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.

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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