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