) Carter CA, Donahue T, Sun L, Wu H, McLeod DG, Amling C. Temporarily deferred therapy (watchful waiting) for men younger than 70 Years and with low-risk localized prostate cancer in the prostate-specific antigen era. JCO 2003; 21: 4001-8.
7) Hanks GE. Three-dimensional conformal radiation therapy for prostate cancer. In: D’Amico AV, Hanks GE, eds. Radiotherapuetic management of prostate adenocarcinoma. Londres: Arnold, 1999: 21-50.
8) Armstrong J. Three-dimensional conformal radiation the-rapy: evidence-based treatment of prostate cancer. Radioth Oncol 2002; 64: 235-7.
9) American Joint Committee on Cancer. Cancer Staging Manual. 6ª ed. New York: Springer, 2002: 309-12.
10) Chism DB, Hanlon AL, Troncoso P, Al-Saleem T, Horwitz EM, Pollack A. The Gleason score shift: Score four and seven years ago. Int J Radiat Oncol Biol Phys 2003; 56(5): 1241-7.
11) Smith EB, Frierson HF, Jr, Mills SE, Boyd JC, Theodorescu D. Gleason scores of prostate biopsy and radical prostatectomy specimens over the past 10 years: Is there evidence for systematic upgrading? Cancer 2002; 94: 2282-7.
12) Bayley AJ, Catton CN, Haycocks T, Kelly V, Alasti H, Bristow R, et al. A randomized trial of supine vs. prone positioning in patients undergoing escalated dose conformal radiotherapy for prostate cancer. Radioth Oncol 2004; 70: 37-44.
13) Tinger A, Michalski JM, Cheng A, Low DA, Zhu R, Bosch WR, et al. A critical evaluation of the planning target volume for 3-D conformal radiotherapy of prostate cancer. Int J Radiat Oncol Biol Phys 1998; 42: 213-21.
14) International Commission on Radiation Units and Measurements (ICRU). Prescribing, recording, and reporting photon beam therapy. Washington: ICRU, 1993: 280 pp. (ICRU Report No. 50).
15) Hanks GE, Hanlon AL, Pinover WH, Horwitz EM, Price RA, Schultheiss T. Dose selection for prostate cancer patients based on dose comparison and dose response studies. Int J Radiat Oncol Biol Phys 2000; 46: 823-32.
16) Partin AW, Kattan MW, Subong EN, Walsh PC, Wojno KL, Oesterling JE, et al. Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer. A multi-institutional update. JAMA 1997; 277: 1445-51.
17) Cox DR. Regression models and life tables (with discussion), J R Stat Soc B 1972; 34: 187-200.
18) American Society for Therapeutic Radiology and Oncology Consensus Panel. Consensus statement: Guidelines for PSA following radiation therapy. Int J Radiat Oncol Biol Phys 1997; 37: 1035-41.
19) Thames H, Kuban D, Levy L, Horwitz EM, Kupelian P, Martínez AA. Comparison of alternative biochemical failure definitions based on clinical outcome in 4839 prostate cancer patients treated by external beam radiotherapy between 1986 and 1995. Int J Radiat Oncol Biol Phys 2003; 57: 929-43.
20) Kaplan EL, Meier P. Non parametric estimation from incomplete observations. J Am Statist Assoc 1958; 53: 457-81.
21) Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep 1966; 50: 163-70.
22) Storey MR, Pollack A, Zagars G, Smith L, Antolak J, Rosen I. Complications from radiotherapy dose escalation in prostate cancer: preliminary results of a randomized trial. Int J Radiat Oncol Biol Phys 2000; 48: 635-42.
23) Pilepich MV, Winter K, John MJ, Mesic JB, Sause W, Rubin P, et al. Phase III radiation therapy oncology group (RTOG) trial 86-10 of androgen deprivation adjuvant to definitive radiotherapy in locally advanced carcinoma of the prostate. Int J Rad Oncol Biol Phys 2001; 50: 1243-52.
24) Liu M, Pickles T, Arganovich A, Berthelet E, Duncan G, Keyes M, et al. Impact of neoadjuvant androgen ablation and other factors on late toxicity after external beam prostate radiotherapy. Int J Rad Oncol Biol Phys 2004; 58: 59-67.
25) Zelefsky M, Fuks Z, Chan H. Ten-year results of dose escalation with 3-dimensional conformal radiotherapy for patients with clinically localized prostate cancer. Int J Rad Oncol Biol Phys 2003: 57(2S): S149-S150.
26) Michalsky JM, Purdy JA, Winter K, Roach M 3rd, Vijayakumar S, Sandler HM, et al. Preliminary report of toxicity following 3D radiation therapy for prostate cancer on 3DOG/RTOG 9406. Int J Radiat Oncol Biol Phys 2000; 46: 391-402.
27) Sandler HM, Dunn RL, McLaughlin PW, Hayman JA, Sullivan MA, Taylor JM. Overall survival after prostate-specific-antigen-detected recurrence following conformal radiation therapy. Int J Radiat Oncol Biol Phys 2000; 48: 629-33.
28) Kupelian PA, Buchsbaum JC, Elshaikh MA, Reddy CA, Klein EA. Improvement in relapse-free survival throughout the PSA era in patients with localized prostate cancer treated with definitive radiotherapy: Year of treatment an independent predictor of outcome. Int J RadiatOncol Biol Phys 2002; 57: 629-34.
29) Kuban DA, Thames HD, Levy LB, Horwitz EM, Kupelian PA, Martinez AA, et al. Long-term multi-institutional analysis of stage T1–T2 prostate cancer treated with radiotherapy in the PSA era. Int J Radiat Oncol Biol Phys 2003; 57: 915-28.
30) Kupelian PA, Elshaikh M, Reddy CA, Zippe C, Klein EA. Comparison of the efficacy of local therapies for localized prostate cancer in the prostate-specific antigen era: a large single-institution experience with radical prostatectomy and external-beam radiotherapy JCO 2002; 20: 3376-85.
Cómo citar
1.
Leborgne F, Leborgne JH, Zubizarreta E, Ortega B, Leborgne Deus J, Aguiar S, Curochquin R, Mezzera J, Mullin M, Leborgne F, Beraza J. Cáncer localizado de próstata. Rev. Méd. Urug. [Internet]. 1 [citado 25 de noviembre de 2024];20(3):193-01. Disponible en: https://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/870
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