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Cours nationaux de DES de Radiothérapie oncologique Nancy – 2 au 4 février 2012

Résultats fonctionnels de la curiethérapie VS radiothérapie externe VS chirurgie des cancers de prostate. Cours nationaux de DES de Radiothérapie oncologique Nancy – 2 au 4 février 2012. Alberto BOSSI – Institut Gustave Roussy Villejuif.

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Cours nationaux de DES de Radiothérapie oncologique Nancy – 2 au 4 février 2012

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  1. Résultats fonctionnels de la curiethérapie VS radiothérapie externe VS chirurgie des cancers de prostate Cours nationaux de DES de Radiothérapie oncologiqueNancy – 2 au 4 février 2012 Alberto BOSSI – Institut Gustave Roussy Villejuif

  2. 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

  3. …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.

  4. Sanda, NEJM, 2008

  5. 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-26 Service Satisfaction Scale for Cancer Care, SCA (+ Partners) Sanda, NEJM, 2008

  6. AGE COMORBIDITIES Sanda, NEJM, 2008

  7. PR EBRT BT PSA GLEASON bps STAGE Sanda, NEJM, 2008

  8. Sexual Score Urinary Incontinence Urinary Irritation and Obstructive Score Bowel and Rectal Score Vitality and Hormonal Score Sanda, NEJM, 2008

  9. Sexual score Sanda, NEJM, 2008

  10. Urinary Incontinence Prostatectomy Radiotherapy Brachytherapy Sanda, NEJM, 2008

  11. Urinary Irritation Obstruction Score Prostatectomy Radiotherapy Brachytherapy Sanda, NEJM, 2008

  12. Bowel Rectal Score Prostatectomy Radiotherapy Brachytherapy Sanda, NEJM, 2008

  13. Vitality or Hormonal Score Prostatectomy Radiotherapy Brachytherapy Sanda, NEJM, 2008

  14. RP, EBRT or brachytherapy?Are there differences in Toxicity / Quality of Life? prospective, non-randomised study; median follow-up (FU) 2.5 yr Urinary incontinence Bowel/rectal function Adapted from: Sanda MG et al. NEJM 2008

  15. Quality of Life and Satisfaction with the Outcome “…symptoms related to sexual function, vitality and urinary function were independently associated with outcome satisfaction among patients.” Sanda, NEJM, 2008

  16. Adapted from: Sanda MG et al. NEJM 2008

  17. Merrick, J Urol, 2003

  18. Merrick, J Urol, 2003

  19. TRIFECTA after RP AUA#1748: Antebi E. J Urol 2010:183(4 Suppl):e675(abs.1748) • 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

  20. Valdagni, Cancer, 2009

  21. Valdagni, IJROBP, 2009

  22. Valdagni, Cancer, 2009

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