Onkológia 3/2017

Position of radiotherapy in the treatment of generalized prostate cancer

Radiotherapy is unreplaceable in the management of generalized prostate cancer. Local radiotherapy directed towards primary tumor and involved lymph nodes can offer effective palliation of symptoms such as pain, compression, obstruction or hematuria. The most frequent indication of radiotherapy, however, is the treatment of bone metastases. A single dose of 8 Gy of palliative external beam radiotherapy is the preferred treatment of oligometastatic disease. However, if there is a risk of pathological fracture, or the fracture is already present, fractionated radiotherapy is necessary. Hemibody irradiation and treatment by radioisotopes strontium-89 and samarium-153 all offer comparably effective palliation of pain in case of diffuse metastatic skeletal involvement. Major limitation of these therapies, though, is their considerable hematological toxicity. The treatment of bone metastases in castrate-resistant disease by an alpha emitter radium-223 provides the advantage of effective pain control with minimal toxicity of the treatment as well as prolongation of the overall survival and improvement in patients quality of life.

Keywords: prostate cancer, bone metastases, radiotherapy, radioisotopes, radium-223