Behandlung des Primärtumors beim oligometastasierten Prostatakarzinom

Zusammenfassung

Bei der Therapie des metastasierten Prostatakarzinoms wurden in letzter Zeit deutliche Fortschritte erzielt. Zusätzlich zur Androgendeprivation stehen verschiedene Optionen zur Verfügung, wie gegen den Androgenrezeptor gerichtete Therapien und die Taxan-basierte Chemotherapie. Nach wie vor wird diskutiert, ob oligometastasierte Patienten primär nur systemisch behandelt werden sollten, ober ob sie von einer zusätzlichen Lokaltherapie des Primärtumors profitieren. Bis Mitte 2018 gab es keine evidenzbasierte Empfehlung, bei neu diagnostiziertem Prostatakarzinom mit Fernmetastasen eine lokale Bestrahlung der Prostata durchzuführen. Diese konnte als Einzelfallentscheidung aufgrund der Daten retrospektiver Serien indiziert werden. Dementsprechend gab es hierzu keine Empfehlungen in den Leitlinien. Durch die 2018 /19 publizierten Daten der STAMPEDE- und der HORRAD-Studie ist die Indikation zu einer lokalen Bestrahlung des Primärtumors beim oligometastasierten Prostatakarzinom mit weniger als 4 Knochenmetastasen nun klar belegt. Die folgende Übersicht fasst die Daten der beiden Studien zusammen, bewertet diese und gibt eine Empfehlung für den Einsatz der lokalen Strahlentherapie der Prostata in der oligometastasierten Situation.

Abstract

In the treatment of metastatic prostate cancer, significant improvements have recently been made. In addition to androgen deprivation, various options are available, such as anti-androgen receptor therapies with abiraterone and enzalutamide and taxane-based chemotherapy. It is still being discussed whether oligometastatic patients should only be treated systemically, or whether they benefit from additional local therapy for the primary tumour. Until mid-2018, there was no evidence-based recommendation to perform local prostate irradiation in newly diagnosed prostate cancer with distant metastases. At best, this could be indicated as an individual decision based on data from retrospective series. Accordingly, there were no recommendations in the guidelines. The data from the STAMPEDE study and the HORRAD study were published in 2018 /19 and clearly demonstrate the indication for local irradiation of the primary tumour in oligometastatic prostate cancer with less than 4 bone metastases. The following overview summarises the data from these two studies, evaluates them and finally gives a recommendation for the use of local prostate radiation therapy in the oligometastatic situation.

Schlüsselwörter

Prostatakarzinom - Oligometastasierung - Primärtumor - Lokalbehandlung - Strahlentherapie

Keywords

Prostate cancer - oligometastases - primary tumor - local treatment - radiotherapy

Publication History

Article published online:
05 May 2020

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