Эффективность и безопасность применениярадия-223 в лечении метастатического кастрационнорезистентного рака предстательной железы

Метастазы в кости развиваются у большинства больных раком предстательной железы (РПЖ) как закономерный этап течения болезни. Костная система представляет собой наиболее типичное и в большинстве случаев единственное место метастазирования РПЖ. Вовлечение костей – ключевое событие, поскольку оно связано со снижением продолжительности жизни и ухудшением прогноза, например костными осложнениями (включая необходимость хирургического вмешательства или паллиативной лучевой терапии, патологический перелом и компрессию спинного мозга), что приводит к значительному снижению качества жизни пациентов.

Проблема принятия терапевтических решений при метастатическом кастрационно-резистентном РПЖ (мКРРПЖ) не решена. В последние годы было разработано несколько терапевтических вариантов, значительно повышающих выживаемость пациентов с мКРРПЖ. Наличие нескольких активных агентов предоставляет онкологам беспрецедентную возможность адаптировать свой выбор к клиническим характеристикам каждого пациента, к каждой линии лечения, но в то же время создает проблему определения оптимальной терапевтической последовательности для отдельного больного. В России радий-223 одобрен для пациентов без висцерального поражения с метастазами в кости. Он может быть назначен пациентам с метастазами в лимфатические узлы и пациентам с массивным костным метастатическим поражением, если им противопоказаны другие препараты, однако применение радия-223 оптимально при поражении костей и хороших резервных возможностях костного мозга.

Вследствие эволюции стратегии лечения, сложности процесса оценки динамики лечения и вариабельности клинических аспектов заболевания мультидисциплинарный подход приобретает сегодня первостепенное значение.

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