Zie ook de literatuurlijsten niet-toxische middelen en behandelingen specifiek bij de verschillende vormen van kanker en bij chemo, bestraling en operaties van arts-bioloog drs. Engelbert Valstar

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1 april 2019: Bron: European Urology

Patienten met reeds in de botten uitgezaaide prostaatkanker krijgen vaak extra bestraling aanvullend op hormoontherapie. Nu blijkt dat alleen prostaatkankerpatiënten die 5 of minder botuitzaaiingen hebben op moment van bestraling daarvan enigszins profiteren met een betere overall overleving van 7 procent op drie jaar. Wanneer patiënten al meer uitzaaiingen hebben en bestraald worden heeft dat geen effect op de overall overleving na drie jaar. Dit blijkt uit een reviewstudie en meta-analyse van drie grote fase studies.

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Large image of Fig. 1.

Fig. 1

Effect of adding prostate radiotherapy to ADT on (A) survival, (B) progression-free survival, (C) biochemical progression, and (D) failure-free survival in men with mHSPC. Each filled square denotes the HR for that trial comparison, with the horizontal lines showing the 95% confidence interval (CI). The size of the square is directly proportional to the amount of information contributed by a trial. The diamond represents a (fixed-effect) meta-analysis of the trial HRs, with the centre of this diamond indicating the HR and the extremities the 95% CI. ADT = androgen deprivation therapy; HR = hazard ratio; RT = radiotherapy.

Hier de resultaten uit de STOPCAP studie: 

Prostate Radiotherapy for Metastatic Hormone-sensitive Prostate Cancer: A STOPCAP Systematic Review and Meta-analysis die gratis is in te zien of te downloaden:

Uit het abstract: We identified one ongoing (PEACE-1) and two completed (HORRAD and STAMPEDE) eligible trials. Pooled results of the latter (2126 men; 90% of those eligible) showed no overall improvement in survival (HR = 0.92, 95% confidence interval 0.81–1.04, p = 0.195) or PFS (HR = 0.94, 95% CI 0.84–1.05, p = 0.238) with prostate radiotherapy. There was an overall improvement in biochemical progression (HR = 0.74, 95% CI 0.67–0.82, p = 0.94 × 10−8) and FFS (HR = 0.76, 95% CI 0.69–0.84, p = 0.64 × 10−7), equivalent to ∼10% benefit at 3 yr. The effect of prostate radiotherapy varied by metastatic burden—a pattern consistent across trials and outcome measures, including survival (<5, ≥5; interaction HR = 1.47, 95% CI 1.11–1.94, p = 0.007). There was 7% improvement in 3-yr survival in men with fewer than five bone metastases.

Het abstract zelf:

Prostate cancer that has spread to other parts of the body (metastases) is usually treated with hormone therapy. In men with fewer than five bone metastases, addition of prostate radiotherapy helped them live longer and should be considered.

Prostate Radiotherapy for Metastatic Hormone-sensitive Prostate Cancer: A STOPCAP Systematic Review and Meta-analysis

Sarah Burdetta,low asterisk,'Correspondence information about the author Sarah Burdett
,
Liselotte M. Boevéb,c,
,
Fiona C. Inglebyd,
,
David J. Fishera
,
Larysa H. Rydzewskaa
,
Claire L. Valea
,
George van Andelc
,
Noel W. Clarkee
,
Maarten C. Hulshoff
,
Nicholas D. Jamesg
,
Christopher C. Parkerh
,
Mahesh K. Parmard
,
Christopher J. Sweeneyi
,
Matthew R. Sydesd
,
Bertrand Tombalj
,
Paul C. Verhagenk
,
Jayne F. Tierneya
the STOPCAP M1 Radiotherapy Collaborators
Associate Editor: Matthew Cooperberg
Statistical Editor: Andrew Vickers

Abstract

Background

Many trials are evaluating therapies for men with metastatic hormone-sensitive prostate cancer (mHSPC).

Objective

To systematically review trials of prostate radiotherapy.

Design, setting, and participants

Using a prospective framework (framework for adaptive meta-analysis ), we prespecified methods before any trial results were known. We searched extensively for eligible trials and asked investigators when results would be available. We could then anticipate that a definitive meta-analysis of the effects of prostate radiotherapy was possible. We obtained prepublication, unpublished, and harmonised results from investigators.

Intervention

We included trials that randomised men to prostate radiotherapy and androgen deprivation therapy (ADT) or ADT only.

Outcome measurements and statistical analysis

Hazard ratios (HRs) for the effects of prostate radiotherapy on survival, progression-free survival (PFS), failure-free survival (FFS), biochemical progression, and subgroup interactions were combined using fixed-effect meta-analysis.

Results and limitations

We identified one ongoing (PEACE-1) and two completed (HORRAD and STAMPEDE) eligible trials. Pooled results of the latter (2126 men; 90% of those eligible) showed no overall improvement in survival (HR = 0.92, 95% confidence interval 0.81–1.04, p = 0.195) or PFS (HR = 0.94, 95% CI 0.84–1.05, p = 0.238) with prostate radiotherapy. There was an overall improvement in biochemical progression (HR = 0.74, 95% CI 0.67–0.82, p = 0.94 × 10−8) and FFS (HR = 0.76, 95% CI 0.69–0.84, p = 0.64 × 10−7), equivalent to ∼10% benefit at 3 yr. The effect of prostate radiotherapy varied by metastatic burden—a pattern consistent across trials and outcome measures, including survival (<5, ≥5; interaction HR = 1.47, 95% CI 1.11–1.94, p = 0.007). There was 7% improvement in 3-yr survival in men with fewer than five bone metastases.

Conclusions

Prostate radiotherapy should be considered for men with mHSPC with a low metastatic burden.

Patient summary

Prostate cancer that has spread to other parts of the body (metastases) is usually treated with hormone therapy. In men with fewer than five bone metastases, addition of prostate radiotherapy helped them live longer and should be considered.

References

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