Cours nationaux de DES de Radiothérapie oncologiqueNancy – 2 au 4 février 2012
Alberto BOSSI – Institut Gustave Roussy Villejuif
Résultats fonctionnels dela curiethérapie VS radiothérapie externe VS chirurgie des cancers de prostate
RP, EBRT or brachytherapy?Are there differences in efficacy?
no randomised controlled trials (RCTs) comparing
● radical prostatectomy (RP)
● external beam radiation therapy (EBRT)
● brachytherapy (BT)
virtually impossible to state that
one therapy is clearly superior over another...
Heidenreich A et al. Eur Urol 2011;59:61-71;Wilkins A et al. Nat Rev Clin Oncol 2010;7:583-9
…du fait de l’équivalence d’efficacité des différents
traitements locaux du cancer de la prostate avec
plus de 15 ans de recul, la toxicité des traitements
et la qualité de vie post thérapeutique apparaissent
comme étant des éléments décisionnels majeurs
en faveur d’un traitement plutôt que d’un autre.
Sanda, NEJM, 2008
1201 pts, from 2003 to 2006 (+ 625 partners)
Nine University affiliated Hospitals
T1 – T2 Prostate Cancer: RP (+/- robot), 603
EBRT (+/- HT), 292
BT (+/- EBRT), 306
Median follow-up: 30 months
Expanded Prostate Cancer Index, EPIC-26Service Satisfaction Scale for Cancer Care, SCA
(+ Partners)
Sanda, NEJM, 2008
AGE
COMORBIDITIES
Sanda, NEJM, 2008
EBRTPR BT
PSA
GLEASON bps
STAGE
Sanda, NEJM, 2008
Sexual Score
Urinary Incontinence
Urinary Irritation and Obstructive Score
Bowel and Rectal Score
Vitality and Hormonal Score
Sanda, NEJM, 2008
Sanda, NEJM, 2008
Sexual score
Prostatectomy
Radiotherapy
Brachytherapy
Urinary Incontinence
Sanda, NEJM, 2008
Brachytherapy
Radiotherapy
Prostatectomy
Sanda, NEJM, 2008
Urinary IrritationObstruction Score
Prostatectomy
Radiotherapy
Brachytherapy
Sanda, NEJM, 2008
BowelRectal Score
Prostatectomy
Radiotherapy
Brachytherapy
Vitality orHormonal Score
Sanda, NEJM, 2008
prospective, non-randomised study; median follow-up (FU) 2.5 yr
Adapted from: Sanda MG et al. NEJM 2008
RP, EBRT or brachytherapy?Are there differences in Toxicity / Quality of Life?
Urinary incontinence Bowel/rectal function
Quality of Life and Satisfaction with the Outcome
“…symptoms related to sexual function, vitality and urinaryfunction were independently associated with outcomesatisfaction among patients.”
Sanda, NEJM, 2008
Quality of Life Domain Treatment Group Independent variable
Sexual Function ProstatectomyAge / PSA /
Nerve Sparing
RadiotherapyAge / Prostate Size /
Neoadjuvant Hormones
Brachytherapy Age / PSA
Vitality Hormone Function
Prostatectomy Obesity
RadiotherapyObesity / Prostate Size /
Neoadjuvant HT
BrachytherapyAge / Prostate Size /
Neoadjuvant Hormones
Urinary Irritation Obstruction
Prostatectomy Prostate Size
RadiotherapyProstate Size /
Neoadjuvant HT
BrachytherapyProstate Size / PSA /
Neoadjuvant HT
Adapted from: Sanda MG et al. NEJM 2008
Merrick, J Urol, 2003
Merrick, J Urol, 2003
TRIFECTA after RP
» Single-centre, single-surgeon study in 1,005 men with localised PCa undergoing RP
» Mean age 59 yrs; mean FU 54 mo
» Trifecta: recurrence-free, potent and continent» At 2 yrs: 63.5%; at 5 yrs: 60.5%
» Age, pathologic Gleason score, pathologic stage, prostate specimen weight and nerve sparing independent predictors of achieving trifecta after RP
Trifecta is affected by age, pathologic Gleason score, nerve sparing, resected prostate weight and pathologic stage but not by clinical stage or BMI. This may aid in counseling pts undergoing RP
AUA#1748: Antebi E. J Urol 2010:183(4 Suppl):e675(abs.1748)
Valdagni, Cancer, 2009
Valdagni, IJROBP, 2009
Valdagni, Cancer, 2009