Zadnja postignuća u radioterapiji raka prostate
| Autor: | Murgić, Jure, Fröbe, Ana, Kiang Chua, Melvin Lee |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2022 |
| Předmět: |
Prostate Cancer
Radiotherapy Hypofractionation Stereotactic Body Radiotherapy Dose Escalation Clinical Trials Rak prostate radioterapija hipofrakcioniranje stereotaksijska radioterapija eskalacija doze kliničke studije General Medicine prostate cancer radiotherapy hypofractionation stereotactic body radiotherapy dose escalation clinical trials |
| Zdroj: | Acta clinica Croatica Volume 61. Issue Supplement 3 |
| ISSN: | 0353-9466 1333-9451 |
| Popis: | Radiotherapy is the attractive treatment option for prostate cancer and has a clear role in all stages of the disease. Over the last decade, advances in technology, imaging capabilities, and improved radiobiological understanding have deeply transformed radiotherapy for prostate cancer, allowing dose escalation and wide adoption of hypofractionation. Furthermore, the integration of magnetic resonance imaging (MRI) and improved physical precision of dose delivery have given an impetus to additionally target intraprostatic tumor lesions, previously agnostic to conventional radiotherapy target definition concept. The emerging data from randomized clinical trials and observation research show that ultra-hypofractionation is a safe approach while further follow-up is needed to assess its efficacy compared to standard fractionation. There is an ongoing uncertainty surrounding true alpha/beta ratio for prostate cancer since hypofractionation has so far failed to yield theoretically envisioned superior biochemical control outcomes. Finally, recently published randomized trial settled ongoing controversy regarding the role of elective pelvic lymph node radiotherapy in patients with high-risk prostate cancer, showing clear benefit when pelvic nodes were treated to 50 Gy. The role of partial gland dose escalation/tumor boosting is evolving, and more data is needed to adopt this approach in routine clinical care. Going forward, molecular imaging will be crucial to assess biology of the disease, predict a response potentially, and optimally personalize radiotherapy treatment decisions. In this narrative review, we critically analyzed the published literature and provided practical summary of recent prostate radiotherapy advances for busy clinicians. Radioterapija je neizostavan oblik liječenja raka prostate i ima ulogu u svim fazama bolesti. Zadnjeg desetljeća napreci u tehnologiji i radiobiologiji su preobrazili radioterapiju raka prostate te omogućili eskalaciju doze i hipofrakcioniranje. Nadalje, integracija magnetske rezonance i povećana fizikalna preciznost isporuke radioterapije omogućila je ciljanje intraprostatičkih tumora. Mnoge studije pokazuju da je ultra hipofrakcioniranje obećavajući koncept liječenja, iako postoje mnoge nejasnoće o pravom alfa-beta omjeru raka prostate te posljedičnom stvarnom terapijskom benefitu hipofrakcioniranja. Recentno objavljena studija ukazala je na korist elektivne radioterapije zdjeličnih limfnih čvorova u bolesnika sa visokorizičnim rakom prostate. Nadalje, u tijeku su studije koje će ocijeniti valjanost daljnje intraprostatičke eskalacije doze. Moderno molekularno oslikavanje donosi veliku promjenu u načinu kako shvaćamo i liječimo rak prostate. U ovom preglednom članku kritički smo analizirali literaturu i dali smjernice za svakodnevnu radioterapijsku kliničku praksu. |
| Databáze: | OpenAIRE |
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