Raadpleeg ook onze lijst van niet-toxische ondersteuning bij prostaatkanker van arts-bioloog drs. Engelbert Valstar :

https://kanker-actueel.nl/NL/studiepublicaties-van-niet-toxische-middelen-en-behandelingen-uitgesplitst-in-aparte-lijst-gerelateerd-aan-specifiek-prostaatkanker-uit-literatuurlijst-van-arts-bioloog-drs-engelbert-valstar.html

Als donateur kunt u ook korting krijgen bij verschillende bedrijven, waaronder bij Medpro voor o.a. prostasol een veelgebruikt natuurlijk middel bij prostaatkanker als alternatief voor hormoontherapie

Hoe u als donateur korting kunt krijgen zie:

Voor Medpro dit artikel: https://kanker-actueel.nl/ops-korting-adres-en-gegevens-voor-online-bestellen-van-bepaalde-voedingssupplementen-met-15-korting-bij-medpro-scherpenzeel.html

Zie ook in gerelateerde artikelen, bv dit artikel: https://kanker-actueel.nl/een-nieuwe-manier-van-bestralen-via-mri-controle-verkort-het-aantal-behandelingen-voor-mannen-met-prostaatkanker-drastisch-en-beschermt-beter-tegen-bijwerkingen.html

4 oktober 2021: European Urology Oncology Published:September 03, 2021

Kortdurende, hooggedoseerde radiotherapie, al of niet begeleid met MRI, voor prostaatkankerpatiënten met een gemiddeld risico (lokaal prostaatkanker) geeft zelfde resultaten op 5-jaars overleving en wordt goed verdragen met beperkte bijwerkingen die in zelfde omvang gezien worden in vergelijking met een conventionele radiotherapie - bestraling. (Zie ook richtlijnen prostaatkanker)

Conventionele radiotherapie werd gegeven met 74 Gy/37 fracties gedurende 7,4 weken) of hypogefractioneerde radiotherapie met 60 Gy/20 fracties gedurende 4 weken of met 57 Gy/19 fracties gedurende 3,8 weken) werd toegediend met intensiteit-gemoduleerde technieken.

Na 5 jaar studie follow-up kwamen er relatief weinig (minder dan 10 procent) matige of ernstige bijwerkingen van darmklachten, urinewegklachten (incontinentie) en seksuele klachten voor. Bovendien hadden de gehypofractioneerde hooggedoseerde radiotherapieschema's geen merkbare invloed op de door de patiënt gerapporteerde bijwekringen en resultaten in vergelijking met een conventionele dosering.

De Kwaliteit van Leven substudie rekruteerde 2100 patiënten; 1141 formulieren op 5-jaars meting waren beschikbaar van 1957 patiënten die nog in leven waren (58%). Er waren geen statistisch significante verschillen in de 5-jaarsprevalentie van algemene "matige of ernstige" darmproblemen: 19/349 (5,4%) voor 74 GY, 29/381 (7,6%) voor 60 GY en 21/393 (5,3%) voor 57 Gy;
Algehele urinaire of seksuele problemen na 5 jaar waren vergelijkbaar tussen de radiotherapeutische schema's. Darm- en urinewegsymptomen bleven stabiel van 2 tot 5 jaar voor alle schema's.Door de patiënt gerapporteerde kwaliteit van leven op lange termijn bevestigt de veiligheid van matig gehypofractioneerde radiotherapie

Hier de grafieken van veel voorkomende bijwerkingen bij bestrlaing van de prostaat en bekkengebied.

Fig. 2

Fig. 2 Overall bowel, urinary, and sexual bother. Data are (A) prevalence of overall bowel bother, (B) change from preradio therapy time point to 5 yr for overall bowel bother, (C) prevalence of overall urinary bother, (D) change from preradiotherapy time point to 5 yr for overall urinary bother, (E) prevalence of overall sexual bother, and (F) change from preradiotherapy time point to 5 yr for overall sexual bother. A negative change in bother score from baseline/before RT to 5 yr indicates an improvement in QoL; a positive change in bother score represents worsening QoL. Odds ratios <1 favour the hypofractionated schedules, indicating lower odds of an increase in bother score than in the 74 Gy group. CI = confidence interval; OR = odds ratio; pts = patients; QoL = quality of life; RT = radiotherapy.

De onderzoekers stellen dat de resultaten van deze studie drie belangrijke bevindingen opleveren.

Ten eerste resulteert moderne radiotherapie met IMRT, zelfs zonder rectale spacers of geavanceerde beeldgeleiding (MRI) in beperkte langdurige darm- en urinewegsymptomen (<10% prevalentie van matige tot grote last werd gerapporteerd in beide schema's).
Ten tweede verslechterden darm- en urineproblemen niet tussen 6 maanden en 5 jaar na de bestralingen, terwijl de seksuele functie met de tijd en de leeftijd van de patiënt bleef afnemen.
Ten derde, en het belangrijkste, waren de eindpunten met betrekking tot kwaliteit van leven vergelijkbaar tussen conventionele en hypogefractioneerde schema's, wat het gebruik van 20 fracties radiotherapie ten opzichte van conventionele radiotherapie bij prostaatkanker met een gemiddeld en hoog risico verder ondersteunt.

Conclusie:
De onderzoekers stellen naar aanleiding van deze studie dat voor prostaatkankerpatiënten met gemiddeld risico (lokale prostaatkanker) matige hypogefractioneerde radiotherapie de voorkeur verdient boven conventioneel gefractioneerde radiotherapie.

Het volledige studierapport is gratis in te zien of te downloaden. Klik op de titel van het abstract.

016)

John N. Staffurth †
Joanne S. Haviland †
Anna Wilkins
David Dearnaley ‡
Emma Hall ‡
on behalf of the CHHiP Trial Management Group
Show all authors
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Open AccessPublished:September 03, 2021DOI:https://doi.org/10.1016/j.euo.2021.07.005

Abstract

Background

Moderate hypofractionation is the recommended standard of care for localised prostate cancer following the results of trials including Conventional or Hypofractionated High Dose Intensity Modulated Radiotherapy in Prostate Cancer (CHHiP). Evaluation of long-term patient-reported outcomes (PROs) is important to confirm safety and enhance patient information.

Objective

To determine whether 5-yr PROs from the CHHiP quality of life (QoL) substudy confirm 2-yr findings and assess patterns over follow-up.

Design, setting, and participants

A phase III randomised controlled trial recruited from 2002 to 2011. The QoL substudy completed accrual in 2009; participants were followed up to 5 yr after radiotherapy. Analyses used data snapshot taken on August 26, 2016. A total of 71 radiotherapy centres were included in the study (UK, Republic of Ireland, Switzerland, and New Zealand); all 57 UK centres participated in the QoL substudy. CHHiP recruited 3216 men with localised prostate cancer (cT1b-T3aN0M0).

Intervention

Conventional (74 Gy/37 fractions/7.4 wk) or hypofractionated radiotherapy (60 Gy/20 fractions/4 wk or 57 Gy/19 fractions/3.8 wk) was delivered with intensity-modulated techniques.

Outcome measurements and statistical analysis

University of California Los Angeles Prostate Cancer Index, Short Form 36 and Functional Assessment of Cancer Therapy—Prostate, or Expanded Prostate Cancer Index Composite and Short Form 12 questionnaires were administered at baseline, before radiotherapy, at 10 wk, and at 6, 12, 18, 24, 36, 48, and 60 mo after radiotherapy. The QoL primary endpoint was overall bowel bother.

Results and limitations

The QoL substudy recruited 2100 patients; 1141 5-yr forms were available from 1957 patients still alive (58%). There were no statistically significant differences in 5-yr prevalence of overall “moderate or big” bowel bother: 19/349 (5.4%), 29/381 (7.6%), and 21/393 (5.3%) for 74, 60, and 57 Gy, respectively; overall urinary or sexual bother at 5 yr was similar between schedules. Bowel and urinary symptoms remained stable from 2 to 5 yr for all schedules. Some evidence of worsening overall sexual bother from baseline to 5 yr was less likely in the hypofractionated schedules compared with 74 Gy (odds ratios for increase in bother score vs 74 Gy: 0.55 [0.30–0.99], p = 0.009 for 60 Gy, and 0.52 [0.29–0.94], p = 0.004 for 57 Gy). General QoL scores were similar between schedules at 5 yr.

Conclusions

Longer follow-up confirms earlier findings, with similar patient-reported bowel, urinary, and sexual problems between schedules overall. The continued low incidence of moderate or high bother confirms that moderate hypofractionation should be the standard of care for intermediate-risk localised prostate cancer.

Patient summary

We looked at patient-reported outcomes up to 5 yr after treatment in a trial of different radiotherapy schedules for prostate cancer. The findings confirmed that shorter radiotherapy schedules were as safe as standard radiotherapy in terms of bowel, urinary, and sexual problems.

Take Home Message

Bowel, urinary, and sexual symptoms were similar between schedules up to 5 yr. The continued low incidence of moderate/high bother confirms that moderate hypofractionated radiotherapy should be considered the standard of care for men with intermediate-risk prostate cancer.

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