1
|
Sepulcri M, Fusella M, Cuppari L, Zorz A, Paiusco M, Evangelista L. Value of 18F-fluorocholine PET/CT in predicting response to radical radiotherapy in patients with localized prostate cancer. Clin Transl Radiat Oncol 2021; 30:71-77. [PMID: 34409175 PMCID: PMC8361027 DOI: 10.1016/j.ctro.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/07/2021] [Accepted: 07/18/2021] [Indexed: 11/16/2022] Open
Abstract
PURPOSE This study aims to establish whether metabolic parameters obtainable from FCH PET/CT can predict long-term response to radical radiotherapy (rRT) in patients with localized prostate cancer (PCa). METHODS Drawing on a single-center database, we retrospectively reviewed the pre-treatment FCH PET/CT scans of 50 patients who underwent rRT between 2012 and 2017. Patients were enrolled if they had a follow-up of at least 3 years after rRT. Various metabolic parameters were considered for each PET/CT, including FCH multifocality. rRT was administered to all patients for a total equivalent dose of 76-80 Gy, using a standard or hypofractionated schedule. Patients were classified as disease-free (DF) if their PSA levels after rRT rose by <2 ng/mL vis-à-vis their PSA nadir, or as not disease free (NDF) if their PSA levels rose by more than 2 ng/ml. RESULTS A multifocal FCH uptake in the prostate gland was identified in 27 patients (54%). At 3-year follow-up, 37 patients (74%) were judged DF, and 13 (26%) were NDF. The SUVmax and SUVmean, and the sum of the two values in all FCH foci in the prostate gland were significantly higher for NDF patients than for DF patients (all p < 0.005). The sum of the TLCKA levels in all FCH foci was likewise significantly higher in patients who were NDF than in those found DF (median 54.5 vs. 29.4; p < 0.05). At univariate analysis, the most of PET-metrics and Gleason Score were predictors of biochemical relapse after 3-year follow-up (all p < 0.05). CONCLUSION Higher SUVs seems predict a worse outcome for patients with multifocal intraprostatic lesions who are candidates for rRT.
Collapse
Affiliation(s)
- Matteo Sepulcri
- Department of Radiation Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Marco Fusella
- Department of Medical Physics, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Lea Cuppari
- Nuclear Medicine Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Alessandra Zorz
- Department of Medical Physics, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Marta Paiusco
- Department of Medical Physics, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Laura Evangelista
- Nuclear Medicine Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| |
Collapse
|
2
|
Latge A, Heimburger C, Severac F, Meyer N, Somme F, Imperiale A. Impact of pelvic dynamic acquisition on final reading of 18 F-Fluorocholine positron emission tomography in patients with prostate adenocarcinoma: True need or unnecessary burden? J Med Imaging Radiat Oncol 2021; 66:324-331. [PMID: 34323005 DOI: 10.1111/1754-9485.13296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/11/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Despite the increasing use of 18 F-fluorocholine (18 F-FCH) positron emission tomography (PET) in patients with prostate cancer, the acquisition protocol remains debated. We have evaluated the influence of the pelvic dynamic phase on the final reading of whole-body 18 F-FCH PET, to assess the need for a two-stage protocol. Reading the physician's experience and patient's previous treatment profile was also considered as potential influencing factors on final PET interpretation. METHODS All 18 F-FCH PET/CT performed from January 2018 to September 2019 in patients with prostate cancer and including a pelvic dynamic phase followed by a delayed whole-body acquisition were retrospectively retrieved. PET/CT were analysed by one expert nuclear medicine physician and one resident. The whole-body scan was analysed blinded (first reading) and nonblinded from the results of the dynamic phase. RESULTS 221 consecutive PET/CT were selected from 201 patients previously treated by radical prostatectomy (n = 31), pelvic radiation therapy (n = 60), or both (n = 94). 24 patients had no previous treatments, and 12 benefited from other focal treatments. In the whole population, dynamic acquisition modified final interpretation of 32/221 scans (14.5%) for residents, 26 (11.8%) for experts and 19 (8.6%) for consensual reading. No influence of previous treatments was found. The availability of a dynamic phase would have been responsible for treatment modification in 5/221 scans (2.3%). Considering only the prostate bed, dynamic acquisition modified the final interpretation in 7/125 (5.6%) studies (consensual reading) from patients with previous prostatic surgery and 4/84 (4.8%) scans from patients without a history of prostatic surgical intervention. No significant influence of dynamic acquisition was found on the final PET interpretation on prostate lodge accordingly to previous prostatic surgery. CONCLUSION The dynamic phase changes the interpretation of 18 F-FCH PET in about 9% of cases and the therapeutic strategy in <3% of patients. The influence of the early phase reduces with physician experience. Patient's treatment profile does not appear to have a significant influence on the variability of interpretation, also including the prostate bed.
Collapse
Affiliation(s)
- Adrien Latge
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), Strasbourg, France
| | - Céline Heimburger
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), Strasbourg, France
| | - Francois Severac
- Public Health, Strasbourg University Hospitals, Strasbourg, France
| | - Nicolas Meyer
- Public Health, Strasbourg University Hospitals, Strasbourg, France.,ICube, UMR7357, University of Strasbourg, Strasbourg, France
| | - François Somme
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), Strasbourg, France
| | - Alessio Imperiale
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), Strasbourg, France.,Molecular Imaging - DRHIM, IPHC, UMR 7178, CNRS/University of Strasbourg, Strasbourg, France
| |
Collapse
|
3
|
Supiot S, Vaugier L, Pasquier D, Buthaud X, Magné N, Peiffert D, Sargos P, Crehange G, Pommier P, Loos G, Hasbini A, Latorzeff I, Silva M, Denis F, Lagrange JL, Morvan C, Campion L, Blanc-Lapierre A. OLIGOPELVIS GETUG P07, a Multicenter Phase II Trial of Combined High-dose Salvage Radiotherapy and Hormone Therapy in Oligorecurrent Pelvic Node Relapses in Prostate Cancer. Eur Urol 2021; 80:405-414. [PMID: 34247896 DOI: 10.1016/j.eururo.2021.06.010] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 06/15/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Oligorecurrent pelvic nodal relapse in prostatic cancer is a challenge for regional salvage treatments. Androgen depriving therapies (ADTs) are a mainstay in metastatic prostate cancer, and salvage pelvic radiotherapy may offer long ADT-free intervals for patients harboring regional nodal relapses. OBJECTIVE To assess the efficacy of the combination of ADT and salvage radiotherapy in men with oligorecurrent pelvic node relapses of prostate cancer. DESIGN, SETTING, AND PARTICIPANTS We performed an open-label, phase II trial of combined high-dose intensity-modulated radiotherapy and ADT (6 mo) in oligorecurrent (five or fewer) pelvic node relapses in prostate cancer, detected by fluorocholine positron-emission tomography computed tomography imaging. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was 2-yr progression-free survival defined as two consecutive prostate-specific antigen levels above the level at inclusion and/or clinical evidence of progression as per RECIST 1.1 and/or death from any cause. RESULTS AND LIMITATIONS Between August 2014 and July 2016, 67 patients were recruited in 15 centers. Half of the patients had received prior prostatic irradiation. The median age was 67.7 yr. After a median follow-up of 49.4 mo, 2- and 3-yr progression-free survival rates were 81% and 58%, respectively. Median progression-free survival was 45.3 mo. The median biochemical relapse-free survival (BRFS) was 25.9 mo. At 2 and 3 yr, the BRFS rates were 58% and 46%, respectively. Grade 2 + 2-yr genitourinary and gastrointestinal toxicities were 10% and 2%, respectively. CONCLUSIONS Combined high-dose salvage pelvic radiotherapy and ADT appeared to prolong tumor control in oligorecurrent pelvic node relapses in prostate cancer with limited toxicity. After 3 yr, nearly half of patients were in complete remission. Our study showed initial evidence of benefit, but a randomized trial is required to confirm this result. PATIENT SUMMARY In this report, we looked at the outcomes of combined high-dose salvage pelvic radiotherapy and 6-mo-long hormone therapy in oligorecurrent pelvic nodal relapse in prostatic cancer. We found that 46% of patients presenting with oligorecurrent pelvic node relapses in prostate cancer were in complete remission after 3 yr following combined treatment at the cost of limited toxicity.
Collapse
Affiliation(s)
- Stéphane Supiot
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Nantes, St-Herblain, France; Centre de Recherche en Cancérologie Nantes-Angers (CRCNA), UMR 1232 Inserm - 6299 CNRS, Institut de Recherche en Santé de l'Université de Nantes, Nantes Cedex, France.
| | - Loig Vaugier
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Nantes, St-Herblain, France
| | - David Pasquier
- Academic Radiation Oncology Department, Centre Oscar Lambret, Lille, France; Centre de Recherche en Informatique, Signal et Automatique de Lille, CRIStAL UMR CNRS 9189, Université de Lille, Lille, France
| | - Xavier Buthaud
- Department of Radiation Oncology, Centre Catherine de Sienne, Nantes, France
| | - Nicolas Magné
- Department of Radiation Oncology, Institut de Cancérologie de la Loire, St Priest en Jarez, France
| | - Didier Peiffert
- Department of Radiation Oncology, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy, France
| | - Paul Sargos
- Department of Radiation Oncology, Institut Bergonié, Bordeaux, France
| | - Gilles Crehange
- Department of Radiation Oncology, Georges-Francois Leclerc Cancer Center, Dijon, France
| | - Pascal Pommier
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
| | - Genevieve Loos
- Department of Radiation Oncology, Centre Jean Perrin, Clermont-Ferrand, France
| | - Ali Hasbini
- Department of Radiation Oncology, Clinique Pasteur, Brest, France
| | - Igor Latorzeff
- Department of Radiation Oncology, Oncorad Clinique Pasteur, Toulouse, France
| | - Marlon Silva
- Department of Radiation Oncology, Centre Francois Baclesse, Caen, France
| | - Fabrice Denis
- Department of Radiation Oncology, Centre Jean Bernard, Le Mans, France
| | | | - Cyrille Morvan
- Department of Nuclear medicine, Institut de Cancérologie de l'Ouest, Boulevard J. Monod, Nantes, St-Herblain, France
| | - Loic Campion
- Department of Biostatistics, Institut de Cancérologie de l'Ouest, Boulevard J. Monod, Nantes, St-Herblain, France
| | - Audrey Blanc-Lapierre
- Department of Biostatistics, Institut de Cancérologie de l'Ouest, Boulevard J. Monod, Nantes, St-Herblain, France
| |
Collapse
|
4
|
Ferrari M, Renard J, Pereira Mestre R, Bosetti DG, Stoffel F, Treglia G. Change of management by using hybrid imaging with radiolabelled choline in biochemical recurrent prostate cancer: a systematic review and a meta-analysis. Clin Transl Imaging 2021. [DOI: 10.1007/s40336-020-00407-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
5
|
Metabolic regulation of prostate cancer heterogeneity and plasticity. Semin Cancer Biol 2020; 82:94-119. [PMID: 33290846 DOI: 10.1016/j.semcancer.2020.12.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/12/2020] [Accepted: 12/03/2020] [Indexed: 02/07/2023]
Abstract
Metabolic reprogramming is one of the main hallmarks of cancer cells. It refers to the metabolic adaptations of tumor cells in response to nutrient deficiency, microenvironmental insults, and anti-cancer therapies. Metabolic transformation during tumor development plays a critical role in the continued tumor growth and progression and is driven by a complex interplay between the tumor mutational landscape, epigenetic modifications, and microenvironmental influences. Understanding the tumor metabolic vulnerabilities might open novel diagnostic and therapeutic approaches with the potential to improve the efficacy of current tumor treatments. Prostate cancer is a highly heterogeneous disease harboring different mutations and tumor cell phenotypes. While the increase of intra-tumor genetic and epigenetic heterogeneity is associated with tumor progression, less is known about metabolic regulation of prostate cancer cell heterogeneity and plasticity. This review summarizes the central metabolic adaptations in prostate tumors, state-of-the-art technologies for metabolic analysis, and the perspectives for metabolic targeting and diagnostic implications.
Collapse
|
6
|
López Rodríguez E, Tirado Hospital J, Álvarez Pérez R, Gómez Izquierdo L, Jiménez-Hoyuela J. Usefulness of 18F-Choline Positron Emission Tomography - Computed Tomography in the therapeutic management of patients with biochemical recurrence of prostate adenocarcinoma treated with brachytherapy. Actas Urol Esp 2020; 44:437-443. [PMID: 32576406 DOI: 10.1016/j.acuro.2020.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 04/19/2020] [Accepted: 05/03/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The objective of the study was to evaluate the usefulness of 18F-choline PET/CT in biochemically recurrent prostate cancer patients treated with brachytherapy, as well as to assess the changes in therapeutic management derived from its outcome. MATERIAL AND METHODS Retrospective study of 20 patients between 51 and 78 years old, with a history of prostate adenocarcinoma that had been treated with brachytherapy and presented biochemical recurrence (PSA 3.1-12 ng/ml) and staging tests (CT and bone scan) without alterations, were included. The findings visualized in the PET/CT scan with 18F-choline were correlated with the histopathology and/or the evolution of the PSA after therapy. RESULTS 18F-choline PET/CT scan only detected local recurrence in 15 patients. Local and regional recurrences were seen in 4 patients, and 1 patient presented local and bone recurrence. Local recurrence detected in PET was confirmed by anatomopathological studies in 85% of the cases. In one patient, these findings (PET scan) turned out to be prostatitis, and it could not be confirmed in another patient. Of the cases with local and regional recurrence, local recurrence was histologically confirmed in 3 out of 4 patients. 18F-choline PET/CT changed the therapeutic management in 25% of the patients, discarding the initially planned salvage surgery in 3 cases, 1 radiotherapy and 1 brachytherapy. CONCLUSION 18F-choline PET/CT could be a useful technique in the group of patients with biochemical recurrence after brachytherapy, providing locoregional and distant involvement findings which had not been detected with conventional imaging tests, thus determining a more adequate therapeutic management.
Collapse
|
7
|
Turpin A, Girard E, Baillet C, Pasquier D, Olivier J, Villers A, Puech P, Penel N. Imaging for Metastasis in Prostate Cancer: A Review of the Literature. Front Oncol 2020; 10:55. [PMID: 32083008 PMCID: PMC7005012 DOI: 10.3389/fonc.2020.00055] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 01/13/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Initial staging and assessment of treatment activity in metastatic prostate cancer (PCa) patients is controversial. Indications for the various available imaging modalities are not well-established due to rapid advancements in imaging and treatment. Methods: We conducted a critical literature review of the main imaging abnormalities that suggest a diagnosis of metastasis in localized and locally advanced PCa or in cases of biological relapse. We also assessed the role of the various imaging modalities available in routine clinical practice for the detection of metastases and response to treatment in metastatic PCa patients. Results: In published clinical trials, the most commonly used imaging modalities for the detection and evaluation of therapeutic response are bone scan, abdominopelvic computed tomography (CT), and pelvic and bone magnetic resonance imaging (MRI). For the detection and follow-up of metastases during treatment, modern imaging techniques i.e., choline-positron emission tomography (PET), fluciclovine-PET, or Prostate-specific membrane antigen (PSMA)-PET provide better sensitivity and specificity. This is particularly the case of fluciclovine-PET and PSMA-PET in cases of biochemical recurrence with low values of prostate specific antigen. Conclusions: In routine clinical practice, conventional imaging still have a role, and communication between imagers and clinicians should be encouraged. Present and future clinical trials should use modern imaging methods to clarify their usage.
Collapse
Affiliation(s)
- Anthony Turpin
- Department of Medical Oncology, CHU Lille, Lille, France.,Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, UMR9020 - UMR-S 1277 - Canther - Cancer Heterogeneity, Plasticity and Resistance to Therapies, Lille, France
| | - Edwina Girard
- Medical Oncology Department, Centre Oscar Lambret, Lille, France
| | - Clio Baillet
- Nuclear Medicine Department, CHU Lille, Lille, France
| | - David Pasquier
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France.,CRISTAL UMR CNRS 9189, Lille University, Villeneuve-d'Ascq, France
| | | | | | | | - Nicolas Penel
- Department of Medical Oncology, CHU Lille, Lille, France.,Medical Oncology Department, Centre Oscar Lambret, Lille, France
| |
Collapse
|
8
|
Qualitative and quantitative reproducibility of [18]fluoromethycholine PET/computed tomography in prostate cancer. Nucl Med Commun 2020; 41:147-154. [PMID: 31939917 DOI: 10.1097/mnm.0000000000001129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Recurrence occurs in more than 50% of prostate cancer. To be effective, treatments require precise localization of tumor cells. [F]fluoromethylcholine ([18F]FCH) PET/computed tomography (CT) is currently used to restage disease in cases of biochemical relapse. To be used for therapy response as has been suggested, repeatability limits of PET derived indices need to be established. OBJECTIVE The aim of our study was to prospectively assess the qualitative and quantitative reproducibility [18F]FCH PET/CT in prostate cancer. METHODS Patients with histologically proven prostate cancer referred for initial staging or restaging were prospectively included. All patients underwent two [18F]FCH PET/CTs in the same conditions within a maximum of 3 weeks' time. We studied the repeatability of the visual report and the repeatability of SUVmax and its evolution over the acquisition time in lesions, liver and vascular background. Statistical analysis was performed using the Bland-Altman approach. RESULTS Twenty-one patients were included. Reporting repeatability was excellent with 97.8% of concordance. Mean repeatability of SUVmax considering all times and all lesions was 2.2% ± 20. Evolution of SUVmax was unpredictable, either increasing or decreasing over the acquisition time, both for lesions and for physiological activity. CONCLUSION Our study demonstrated that visual report of [18F]FCH PET/CT was very reproducible and that the repeatability limits of SUVmax was similar to those of other PET radiotracers. An SUVmax difference of more than 40% should be considered as representing a treatment response effect. Change of SUVmax during the acquisition time varied and should not be considered as an interpretation criterion.
Collapse
|
9
|
Comparing the Staging/Restaging Performance of 68Ga-Labeled Prostate-Specific Membrane Antigen and 18F-Choline PET/CT in Prostate Cancer: A Systematic Review and Meta-analysis. Clin Nucl Med 2019; 44:365-376. [PMID: 30888999 DOI: 10.1097/rlu.0000000000002526] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE PET/CT using prostate-specific membrane antigen (PSMA) and choline radiotracers is widely used for diagnosis of prostate cancer. However, the roles of and differences in diagnostic performance between these 2 radiotracers for prostate cancer are unclear. The aim of this study was to compare the staging and restaging performance of Ga-labeled PSMA and F-choline PET/CT imaging in prostate cancer. METHODS A comprehensive search was performed in PubMed for studies reporting the staging performance of Ga-PSMA and F-choline PET/CT in prostate cancer from the inception of the database to October 1, 2018, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Thirty-five studies were included in this systematic review and meta-analysis. Pooled estimates of patient- and lesion-based sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) for Ga-PSMA and F-choline PET/CT were calculated alongside 95% confidence intervals. Summary receiver operating characteristic curves were plotted, and the area under the summary receiver operating characteristic curve (AUC) was determined alongside the Q* index. RESULTS The patient-based overall pooled sensitivity, specificity, PLR, NLR, DOR, and AUC of Ga-PSMA PET/CT for staging in prostate cancer (13 studies) were 0.92, 0.94, 7.91, 0.14, 79.04, and 0.96, respectively, whereas those of F-choline PET/CT (16 studies) were 0.93, 0.83, 4.98, 0.10, 68.27, and 0.95. The lesion-based overall pooled sensitivity, specificity, PLR, NLR, DOR, and AUC of Ga-PSMA PET/CT for staging in prostate cancer (9 studies) were 0.83, 0.95, 23.30, 0.17, 153.58, and 0.94, respectively, and those of F-choline PET/CT (4 studies) were 0.81, 0.92, 8.59, 0.20, 44.82, and 0.98. In both patient- and lesion-based imaging, there was no statistically significant difference in the abilities of detecting or excluding prostate cancer between Ga-PSMA PET/CT and F-choline PET/CT. CONCLUSIONS For staging and restaging performance in patients with prostate cancer, there was no significant difference between Ga-PSMA PET/CT and F-choline PET/CT. Ga-PSMA PET/CT and F-choline PET/CT have demonstrated high diagnostic performance for accurate staging and restaging in patients with prostate cancer, and thus both should be considered for staging in this disease.
Collapse
|
10
|
Effect of positive carbon-11-choline PET/CT results in the therapeutic management of prostate cancer biochemical relapse. Nucl Med Commun 2018; 40:79-85. [PMID: 30521498 PMCID: PMC6282669 DOI: 10.1097/mnm.0000000000000936] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Carbon-11-(C)-choline PET/computed tomography (CT) has shown good results in re-staging of prostate cancer (PCa) with raised serum levels of prostate-specific antigen. Our aim was to evaluate the effect of positive C-choline PET/CT results in the therapeutic management of patients with PCa with biochemical relapse (BR) after curative intention treatment. PATIENTS AND METHODS A total of 112 patients with PCa BR and positive C-choline PET/CT were retrospectively evaluated. PET/CT was acquired 20 min after intravenous administration of 555-740 MBq of C-choline. The therapeutic management after C-choline PET/CT was obtained from the clinical records. The minimum follow-up time was 18 months. RESULTS In 80 (71.4%) of 112 patients, C-choline PET/CT showed local recurrence of PCa; in 17 (15.2%) patients, distant recurrence; and in 15 (13.4%) patients, local plus distant recurrence. A second malignancy was detected in five (4.5%) patients. The planned therapeutic management was changed as per positive C-choline PET/CT result in 74 (66.1%) patients and were treated as follows: 31 (27.7%) patients with HT, combined with other treatments in eight (7.1%), 17 (15.2%) with BT, 13 (11.6%) with external beam radiotherapy, one (0.9%) with RP, and four (3.6%) with chemotherapy. Treatment approach was not modified in 37 (33%) patients. No data was available from one (0.9%) patient. CONCLUSION Positive C-choline PET/CT result had an important effect in the therapeutic management of patients with PCa and BR, leading to a change in the planned approach in two (66.1%) out of three patients. In addition, in 4.5% of the patients, the C-choline PET/CT allowed the detection of a second malignancy.
Collapse
|
11
|
Kjölhede H, Almquist H, Lyttkens K, Bratt O. Pre-treatment 18F-choline PET/CT is prognostic for biochemical recurrence, development of bone metastasis, and cancer specific mortality following radical local therapy of high-risk prostate cancer. Eur J Hybrid Imaging 2018; 2:16. [PMID: 30148254 PMCID: PMC6097795 DOI: 10.1186/s41824-018-0034-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 05/15/2018] [Indexed: 11/28/2022] Open
Abstract
Background The aim of this study was to determine whether lymph node metastasis on pre-treatment 18F-choline PET/CT is an independent prognostic factor for biochemical recurrence (BCR), skeletal metastasis, and cancer specific mortality (CSM), after radical local treatment (radical prostatectomy and/or radiotherapy) in men with high-risk prostate cancer. Medical records were reviewed for men with newly diagnosed high-risk prostate cancer who had pre-treatment 18F-choline positron emission tomography fused with computed tomography (PET/CT) scan for primary metastasis staging. Results Of 174 eligible men, 124 met the criteria for inclusion. The PET/CT scan was negative for metastasis in 97 (78%) men, inconclusive in 15 (12%), and positive in 12 (10%). The men with a positive PET/CT scan had significantly shorter time to BCR (p = 0.02), time to skeletal metastasis (p = 0.002), and time to prostate cancer specific death (p < 0.001). On multivariable Cox regression analysis, including also tumour stage, Gleason score, and PSA, a non-negative PET/CT scan was the only significant covariate for time to BCR (HR 2.6, 95% CI 1.3–5.5) and time to skeletal metastasis (HR 2.7, 95% CI 1.3–5.9). Conclusions In men with a newly diagnosed high-risk prostate cancer and a negative or inconclusive bone scan, 18F-choline uptake on PET/CT suggestive metastasis was associated with recurrence, progression to distant metastasis, and prostate cancer death. This strongly indicates that the choline uptakes represented metastasis and not false positive findings.
Collapse
Affiliation(s)
- Henrik Kjölhede
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Helén Almquist
- 2Center for Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Kerstin Lyttkens
- 2Center for Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Ola Bratt
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden
| |
Collapse
|
12
|
Vija Racaru L, Sinigaglia M, Kanoun S, Ben Bouallègue F, Tal I, Brillouet S, Bauriaud-Mallet M, Zerdoud S, Dierickx L, Vallot D, Caselles O, Gabiache E, Pascal P, Courbon F. Fluorine-18-fluorocholine PET/CT parameters predictive for hematological toxicity to radium-223 therapy in castrate-resistant prostate cancer patients with bone metastases: a pilot study. Nucl Med Commun 2018; 39:672-679. [PMID: 29790867 PMCID: PMC6023601 DOI: 10.1097/mnm.0000000000000850] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/30/2018] [Accepted: 03/31/2018] [Indexed: 01/17/2023]
Abstract
PURPOSE This study aims to predict hematological toxicity induced by Ra therapy. We investigated the value of metabolically active bone tumor volume (MBTV) and total bone lesion activity (TLA) calculated on pretreatment fluorine-18-fluorocholine (F-FCH) PET/CT in castrate-resistant prostate cancer (CRPC) patients with bone metastases treated with Ra radionuclide therapy. PATIENTS AND METHODS F-FCH PET/CT imaging was performed in 15 patients with CRPC before treatment with Ra. Bone metastatic disease was quantified on the basis of the maximum standardized uptake value (SUV), total lesion activity (TLA=MBTV×SUVmean), or MBTV/height (MBTV/H) and TLA/H. F-FCH PET/CT bone tumor burden and activity were analyzed to identify which parameters could predict hematological toxicity [on hemoglobin (Hb), platelets (PLTs), and lymphocytes] while on Ra therapy. Pearson's correlation was used to identify the correlations between age, prostate-specific antigen, and F-FCH PET parameters. RESULTS MBTV ranged from 75 to 1259 cm (median: 392 cm). TLA ranged from 342 to 7198 cm (median: 1853 cm). Patients benefited from two to six cycles of Ra (n=56 cycles in total). At the end of Ra therapy, five of the 15 (33%) patients presented grade 2/3 toxicity on Hb and lymphocytes, whereas three of the 15 (20%) patients presented grade 2/3 PLT toxicity.Age was correlated negatively with both MBTV (r=-0.612, P=0.015) and TLA (r=-0.596, P=0.018). TLA, TLA/H, and MBTV/H predicted hematological toxicity on Hb, whereas TLA/H and MBTV/H predicted toxicity on PLTs at the end of Ra cycles. Receiver operating characteristic curve analysis allowed to define the cutoffs for MBTV (915 cm) and TLA (4198 cm) predictive for PLT toxicity, with an accuracy of 0.92 and 0.99. CONCLUSION Tumor bone burden calculation is feasible with F-FCH PET/CT with freely available open-source software. In this pilot study, baseline F-FCH PET/CT markers (TLA, MBTV) have shown abilities to predict Hb and PLT toxicity after Ra therapy and could be explored for patient selection and treatment optimization.
Collapse
Affiliation(s)
- Lavinia Vija Racaru
- Department of Nuclear Medicine, Claudius Regaud Institute, Toulouse Oncology University Institute-IUCT-Oncopole
- Department of Biophysics and Nuclear Medicine, Faculty of Medicine, Paul Sabatier University
- INSERM U1037, Toulouse Oncology Research Centre (Centre de recherches en cancérologie de Toulouse, CRCT)
| | - Mathieu Sinigaglia
- Department of Nuclear Medicine, Claudius Regaud Institute, Toulouse Oncology University Institute-IUCT-Oncopole
| | - Salim Kanoun
- Department of Nuclear Medicine, Claudius Regaud Institute, Toulouse Oncology University Institute-IUCT-Oncopole
| | | | - Ilan Tal
- IT Department, Beth Israel Deaconess Medical Center, Haifa, Israel
| | - Sévérine Brillouet
- Department of Nuclear Medicine, Claudius Regaud Institute, Toulouse Oncology University Institute-IUCT-Oncopole
- INSERM U1037, Toulouse Oncology Research Centre (Centre de recherches en cancérologie de Toulouse, CRCT)
| | - Mathilde Bauriaud-Mallet
- Department of Nuclear Medicine, Claudius Regaud Institute, Toulouse Oncology University Institute-IUCT-Oncopole
- INSERM U1037, Toulouse Oncology Research Centre (Centre de recherches en cancérologie de Toulouse, CRCT)
| | - Slimane Zerdoud
- Department of Nuclear Medicine, Claudius Regaud Institute, Toulouse Oncology University Institute-IUCT-Oncopole
| | - Lawrence Dierickx
- Department of Nuclear Medicine, Claudius Regaud Institute, Toulouse Oncology University Institute-IUCT-Oncopole
| | - Delphine Vallot
- Department of Nuclear Medicine, Claudius Regaud Institute, Toulouse Oncology University Institute-IUCT-Oncopole
| | - Olivier Caselles
- Department of Nuclear Medicine, Claudius Regaud Institute, Toulouse Oncology University Institute-IUCT-Oncopole
| | - Erwan Gabiache
- Department of Nuclear Medicine, Claudius Regaud Institute, Toulouse Oncology University Institute-IUCT-Oncopole
| | - Pierre Pascal
- Department of Nuclear Medicine, Claudius Regaud Institute, Toulouse Oncology University Institute-IUCT-Oncopole
- Department of Nuclear Medicine, Toulouse University Hospitals, Toulouse, France
| | - Frederic Courbon
- Department of Nuclear Medicine, Claudius Regaud Institute, Toulouse Oncology University Institute-IUCT-Oncopole
- Department of Biophysics and Nuclear Medicine, Faculty of Medicine, Paul Sabatier University
- INSERM U1037, Toulouse Oncology Research Centre (Centre de recherches en cancérologie de Toulouse, CRCT)
- Department of Nuclear Medicine, Toulouse University Hospitals, Toulouse, France
| |
Collapse
|
13
|
Palard-Novello X, Blin AL, Le Jeune F, Garin E, Salaün PY, Devillers A, Gambarota G, Querellou S, Bourguet P, Saint-Jalmes H. Optimization of temporal sampling for 18F-choline uptake quantification in prostate cancer assessment. EJNMMI Res 2018; 8:49. [PMID: 29904817 PMCID: PMC6002329 DOI: 10.1186/s13550-018-0410-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/06/2018] [Indexed: 01/12/2023] Open
Abstract
Background Suboptimal temporal sampling of time-activity curves (TAC) from dynamic 18F-fluoromethylcholine (FCH) PET images may introduce bias in quantification of FCH uptake in prostate cancer assessment. We sought to define an optimal temporal sampling protocol for dynamic FCH PET imaging. Seven different time samplings were tested: 5 × 60″, 10 × 30″, 15 × 15″–1 × 75″, 6 × 10″–8 × 30″, 12 × 5″–8 × 30″; 10 × 5″–4 × 10″–3 × 20″–5 × 30″, and 8 × 3″–8 × 12″–6 × 30″. First, the irreversible and reversible one-tissue compartment model with blood volume parameter (VB) (respectively, 1T1K+VB and 1T2k+VB, with K1 = transfer coefficient from the arterial blood to the tissue compartment and k2 = transfer coefficient from the tissue compartment to the arterial blood) were compared for 37 lesions from 32 patients who underwent FCH PET imaging for initial or recurrence assessment of prostate cancer, and the model was selected using the Akaike information criterion. To determine the optimal time sampling, K1 values extracted from 1000 noisy-simulated TAC using Monte Carlo method from the seven different time samplings were compared to a target K1 value which is the average of the K1 values extracted from the 37 lesions using an imaging-derived input function for each patient. K1 values extracted with the optimal time sampling for each tumoral lesion were compared to K1 values extracted from each of the other time samplings for the 37 lesions. Results The 1T2k + VB model was selected. The target K1 value as the objective was 0.506 mL/ccm/min (range 0.216–1.246). Results showed a significant difference between K1 values from the simulated TAC with the seven different time samplings analyzed. The closest K1 value from the simulated TAC to the target K1 value was obtained by the 12 × 5″–8 × 30″ time sampling. Concerning the clinical validation, K1 values extracted from the optimal time sampling (12 × 5″–8 × 30″) were significantly different with K1 values extracted from the other time samplings, except for the comparison with K1 values extracted from the 10 × 5″–4 × 10″–3 × 20″–5 × 30″ time sampling. Conclusions A two-phase framing of dynamic PET reconstruction with frame durations of 5 s (blood phase) and 30 s (tissue phase) could be used to sample the TAC for uptake quantification in prostate cancer assessment.
Collapse
Affiliation(s)
- Xavier Palard-Novello
- LTSI-UMR1099, Univ Rennes, Inserm, F-35000, Rennes, France. .,Department of Nuclear Medicine, Centre Eugène Marquis, Rennes, France.
| | - Anne-Lise Blin
- LTSI-UMR1099, Univ Rennes, Inserm, F-35000, Rennes, France
| | - Florence Le Jeune
- Department of Nuclear Medicine, Centre Eugène Marquis, Rennes, France.,Univ Rennes-EA 4712, Rennes, France
| | - Etienne Garin
- Department of Nuclear Medicine, Centre Eugène Marquis, Rennes, France.,UMR 124, Univ Rennes, Inserm, Rennes, France
| | - Pierre-Yves Salaün
- Department of Nuclear Medicine, Centre Hospitalier Universitaire, Brest, France.,University of Bretagne Occidentale-EA 3878, Brest, France
| | - Anne Devillers
- Department of Nuclear Medicine, Centre Eugène Marquis, Rennes, France
| | | | - Solène Querellou
- Department of Nuclear Medicine, Centre Hospitalier Universitaire, Brest, France.,University of Bretagne Occidentale-EA 3878, Brest, France
| | - Patrick Bourguet
- Department of Nuclear Medicine, Centre Eugène Marquis, Rennes, France
| | - Hervé Saint-Jalmes
- LTSI-UMR1099, Univ Rennes, Inserm, F-35000, Rennes, France.,Department of Nuclear Medicine, Centre Eugène Marquis, Rennes, France
| |
Collapse
|
14
|
Prado Júnior LM, Marino FM, Barra R, do Prado LFM, Barra Sobrinho A. One-year experience with 68Ga-PSMA PET/CT: applications and results in biochemical recurrence of prostate cancer. Radiol Bras 2018; 51:151-155. [PMID: 29991835 PMCID: PMC6034726 DOI: 10.1590/0100-3984.2017.0008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To show the initial (first-year) experience with 68Ga-PSMA PET/CT
at a clinic in Brazil. Materials and Methods Over a one-year period, 96 examinations with 68Ga-PSMA PET/CT (85
related to prostate cancer and 11 related to kidney cancer) were performed
in 90 patients. Results In the prostate and kidney cancer patients alike, the main clinical
indication for 68Ga-PSMA PET/CT was suspicion of recurrence
during follow-up (in 65.8% and 63.0% of the cases, respectively). Among the
prostate cancer patients, 38.5% of those with a prostate specific antigen
(PSA) < 0.5 ng/mL tested positive for recurrence on 68Ga-PSMA
PET/CT, compared with 71.0% of those with a PSA of 0.5-0.99, 85.7% of those
with a PSA of 1.0-1.99, and 92.6% of those with a PSA > 1.99. Conclusion Although 68Ga-PSMA PET/CT is a technique that has only recently
been applied in clinical settings, despite its high cost,
68Ga-PSMA PET/CT shows great promise as a tool in the clinical
management of patients with kidney and prostate cancer, especially in those
with prostate cancer whose PSA levels are elevated even after treatment.
Collapse
Affiliation(s)
- Luciano Monteiro Prado Júnior
- MD, Specialist in Nuclear Medicine, Attending Physician in Charge of the PET/CT Unit at Imagens Médicas de Brasília (IMEB), Brasília, DF, Brazil
| | - Fiorella Menegatti Marino
- Doctoral Student in Neuroscience at the Universidade de Brasília (UnB), Attending Physician in the PET/CT Unit at Imagens Médicas de Brasília (IMEB), Brasília, DF, Brazil
| | - Renato Barra
- MD, MSc, Attending Physician in the PET/CT Unit at Imagens Médicas de Brasília (IMEB), Brasília, DF, Brazil
| | | | - Alaor Barra Sobrinho
- MD, Specialist in Nuclear Medicine, Medical Director at Imagens Médicas de Brasília (IMEB), Brasília, DF, Brazil
| |
Collapse
|
15
|
Cysouw M, Bouman-Wammes E, Hoekstra O, van den Eertwegh A, Piet M, van Moorselaar J, Boellaard R, Dahele M, Oprea-Lager D. Prognostic Value of [ 18F]-Fluoromethylcholine Positron Emission Tomography/Computed Tomography Before Stereotactic Body Radiation Therapy for Oligometastatic Prostate Cancer. Int J Radiat Oncol Biol Phys 2018; 101:406-410. [PMID: 29559285 DOI: 10.1016/j.ijrobp.2018.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/25/2018] [Accepted: 02/05/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE To investigate the predictive value of [18F]-fluoromethylcholine positron emission tomography/computed tomography (PET/CT)-derived parameters on progression-free survival (PFS) in oligometastatic prostate cancer patients treated with stereotactic body radiation therapy (SBRT). METHODS AND MATERIALS In [18F]-fluoromethylcholine PET/CT scans of 40 consecutive patients with ≤4 metachronous metastases treated with SBRT we retrospectively measured the number of metastases, standardized uptake values (SUVmean, SUVmax, SUVpeak), metabolically active tumor volume (MATV), and total lesion choline uptake. Partial-volume correction was applied using the iterative deconvolution Lucy-Richardson algorithm. RESULTS Thirty-seven lymph node and 13 bone metastases were treated with SBRT. Thirty-three patients (82.5%) had 1 lesion, 4 (10%) had 2 lesions, and 3 (7.5%) had 3 lesions. After a median follow-up of 32.6 months (interquartile range, 35.5 months), the median PFS was 11.5 months (95% confidence interval 8.4-14.6 months). Having more than a single metastasis was a significant prognostic factor (hazard ratio 2.74; P = .03), and there was a trend in risk of progression for large MATV (hazard ratio 1.86; P = .10). No SUV or total lesion choline uptake was significantly predictive for PFS, regardless of partial-volume correction. All PET semiquantitative parameters were significantly correlated with each other (P ≤ .013). CONCLUSIONS The number of choline-avid metastases was a significant prognostic factor for progression after [18F]-fluormethylcholine PET/CT-guided SBRT for recurrent oligometastatic prostate cancer, and there seemed to be a trend in risk of progression for patients with large MATVs. The lesional level of [18F]-fluoromethylcholine uptake was not prognostic for progression.
Collapse
Affiliation(s)
- Matthijs Cysouw
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands.
| | - Esther Bouman-Wammes
- Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Otto Hoekstra
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Maartje Piet
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands; Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, Groningen, The Netherlands
| | - Max Dahele
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Daniela Oprea-Lager
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
16
|
Gillebert Q, Huchet V, Rousseau C, Cochet A, Olivier P, Courbon F, Gontier E, Nataf V, Balogova S, Talbot JN. 18F-fluorocholine PET/CT in patients with occult biochemical recurrence of prostate cancer: Detection rate, impact on management and adequacy of impact. A prospective multicentre study. PLoS One 2018; 13:e0191487. [PMID: 29425221 PMCID: PMC5806856 DOI: 10.1371/journal.pone.0191487] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 01/05/2018] [Indexed: 01/11/2023] Open
Abstract
Aim To prospectively evaluate the clinical impact and the diagnostic performance of FCH-PET/CT in patients with occult biochemical recurrence of prostate cancer (PCa). Materials and methods Results of 179 patients (mean PSA = 7.5ng/mL) with negative/inconclusive results of pelvic-MRI and of bone-scintigraphy were analysed. To determine the impact of FCH-PET/CT on diagnostic thinking and on patient management, the referring physicians prospectively filled-in a 1st and 2nd questionnaire related to patient’s planned management before and after FCH-PET/CT. Based on data from a 6-month follow-up after FCH-PET/CT, an independent assessor blinded to results of FCH-PET/CT determined the adequacy of management changes motivated by FCH-PET/CT. Results FCH-PET/CT localised foci evocative of recurrent PCa in 59% (105/179) of patients. Results of FCH-PET/CT motivated a change in scheduled patient management in 56% (100/179) of patients; which was considered as adequate in 89% (89/100) of patients. FCH-PET/CT also led to the detection of lung cancer in two patients. Conclusion FCH PET/CT is a powerful tool to localise the sites of occult biochemical recurrence of PCa, leading to an adequate management change in half of patients.
Collapse
Affiliation(s)
- Quentin Gillebert
- Department of Nuclear Medicine, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris & Université Pierre et Marie Curie, Paris, France
| | - Virginie Huchet
- Department of Nuclear Medicine, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris & Université Pierre et Marie Curie, Paris, France
| | | | - Alexandre Cochet
- Department of Nuclear Medicine, Centre GF Leclerc, Dijon, France
| | - Pierre Olivier
- Department of Nuclear Medicine, CHU Brabois, Vandoeuvre-lès-Nancy, France
| | - Frédéric Courbon
- Department of Nuclear Medicine, Institut Claudius Regaud, Toulouse, France
| | - Eric Gontier
- Department of Nuclear Medicine, HIA Val-de-Grâce, Paris, France
| | - Valérie Nataf
- Department of Nuclear Medicine, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris & Université Pierre et Marie Curie, Paris, France
- Department of radiopharmacy, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sona Balogova
- Department of Nuclear Medicine, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris & Université Pierre et Marie Curie, Paris, France
- Department of Nuclear Medicine, Comenius University & St Elisabeth Oncology Institute, Bratislava, Slovakia
- * E-mail:
| | - Jean-Noël Talbot
- Department of Nuclear Medicine, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris & Université Pierre et Marie Curie, Paris, France
| | | |
Collapse
|
17
|
Gillessen S, Attard G, Beer TM, Beltran H, Bossi A, Bristow R, Carver B, Castellano D, Chung BH, Clarke N, Daugaard G, Davis ID, de Bono J, Borges Dos Reis R, Drake CG, Eeles R, Efstathiou E, Evans CP, Fanti S, Feng F, Fizazi K, Frydenberg M, Gleave M, Halabi S, Heidenreich A, Higano CS, James N, Kantoff P, Kellokumpu-Lehtinen PL, Khauli RB, Kramer G, Logothetis C, Maluf F, Morgans AK, Morris MJ, Mottet N, Murthy V, Oh W, Ost P, Padhani AR, Parker C, Pritchard CC, Roach M, Rubin MA, Ryan C, Saad F, Sartor O, Scher H, Sella A, Shore N, Smith M, Soule H, Sternberg CN, Suzuki H, Sweeney C, Sydes MR, Tannock I, Tombal B, Valdagni R, Wiegel T, Omlin A. Management of Patients with Advanced Prostate Cancer: The Report of the Advanced Prostate Cancer Consensus Conference APCCC 2017. Eur Urol 2018; 73:178-211. [PMID: 28655541 DOI: 10.1016/j.eururo.2017.06.002] [Citation(s) in RCA: 369] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 06/01/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND In advanced prostate cancer (APC), successful drug development as well as advances in imaging and molecular characterisation have resulted in multiple areas where there is lack of evidence or low level of evidence. The Advanced Prostate Cancer Consensus Conference (APCCC) 2017 addressed some of these topics. OBJECTIVE To present the report of APCCC 2017. DESIGN, SETTING, AND PARTICIPANTS Ten important areas of controversy in APC management were identified: high-risk localised and locally advanced prostate cancer; "oligometastatic" prostate cancer; castration-naïve and castration-resistant prostate cancer; the role of imaging in APC; osteoclast-targeted therapy; molecular characterisation of blood and tissue; genetic counselling/testing; side effects of systemic treatment(s); global access to prostate cancer drugs. A panel of 60 international prostate cancer experts developed the program and the consensus questions. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The panel voted publicly but anonymously on 150 predefined questions, which have been developed following a modified Delphi process. RESULTS AND LIMITATIONS Voting is based on panellist opinion, and thus is not based on a standard literature review or meta-analysis. The outcomes of the voting had varying degrees of support, as reflected in the wording of this article, as well as in the detailed voting results recorded in Supplementary data. CONCLUSIONS The presented expert voting results can be used for support in areas of management of men with APC where there is no high-level evidence, but individualised treatment decisions should as always be based on all of the data available, including disease extent and location, prior therapies regardless of type, host factors including comorbidities, as well as patient preferences, current and emerging evidence, and logistical and economic constraints. Inclusion of men with APC in clinical trials should be strongly encouraged. Importantly, APCCC 2017 again identified important areas in need of trials specifically designed to address them. PATIENT SUMMARY The second Advanced Prostate Cancer Consensus Conference APCCC 2017 did provide a forum for discussion and debates on current treatment options for men with advanced prostate cancer. The aim of the conference is to bring the expertise of world experts to care givers around the world who see less patients with prostate cancer. The conference concluded with a discussion and voting of the expert panel on predefined consensus questions, targeting areas of primary clinical relevance. The results of these expert opinion votes are embedded in the clinical context of current treatment of men with advanced prostate cancer and provide a practical guide to clinicians to assist in the discussions with men with prostate cancer as part of a shared and multidisciplinary decision-making process.
Collapse
Affiliation(s)
- Silke Gillessen
- Department of Medical Oncology, Cantonal Hospital St. Gallen and University of Berne, Switzerland.
| | - Gerhardt Attard
- Department of Medical Oncology, The Institute of Cancer Research/Royal Marsden, London, UK
| | - Tomasz M Beer
- Oregon Health & Science University Knight Cancer Institute, OR, USA
| | - Himisha Beltran
- Department of Medical Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Alberto Bossi
- Department of Radiation Oncology, Genito Urinary Oncology, Prostate Brachytherapy Unit, Goustave Roussy, Paris, France
| | - Rob Bristow
- Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto, Toronto, ON, USA
| | - Brett Carver
- Department of Urology, Sidney Kimmel Center for Prostate and Urologic Cancers, New York, NY, USA
| | - Daniel Castellano
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Byung Ha Chung
- Department of Urology, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Noel Clarke
- Department of Urology, The Christie and Salford Royal Hospitals, Manchester, UK
| | - Gedske Daugaard
- Department of Medical Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ian D Davis
- Monash University and Eastern Health, Eastern Health Clinical School, Box Hill, Australia
| | - Johann de Bono
- Department of Medical Oncology, The Institute of Cancer Research/Royal Marsden, London, UK
| | - Rodolfo Borges Dos Reis
- Department of Urology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Charles G Drake
- Department of Medical Oncology, Division of Haematology/Oncology, Columbia University Medical Center, New York, NY, USA
| | - Ros Eeles
- Department of Clinical Oncology and Genetics, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Eleni Efstathiou
- Department of Medical Oncology, University of Texas MD Anderson Cancer Center, TX, USA
| | - Christopher P Evans
- Department of Urology, University of California, Davis School of Medicine, CA, USA
| | - Stefano Fanti
- Department of Nuclear Medicine, Policlinico S. Orsola, Università di Bologna, Italy
| | - Felix Feng
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Karim Fizazi
- Department of Medical Oncology, Gustave Roussy, University of Paris Sud, Paris, France
| | - Mark Frydenberg
- Department of Surgery, Department of Anatomy and Developmental Biology, Faculty of Medicine, Nursing and Health Sciences, Monash University
| | - Martin Gleave
- Department of Urology, Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada
| | - Susan Halabi
- Department of Clinical trials and Statistics, Duke University, Durham, NC, USA
| | | | - Celestia S Higano
- Department of Medicine, Division of Medical Oncology, University of Washington and Fred Hutchinson Cancer Research Center, WA, USA
| | - Nicolas James
- Department of Clinical Oncology, Clinical Oncology Queen Elizabeth Hospital Birmingham and University of Birmingham, Birmingham, UK
| | - Philip Kantoff
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA
| | - Pirkko-Liisa Kellokumpu-Lehtinen
- Department of Clinical Oncology, Tampere University Hospital, Faculty of Medicine and Life Sciences, University of Tampere, Finland
| | - Raja B Khauli
- Department of Urology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Gero Kramer
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Chris Logothetis
- Department of Genitourinary Medical Oncology, MD Anderson Cancer Centre, Houston, TX, USA
| | - Fernando Maluf
- Department of Medical Oncology Hospital Israelita Albert Einstein and Department of Medical Oncology Beneficência Portuguesa de São Paulo
| | - Alicia K Morgans
- Department of Medical Oncology and Epidemiology, Vanderbilt University Medical Center, Division of Hematology/Oncology, Nashville, TN, USA
| | - Michael J Morris
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nicolas Mottet
- Department of Urology, University Hospital Nord St. Etienne, St. Etienne, France
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India
| | - William Oh
- Department of Medical Oncology, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, NY, USA
| | - Piet Ost
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Anwar R Padhani
- Department of Radiology, Mount Vernon Cancer Centre and Institute of Cancer Research, London, UK
| | - Chris Parker
- Department of Clinical Oncology, Royal Marsden NHS Foundation Trust, Sutton, UK
| | | | - Mack Roach
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Mark A Rubin
- Department of Pathology, University of Bern and the Inselspital, Bern (CH)
| | - Charles Ryan
- Department of Medical Oncology, Clinical Medicine and Urology at the Helen Diller Family Comprehensive Cancer Center at the University of, California, San Francisco, CA, USA
| | - Fred Saad
- Department of Urology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Oliver Sartor
- Department of Medical Oncology, Tulane Cancer Center, New Orleans, LA, USA
| | - Howard Scher
- Department of Medical Oncology, Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Centre, New York, NY, USA
| | - Avishay Sella
- Department of Medical Oncology, Department of Oncology, Assaf Harofeh Medical Centre, Tel-Aviv University, Sackler School of Medicine, Zerifin, Israel
| | - Neal Shore
- Department of Urology, Carolina Urologic Research Center, Myrtle Beach, SC, USA
| | - Matthew Smith
- Department of Medical Oncology, Massachusetts General Hospital Cancer Centre, Boston, MA, USA
| | - Howard Soule
- Prostate Cancer Foundation, Santa Monica, CA, USA
| | - Cora N Sternberg
- Department of Medical Oncology, San Camillo Forlanini Hospital, Rome, Italy
| | - Hiroyoshi Suzuki
- Department of Urology, Toho University Sakura Medical Center, Japan
| | - Christopher Sweeney
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Ian Tannock
- Department of Medical Oncology, Princess Margaret Cancer Centre and University of Toronto, Toronto, ON, Canada
| | - Bertrand Tombal
- Department of Urology, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Riccardo Valdagni
- Department of Oncology and Haemato-oncology, Università degli Studi di Milano. Radiation Oncology 1, Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Thomas Wiegel
- Department of Radiation Oncology, Klinik für Strahlentherapie und Radioonkologie des Universitätsklinikum Ulm, Albert-Einstein-Allee, Ulm, Germany
| | - Aurelius Omlin
- Department of Medical Oncology, Cantonal Hospital St. Gallen and University of Berne, Switzerland
| |
Collapse
|
18
|
Michaud L, Touijer KA. [Focus on molecular imaging in prostate cancer]. Prog Urol 2016; 26:619-627. [PMID: 27663306 DOI: 10.1016/j.purol.2016.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 07/14/2016] [Accepted: 08/22/2016] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Prostate cancer is the most frequent cancer in men in France and it is a public health issue. This cancer is heterogenous. There is a clinical need of an accurate non-invasive imaging method to improve diagnosis, guide the choice of therapy and evaluate its efficacy. We undertook to critically review the different molecular imaging probes, currently used or in clinical trial. METHOD A systematic review of the literature was performed in Pubmed/Medline database by searching for articles in French or English published on PET tracer in prostate cancer in clinical application. RESULTS Several PET tracers are under investigation because of the low performance of the FDG in prostate cancer. In France, only two new PET tracers have the marketing authorization: the NaF and choline, but these tracers have several limitations. The NaF analyses only bone metastasis. The choline has changed the recurrence of prostate cancer but is not effective for recurrence with low PSA, furthermore its sensitivity is low for the detection of lymph nodes metastasis in initial disease. Several tracers in trial including the PSMA offer encouraging prospects in initial staging and for recurrences. CONCLUSION An accurate knowledge in molecular biology allowed to develop the metabolic imagery. Many new tracers are under evaluation in prostate cancer. The indication of each of them needs to be established.
Collapse
Affiliation(s)
- L Michaud
- Department of Surgery and Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, États-Unis
| | - K A Touijer
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, États-Unis; Department of Urology, Weill Cornell Medical College, New York, NY, États-Unis.
| |
Collapse
|
19
|
|
20
|
Mertan FV, Lindenberg L, Choyke PL, Turkbey B. PET imaging of recurrent and metastatic prostate cancer with novel tracers. Future Oncol 2016; 12:2463-2477. [PMID: 27527923 DOI: 10.2217/fon-2016-0270] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Early detection of recurrent prostate cancer (PCa) is of paramount importance to deliver prompt and accurate therapy reducing the chance of progression to metastatic disease. However, current imaging modalities such as conventional computed tomography, MRI and PET scanning do not provide sufficient sensitivity, especially at lower prostate-specific antigen values. Moreover, biological characterization of PCa has become increasingly important to provide patient-specific therapy and current imaging poorly characterizes disease aggressiveness. The current uprise of novel PET tracers in recurrent and metastatic PCa shows promising, yet variable sensitivities and specificities in detection, indicating the need for further studies. In this review, we highlight current and new PET tracers that have been developed to improve the detection of recurrent and metastatic PCa.
Collapse
Affiliation(s)
- Francesca V Mertan
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Liza Lindenberg
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA
| |
Collapse
|
21
|
García J, Cozar M, Soler M, Bassa P, Riera E, Ferrer J. Salvage radiotherapy in prostate cancer patients. Planning, treatment response and prognosis using 11 C-choline PET/CT. Rev Esp Med Nucl Imagen Mol 2016. [DOI: 10.1016/j.remnie.2016.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
22
|
Mahajan A, Azad GK, Cook GJ. PET Imaging of Skeletal Metastases and Its Role in Personalizing Further Management. PET Clin 2016; 11:305-18. [PMID: 27321034 DOI: 10.1016/j.cpet.2016.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In oncology, the skeleton is one of the most frequently encountered sites for metastatic disease and thus early detection not only has an impact on an individual patient's management but also on the overall outcome. Multiparametric and multimodal hybrid PET/computed tomography and PET/MR imaging have revolutionized imaging for bone metastases, but irrespective of tumor biology or morphology of the bone lesion it remains unclear which imaging modality is the most clinically relevant to guide individualized cancer care. In this review, we highlight the current clinical challenges of PET imaging in evaluation and quantification of skeletal tumor burden and its impact on personalized cancer management.
Collapse
Affiliation(s)
- Abhishek Mahajan
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai 400012, India
| | - Gurdip Kaur Azad
- Division of Imaging Sciences and Biomedical Engineering, Cancer Imaging Department, King's College London, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Gary J Cook
- Division of Imaging Sciences and Biomedical Engineering, Cancer Imaging Department, King's College London, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK; Clinical PET Centre, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.
| |
Collapse
|
23
|
Lee J, Sato MM, Coel MN, Lee KH, Kwee SA. Prediction of PSA Progression in Castration-Resistant Prostate Cancer Based on Treatment-Associated Change in Tumor Burden Quantified by 18F-Fluorocholine PET/CT. J Nucl Med 2016; 57:1058-64. [PMID: 26912444 DOI: 10.2967/jnumed.115.169177] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 01/26/2016] [Indexed: 01/19/2023] Open
Abstract
UNLABELLED Measurements of metabolically active tumor volume (MATV) can be applied to (18)F-fluorocholine PET/CT to quantify whole-body tumor burden. This study evaluated the serial application of these measurements as systemic treatment response markers and predictors of disease progression in patients with castration-resistant prostate cancer (CRPC). METHODS Forty-two patients completed sequential (18)F-fluorocholine PET/CT scans before and 1-3 mo after starting treatment for CRPC. Whole-body tumor segmentation was applied to determine net MATV from each scan. Changes in net MATV were evaluated as predictors of time to prostate-specific antigen (PSA) progression by Kaplan-Meier and proportional hazards regression analysis. RESULTS Treatments consisted of chemotherapy in 16 patients, antiandrogens in 19 patients, (223)Ra-dichloride in 5 patients, and sipuleucel-T in 2 patients. A significant MATV response (defined as a ≥30% decrease in net MATV) was observed in 20 patients on the basis of in-treatment PET/CT performed an average of 51 d (median, 49 d) into treatment. Significantly longer times to PSA progression were observed in patients who exhibited an MATV response (418 d vs. 116 d, P = 0.0067). MATV response was associated with a hazard ratio of 0.246 (P = 0.0113) for PSA progression, which remained significant when adjusted for treatment type. CONCLUSION Significant changes in whole-body tumor burden can be measured on (18)F-fluorocholine PET/CT over the course of contemporary treatments for CRPC. In this study, these changes were found to be predictive of PSA progression as a potential surrogate marker of treatment outcome. Because (18)F-fluorocholine PET/CT can also be used for localizing resistant tumors, this modality can potentially complement other measures of response in the precision management of advanced prostate cancer.
Collapse
Affiliation(s)
- Joohee Lee
- Oncology Research Program, Queen's Medical Center, Honolulu, Hawaii Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Miles M Sato
- Oncology Research Program, Queen's Medical Center, Honolulu, Hawaii
| | - Marc N Coel
- Hamamatsu/Queen's PET Imaging Center, Queen's Medical Center, Honolulu, Hawaii; and
| | - Kyung-Han Lee
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sandi A Kwee
- Hamamatsu/Queen's PET Imaging Center, Queen's Medical Center, Honolulu, Hawaii; and Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| |
Collapse
|
24
|
García JR, Cozar M, Soler M, Bassa P, Riera E, Ferrer J. Salvage radiotherapy in prostate cancer patients. Planning, treatment response and prognosis using (11)C-choline PET/CT. Rev Esp Med Nucl Imagen Mol 2016; 35:238-45. [PMID: 26803491 DOI: 10.1016/j.remn.2015.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 11/19/2015] [Accepted: 11/22/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the prognostic value of the therapeutic response by (11)C-choline PET/CT in prostate cancer patients with biochemical recurrence in which (11)C-choline PET/CT indicated radio-guided radiotherapy. METHODS The study included 37 patients initially treated with prostatectomy, who were treated due to biochemical recurrence. (11)C-choline PE/CT detected infra-diaphragmatic lymph-node involvement. All were selected for intensity modulated radiation therapy, escalating the dose according to the PET findings. One year after treatment patients underwent PSA and (11)C-choline PET/CT categorizing response (complete/partial/progression). Clinical/biochemical/image monitoring was performed until appearance of second relapse or 36 months in disease-free patients. RESULTS (11)C-choline PET/CT could detect lymph nodes in all 37 patients. They were 18 (48.6%) of more than a centimetre in size and 19 (51.3%) with no pathological CT morphology: 9 (24.3%) with positive lymph nodes of around one centimetre and 10 (27.0%) only less than a centimetre in size. The response by (11)C-choline PET/CT was categorised one year after radiotherapy: 16 patients (43.2%) complete response; 15 (40.5%) partial response, and 6 (16.2%) progression. The response was concordant between the PSA result and (11)C-choline PET/CT in 32 patients (86.5%), and discordant in five (13.5%). New recurrence was detected in 12 patients (80%) with partial response, and 5 (31.2%) with complete response. The mean time to recurrence was 9 months after partial response, and 18 months after complete response (significant difference, p<.0001). CONCLUSION (11)C-choline PET/CT allows the selection of patients with recurrent prostate cancer candidates for radiotherapy and to plan the technique. The evaluation of therapeutic response by (11)C-choline PET/CT has prognostic significance.
Collapse
Affiliation(s)
- J R García
- Unidad PET/TC, CETIR, ERESA, Esplugues, Barcelona, España.
| | - M Cozar
- Unidad PET/TC, CETIR, ERESA, Esplugues, Barcelona, España
| | - M Soler
- Unidad PET/TC, CETIR, ERESA, Esplugues, Barcelona, España
| | - P Bassa
- Unidad PET/TC, CETIR, ERESA, Esplugues, Barcelona, España
| | - E Riera
- Unidad PET/TC, CETIR, ERESA, Esplugues, Barcelona, España
| | - J Ferrer
- Unidad PET/TC, CETIR, ERESA, Esplugues, Barcelona, España
| |
Collapse
|
25
|
Oprea-Lager DE, Kramer G, van de Ven PM, van den Eertwegh AJ, van Moorselaar RJ, Schober P, Hoekstra OS, Lammertsma AA, Boellaard R. Repeatability of Quantitative 18F-Fluoromethylcholine PET/CT Studies in Prostate Cancer. J Nucl Med 2015; 57:721-7. [DOI: 10.2967/jnumed.115.167692] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 12/01/2015] [Indexed: 11/16/2022] Open
|