Когда проводить лучевую терапию после радикальной простатэктомии? Сравнение адъювантной и спасительной лучевой терапии (обзор литературы)

До настоящего времени остаются не решенными вопросы в отношении оптимальных сроков и показаний к проведению лучевой терапии (адъювантной или спасительной) после хирургического лечения рака предстательной железы, поэтому исследования в данном направлении актуальны и востребованны в клинической практике. В статье оценены эффективность адъювантной лучевой терапии по сравнению со спасительной лучевой терапией в отношении выживаемости без рецидива, а также ассоциированные с ними нежелательные явления. В 3 рандомизированных исследованиях и метаанализе подтверждено, что адъювантная лучевая терапия по сравнению со спасительной лучевой терапией не приводит к лучшим показателям выживаемости без рецидива. Выбор между адъювантной и спасительной лучевой терапией должен основываться на индивидуальных особенностях пациента и риске рецидива. Отложенное проведение лучевой терапии может позволить части пациентам избежать избыточного лечения и ассоциированных с ним нежелательных явлений.

1. Sung H., Ferlay J., Siegel R.L. et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 2021;71(3):209–49. DOI: 10.3322/caac.21660

2. Yossepowitch O., Bjartell A., Eastham J.A. et al. Positive surgical margins in radical prostatectomy: outlining the problem and its long-term consequences. Eur Urol 2009;55(1):87–99. DOI: 10.1016/j.eururo.2008.09.051

3. Bloom K.D., Richie J.P., Schultz D. et al. Invasion of seminal vesicles by adenocarcinoma of the prostate: PSA outcome determined by preoperative and postoperative factors. Urology 2004;63(2):333–6. DOI: 10.1016/j.urology.2003.09.042

4. Buhmeida A., Pyrhönen S., Laato M., Collan Y. Prognostic factors in prostate cancer. Diagn Pathol 2006;1(1):4. DOI: 10.1186/1746-1596-1-4

5. Daimantas M., Venclovas Z., Sasnauskas G. et al. The significance of prostate specific antigen persistence in prostate cancer risk groups on long-term oncological outcomes. Cancers (Basel) 2021;13(10):2453. DOI: 10.3390/cancers13102453

6. Roach M. 3rd, Hanks G., Thames H. Jr et al. Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys 2006;65(4):965–74. DOI: 10.1016/j.ijrobp.2006.04.029

7. Würnschimmel C., Wenzel M., Wang N. et al. Radical prostatectomy for localized prostate cancer: 20-year oncological outcomes from a German high-volume center. Urol Oncol 2021;39(12):830.e17–26. DOI: 10.1016/j.urolonc.2021.04.031

8. Lamb B.W., Alghazo O., Murphy D.G. Balancing the benefits and harms of radiotherapy post-radical prostatectomy. Transl Androl Urol 2018;7(Suppl 1):S128–31. DOI: 10.21037/tau.2017.10.07

9. Fossati N., Karnes R.J., Cozzarini C. et al. Assessing the optimal timing for early salvage radiation therapy in patients with prostatespecific antigen rise after radical prostatectomy. Eur Urol 2016;69(4):728–33. DOI: 10.1016/j.eururo.2015.10.009

10. Martini A., Gandaglia G., Fossati N. et al. Defining clinically meaningful positive surgical margins in patients undergoing radical prostatectomy for localised prostate cancer. Eur Urol Oncol 2021;4(1):42–8. DOI: 10.1016/j.euo.2019.03.006

11. Mellado B., Font A., Alcaraz A. et al. Phase II trial of short-term neoadjuvant docetaxel and complete androgen blockade in high-risk prostate cancer. Br J Cancer 2009;101(8):1248–52. DOI: 10.1038/sj.bjc.6605320

12. Hermann R.M., Christiansen H. Long-term results of adjuvant versus early salvage radiation therapy in pT3N0 prostate cancer after radical prostatectomy. Strahlenther Onkol 2018;194(2):181–4. DOI: 10.1007/s00066-017-1242-6

13. Parker C.C., Clarke N.W., Cook A.D. et al. Timing of radiotherapy after radical prostatectomy (RADICALS-RT): a randomised, controlled phase 3 trial. Lancet 2020;396(10260):1413–21. DOI: 10.1016/S0140-6736(20)31553-1

14. Kneebone A., Fraser-Browne C., Duchesne G.M. et al. Adjuvant radiotherapy versus early salvage radiotherapy following radical prostatectomy (TROG 08.03/ANZUP RAVES): a randomised, controlled, phase 3, non-inferiority trial. Lancet Oncol 2020;21(10):1331–40. DOI: 10.1016/S1470-2045(20)30456-3

15. Sargos P., Chabaud S., Latorzeff I. et al. Adjuvant radiotherapy versus early salvage radiotherapy plus short-term androgen deprivation therapy in men with localised prostate cancer after radical prostatectomy (GETUG-AFU 17): a randomised, phase 3 trial. Lancet Oncol 2020;21(10):1341–52. DOI: 10.1016/S1470-2045(20)30454-X

16. Vale C.L., Fisher D., Kneebone A. et al. Adjuvant or early salvage radiotherapy for the treatment of localised and locally advanced prostate cancer: a prospectively planned systematic review and meta-analysis of aggregate data. Lancet 2020;396(10260):1422–31. DOI: 10.1016/S0140-6736(20)31952-8

17. Hwang W.L., Tendulkar R.D., Niemierko A. et al. Comparison between adjuvant and early-salvage postprostatectomy radiotherapy for prostate cancer with adverse pathological features. JAMA Oncol 2018;4(5):e175230. DOI: 10.1001/jamaoncol.2017.5230

18. Abdollah F., Karnes R.J., Suardi N. et al. Impact of adjuvant radiotherapy on survival of patients with node-positive prostate cancer. J Clin Oncol 2014;32(35):3939–47. DOI: 10.1200/JCO.2013.54.7893

19. Tilki D., Preisser F., Tennstedt P. et al. Adjuvant radiation therapy is associated with better oncological outcome compared with salvage radiation therapy in patients with pN1 prostate cancer treated with radical prostatectomy. BJU Int 2017;119(5):717–23. DOI: 10.1111/bju.13679

20. Nath S.K., Rose B.S., Pugh T.J. Who benefits most from early salvage radiation therapy after prostatectomy? Transl Androl Urol 2018;7(Suppl 1):S124–7. DOI: 10.21037/tau.2017.11.23

21. Tilki D., Chen M.H., Wu J. et al. Prostate-specific antigen level at the time of salvage therapy after radical prostatectomy for prostate cancer and the risk of death. J Clin Oncol 2023;41(13):2428–35. DOI: 10.1200/JCO.22.02489

22. Pollack A., Karrison T.G., Balogh A.G. et al. The addition of androgen deprivation therapy and pelvic lymph node treatment to prostate bed salvage radiotherapy (NRG Oncology/RTOG 0534 SPPORT): an international, multicentre, randomised phase 3 trial. Lancet 2022;399(10338):1886–901. DOI: 10.1016/S0140-6736(21)01790-6

23. Jairath N.K., Dal Pra A., Vince R. et al. A systematic review of the evidence for the decipher genomic classifier in prostate cancer. Eur Urol 2021;79(3):374–83. DOI: 10.1016/j.eururo.2020.11.021

24. Dal Pra A., Ghadjar P., Hayoz S. et al. Validation of the Decipher genomic classifier in patients receiving salvage radio-therapy without hormone therapy after radical prostatectomy – an ancillary study of the SAKK 09/10 randomized clinical trial. Ann Oncol 2022;33(9):950–8. DOI: 10.1016/j.annonc.2022.05.007

25. Shipley W.U., Pugh S.L., Lukka H.R. et al. NRG Oncology/RTOG 9601, a phase III trial in prostate cancer patients: anti-androgen therapy (AAT) with bicalutamide during and after salvage radiation therapy (RT) following radical prostatectomy (RP) and an elevated PSA. J Clin Oncol 2016;34(2_suppl):3. DOI: 10.1200/jco.2016.34.2_suppl.3

26. Carrie C., Magné N., Burban-Provost P. et al. Short-term androgen deprivation therapy combined with radiotherapy as salvage treatment after radical prostatectomy for prostate cancer (GETUG-AFU 16): a 112-month follow-up of a phase 3, randomised trial. Lancet Oncol 2019;20(12):1740–9. DOI: 10.1016/S1470-2045(19)30486-3

27. Ghadjar P., Hayoz S., Bernhard J. et al. Dose-intensified versus conventional-dose salvage radiotherapy for biochemically recurrent prostate cancer after prostatectomy: the SAKK 09/10 randomized phase 3 trial. Eur Urol 2021;80(3):306–15. DOI: 10.1016/j.eururo.2021.05.033