3 mei 2021: Resultaten uit een nieuwe recente studie, gepubliceerd 15 maart 2021, tonen aan dat protonenbestraling op de langetermijn een voordeel kan hebben voor prostaatkankerpatiënten. Bij patiënten met lagere Gleasonscores (laag risico patiënten) bleek 100 procent effectiviteit op voorkomen van recidief of PSA stijging. En belangrijk de bijwerkingen op incontinentie en impotentie waren heel klein. Ook bij hoog risico patiënten. Zelfs bij de patiënten uit de hoogste risicogroep was de 10-jaars progressievrije overall overleving 63 procent. 

De mediane follow-up periode van de studie bij totaal 2021 patiënten in 1 ziekenhuis over de periode 2003 tot 2014 was 84 maanden (interkwartielbereik, 60-110 maanden). De 5- en 10-jaars afwezigheid van biochemische terugvalpercentages (progressie op de PSA en aantoonbare recidieven) waren 100% en 100%, 99% en 88%, 93% en 86%, 90% en 79%, 88% en 68%, en 76% en 63% voor respectievelijk de zeer lage, lage, gunstige midden-, ongunstige midden-, hoge en zeer hoge risicogroepen.

Zie dit abstract van het studierapport door te klikken op de titel. Abstract zelf staat onderaan dit artikel.:  

Proton Therapy for Localized Prostate Cancer: Long-Term Results From a Single-Center Experience



20 september 2017: lees ook deze artikelen: 

https://kanker-actueel.nl/NL/protonenbestraling-geeft-hele-goede-resultaten-op-5-jaars-overleving-15-procent-en-ziektevrije-tijd-9-procent-bij-prostaatkankerpatienten-in-vergelijking-met-fotonen-imrt-bestraling.html

en deze: 

https://kanker-actueel.nl/NL/protonenbestraling-wordt-in-amerika-steeds-vaker-toegepast-en-ook-vergoed-astro-publiceert-nieuwe-richtlijnen-voor-gebruikvan-protonenbestraling.html

20 september 2017: Bron: Cancer Medicine

Protonenbestraling voor prostaatkankerpatiënten met lokale vorm van kanker bij de diagnose, dus nog niet zichtbaar uitgezaaid in de botten bv is superieur aan andere vormen van bestralen met een 100 procent 5 jaars overleving gerelateerd aan de kanker zelf en minder bijwerkingen op zowel korte als lange termijn.

Via Jos die een mailtje had gekregen waarin werd verteld door iemand die nauw is betrokken bij de bouw van protonencentra in Nederland dat protonenbestraling in Nederland nog lang geen behandelingsoptie zal kunnen zijn kreeg ik deze studie toegestuurd. Waarom niet in Nederland? Simpelweg omdat Nederland nog geen protonencentra heeft.  Ook vertelde deze man dat protonenbestraling weinig of geen verschil zal maken voor prostaatkankerpatienten en dat slechts enkelen in aanmerking zullen komen hiervoor. Hij antwoordde op basis van deze studie: Long-term outcomes in patients treated with proton therapy for localized prostate cancer gepubliceerd 7 september in Cancer Medicine die de prostaatkankervereniging hem hadden toegestuurd.

Maar m.i. is dit antwoord van deze arts / oncoloog het zoveelste bewijs dat Nederland bijzonder patiënt onvriendelijk is binnen de oncologie. De enige reden dat prostaatkankerpatiënten geen protonenbestraling krijgen aangeboden is omdat er domweg geen capaciteit is in Nederland en België. En verwijzingen naar Duitsland krijgen alleen kinderen en jong volwassenen. Zeg dat dan, maar niet dat het geen geode behandleingsoptie is. Want zowel de overall overleving gerelateerd aan prostaatkanker zelf en het bijwerkingenprofiel zijn duidelijk nog beter met protonenbestraling dan met de meest gebruikte IMRT bestraling (intensity-modulated radiation therapy).

De mediane follow-up periode van deze studie uitgevoerd in de periode tussen 2001 en 2014 bij 1375 patiënten met de diagnose van prsotaatkanker was 70 maanden (range, 4–145 maanden). In totaal, 99% vn de patiënten ontving 74 Gy; 56% van de patiënten kreeg vooraf hormoontherapie. Voor de lage-, gemiddlede-, hoge-, en extreem hoge risico patiënt was de 5-jaars progressievrije tijd (FFBR = geen stijging van PSA) was 99% (95% confidence intervals , 96–100%), 91% (95% CI, 88–93%), 86% (95% CI, 82–89%), en 66% (95% CI, 53–76%), respectievelijk, en de 5-jaars kanker gerelateerde overall overleving (CSS) was 100% (95% CI, 100–100%), 100% (95% CI, 100–100%) , 99% (95% CI, 97–100%), en 95% (95% CI, 94–98%), respectievelijk.

Heironder de overall overlevingsgrafiek uit bovengenoemde studie, waarvan het studieverslag: Long-term outcomes in patients treated with proton therapy for localized prostate cancer gratis is in te zien met nog veel meer grafieken. 

Het abstract van de studie staat onderaan grafiek:

protonenbestraling Japanse studie

Our results demonstrate that the biochemical control of Proton Therapy is favorable particularly for high- and very high-risk patients with prostate cancer and with lower late genitourinary toxicity and indicates the necessity of considering patient age in the treatment protocols.

Original Research

Long-term outcomes in patients treated with proton therapy for localized prostate cancer

Abstract

The aim of this retrospective study was to report long-term clinical outcomes in patients treated with proton therapy (PT) for localized prostate cancer. Between 2001 and 2014, 1375 consecutive patients were treated with PT. Patients were classified into prognostic risk groups based on the National Comprehensive Cancer Network criteria. Freedom from biochemical relapse (FFBR), cancer-specific survival (CSS) and incidence of late gastrointestinal (GI)/genitourinary (GU) toxicities were calculated. Multivariate analysis was performed to identify clinical prognostic factors for FFBR and late toxicities. The median follow-up period was 70 months (range, 4–145 months). In total, 99% of patients received 74 Gy (relative biologic effectiveness ); 56% of patients received neoadjuvant androgen deprivation therapy. For the low-, intermediate-, high-, and very high-risk groups, 5-year FFBR was 99% (95% confidence intervals , 96–100%), 91% (95% CI, 88–93%), 86% (95% CI, 82–89%), and 66% (95% CI, 53–76%), respectively, and 5-year CSS was 100% (95% CI, 100–100%), 100% (95% CI, 100–100%) , 99% (95% CI, 97–100%), and 95% (95% CI, 94–98%), respectively. Patient age, T classification, Gleason score, prostate-specific antigen, and percentage of positive cores were significant prognostic factors for FFBR. Grade 2 or higher GI and GU toxicities were 3.9% and 2.0%. Patient age was a prognostic factor for both late GI and GU toxicities. This study represents the largest cohort of patients treated with PT for localized prostate cancer, with the longest follow-up to date. Our results demonstrate that the biochemical control of PT is favorable particularly for high- and very high-risk patients with lower late genitourinary toxicity and indicates the necessity of considering patient age in the treatment protocols.

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This study demonstrates the favorable biochemical controls of proton therapy even in advanced localized prostate cancer patients with a low incidence of late toxicities, supporting the feasibility of conducting prospective clinical trials.

Clinical Investigation

Proton Therapy for Localized Prostate Cancer: Long-Term Results From a Single-Center Experience

This study will be presented at the 62nd annual meeting of the American Society for Radiation Oncology (ASTRO), October 25-28, 2020, Miami, Florida.

Purpose

Although proton therapy is controversial, it has been used to treat localized prostate cancer over the past 2 decades. The purpose of this study is to examine the long-term efficacy and toxicity of proton therapy for localized prostate cancer.

Methods and Materials

This was a retrospective observational study of 2021 patients from 2003 to 2014 at a single institution. Patients were classified using the risk groups defined by the National Comprehensive Cancer Network guidelines, version 4.2019. Ninety-eight percent of the patients received 74 Gy (relative biological effectiveness) in 37 fractions. Fifty-one and 6% of the patients received neoadjuvant and adjuvant androgen deprivation therapy, respectively. The outcomes were the time of freedom from biochemical relapse and the time to late toxicity by the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0. The outcomes were estimated using the Kaplan-Meier method and were analyzed using multivariable Cox proportional hazards models.

Results

The median follow-up period was 84 months (interquartile range, 60-110). The 5- and 10-year freedom from biochemical relapse rates were 100% and 100%, 99% and 88%, 93% and 86%, 90% and 79%, 88% and 68%, and 76% and 63% for the very low, low, favorable intermediate, unfavorable intermediate, high, and very high-risk groups, respectively. Patients with higher risk experienced biochemical relapse after shorter periods. The 5-year rates of grade 2 or higher late genitourinary and gastrointestinal toxicity were 2.2% and 4.0%, respectively. The results of multivariable analyses indicate that younger patients more often experienced biochemical relapse.

Conclusions

This study demonstrates the favorable biochemical controls of proton therapy even in advanced localized prostate cancer patients with a low incidence of late toxicities, supporting the feasibility of conducting prospective clinical trials. The risk groups defined by the National Comprehensive Cancer Network guidelines, version 4.2019, are useful to classify patients with localized prostate cancer. Our findings might suggest the necessity to develop a treatment strategy that accounts for the patient’s age.

protonenbestraling, prostaatkanker, bijwerkingen, overall overfeving, IMRT bestraling (intensity-modulated radiation therapy)


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1 Reactie op "Protonenbestraling geeft uitstekende resultaten op overleving veroorzaakt door prostaatkanker met veel minder bijwerkingen bij prostaatkankerpatienten met hoog en middelhoog risico"

  • e.valstar :
    03/05/2021
    Het onderzoek is retrospectief, dus niet gerandomiseerd en zegt dus niks! Protonbestraling is erg duur en als er dan nog geen bewijs is dat het beter is dan gewone bestraling dan is het Nederland patientonvriendelijk noemen onzin. Nog afgezien of de indicatie voor bestralen voldoende is (lang niet altijd zo) moet je ook wantrouwig zijn wanneer een belanghebbende met informatie hierover komt.
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