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[寡复发性前列腺癌:当前的管理与展望]

[Oligorecurrent prostate cancer: current management and perspectives].

作者信息

Loubersac Thomas, Guimas Valentine, Rio Emmanuel, Libois Vincent, Rigaud Jérome, Supiot Stéphane

机构信息

Urologie, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France.

Service de radiothérapie, Institut de cancérologie de l'Ouest, boulevard Professeur-Jacques-Monod, 44800 Nantes Saint-Herblain, France.

出版信息

Bull Cancer. 2020 Jun;107(5S):S35-S40. doi: 10.1016/S0007-4551(20)30276-9.

Abstract

Oligometastatic prostate cancer (PCa) is an intense area of research thanks to the development of novel PET tracers such as F-choline or Ga-PSMA. Several retrospective studies in patients with hormone-sensitive oligorecurrent PCa (usually up to 5 metastases with a controlled primary tumor) showed PSA response and a low toxicity profile of metastasis-directed therapies (MDT) such as Stereotactic Body Radiation Therapy (SBRT) or salvage lymph node dissection. More recently, randomized phase 2 studies showed that SBRT can delay the introduction of androgen deprivation, decrease biochemical relapses and increase overall survival. Regarding oligoprogressive metastatic castration-resistant PCa, limited data is however available. Based on these studies the European Association of Urology and the American Society of Radiotherapy EAU now recommend using MDT instead of observation. Several studies are undergoing in France and worldwide in order to confirm the exact role of MDT.

摘要

由于新型正电子发射断层显像(PET)示踪剂如F-胆碱或镓-前列腺特异性膜抗原(Ga-PSMA)的研发,寡转移前列腺癌(PCa)成为一个热门的研究领域。几项针对激素敏感性寡复发PCa患者(通常转移灶不超过5个且原发肿瘤得到控制)的回顾性研究显示,转移导向治疗(MDT)如立体定向体部放疗(SBRT)或挽救性淋巴结清扫术具有前列腺特异抗原(PSA)反应且毒性较低。最近,随机2期研究表明,SBRT可延迟雄激素剥夺治疗的开始,减少生化复发并提高总生存率。然而,关于寡进展性转移性去势抵抗性PCa的数据有限。基于这些研究,欧洲泌尿外科学会和美国放射治疗学会(EAU)现在建议采用MDT而非观察等待。法国和全球正在进行多项研究,以确定MDT的确切作用。

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