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Chen DC, Huang S, Buteau JP, Kashyap R, Hofman MS. Clinical Positron Emission Tomography/Computed Tomography: Quarter-Century Transformation of Prostate Cancer Molecular Imaging. PET Clin 2024; 19:261-279. [PMID: 38199918 DOI: 10.1016/j.cpet.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Although positron emission tomography/computed tomography (PET/CT) underwent rapid growth during the last quarter-century, becoming a new standard-of-care for imaging most cancer types, CT and bone scan remained the gold standard for patients with prostate cancer. This occurred as 2-fluorine-18-fluoro-2-deoxy-d-glucose was perceived to have a limited role owing to low sensitivity in many patients. A resurgence of interest occurred with the use of fluorine-18-sodium-fluoride PET/CT as a replacement for bone scintigraphy, and then choline, fluciclovine, and dihydrotestosterone (DHT) PET/CT as prostate "specific" radiotracers. The last decade, however, has seen a true revolution with the meteoric rise of prostate-specific membrane antigen PET/CT.
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Affiliation(s)
- David C Chen
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Molecular Imaging and Therapeutic Nuclear Medicine, Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Siyu Huang
- Department of Surgery, The University of Melbourne
| | - James P Buteau
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Molecular Imaging and Therapeutic Nuclear Medicine, Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Raghava Kashyap
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Molecular Imaging and Therapeutic Nuclear Medicine, Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael S Hofman
- Prostate Cancer Theranostics and Imaging Centre of Excellence, Molecular Imaging and Therapeutic Nuclear Medicine, Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.
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Scobioala S, Kittel C, Wolters H, Huss S, Elsayad K, Seifert R, Stegger L, Weckesser M, Haverkamp U, Eich HT, Rahbar K. Diagnostic efficiency of hybrid imaging using PSMA ligands, PET/CT, PET/MRI and MRI in identifying malignant prostate lesions. Ann Nucl Med 2021; 35:628-638. [PMID: 33742373 PMCID: PMC8079339 DOI: 10.1007/s12149-021-01606-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 03/10/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The objective of this study was to assess the accuracy of 68Ga-PSMA-11 PET/MRI, 18F-PSMA-1007 PET/CT, 68Ga-PSMA-11 PET/CT, and multiparametric (mp)MRI for the delineating of dominant intraprostatic lesions (IPL). MATERIALS AND METHODS 35 patients with organ-confined prostate cancer who were assigned to definitive radiotherapy (RT) were divided into three groups based on imaging techniques: 68Ga-PSMA-PET/MRI (n = 9), 18F-PSMA-PET/CT (n = 16) and 68Ga-PSMA-PET/CT (n = 10). All patients without PSMA-PET/MRI received an additional mpMRI. PSMA-PET-based automatic isocontours and manual contours of the dominant IPLs were generated for each modality. The biopsy results were then used to validate whether any of the prostate biopsies were positive in the marked lesion using Dice similarity coefficient (DSC), Youden index (YI), sensitivity and specificity. Factors that can predict the accuracy of IPLs contouring were analysed. RESULTS Diagnostic performance was significantly superior both for manual and automatic IPLs contouring using 68Ga-PSMA-PET/MRI (DSC/YI SUV70%-0.62/0.51), 18F-PSMA-PET/CT (DSC/YI SUV70%-0.67/0.53) or 68Ga-PSMA-PET/CT (DSC/YI SUV70%-0.63/0.51) compared to mpMRI (DSC/YI-0.47/0.41; p < 0.001). The accuracy for delineating IPLs was not improved by combination of PET/CT and mpMRI images compared to PET/CT alone. Significantly superior diagnostic accuracy was found for large prostate lesions (at least 15% from the prostate volume) and higher Gleason score (at least 7b) comparing to smaller lesions with lower GS. CONCLUSION IPL localization was significantly improved when using PSMA-imaging procedures compared to mpMRI. No significant difference for delineating IPLs was found between hybrid method PSMA-PET/MRI and PSMA-PET/CT. PSMA-based imaging technique should be considered for the diagnostics of IPLs and focal treatment modality.
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Affiliation(s)
- Sergiu Scobioala
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.
- West German Cancer Center, Muenster and Essen, Germany.
| | - Christopher Kittel
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
- West German Cancer Center, Muenster and Essen, Germany
| | - Heidi Wolters
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
- West German Cancer Center, Muenster and Essen, Germany
| | - Sebastian Huss
- Department of Pathology, University Hospital of Muenster, Muenster, Germany
- West German Cancer Center, Muenster and Essen, Germany
| | - Khaled Elsayad
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
- West German Cancer Center, Muenster and Essen, Germany
| | - Robert Seifert
- Department of Nuclear Medicine, University Hospital of Muenster, Muenster, Germany
- West German Cancer Center, Muenster and Essen, Germany
| | - Lars Stegger
- Department of Nuclear Medicine, University Hospital of Muenster, Muenster, Germany
- West German Cancer Center, Muenster and Essen, Germany
| | - Matthias Weckesser
- Department of Nuclear Medicine, University Hospital of Muenster, Muenster, Germany
- West German Cancer Center, Muenster and Essen, Germany
| | - Uwe Haverkamp
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
- West German Cancer Center, Muenster and Essen, Germany
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
- West German Cancer Center, Muenster and Essen, Germany
| | - Kambiz Rahbar
- Department of Nuclear Medicine, University Hospital of Muenster, Muenster, Germany
- West German Cancer Center, Muenster and Essen, Germany
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Mahase S, Nagar H. Hypofractionated Postoperative Radiotherapy for Prostate Cancer: Is the Field Ready Yet? EUR UROL SUPPL 2020; 22:9-16. [PMID: 34337473 PMCID: PMC8317782 DOI: 10.1016/j.euros.2020.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2020] [Indexed: 12/30/2022] Open
Abstract
Context Radiotherapy (RT) is a valid adjuvant treatment for men with high-risk pathological features after radical prostatectomy and a salvage treatment for biochemical recurrence. A major inconvenience is that RT takes course over 7–8 wk in these settings, which has been shown to limit its use. Retrospective and pilot prospective investigations suggest that hypofractionation may provide noninferior outcomes but report variable results regarding toxicities. Additionally, our evolving understanding of prostate cancer radiobiology suggests that hypofractionated regimens may not increase toxicity. Objective We examine and review the rationale and clinical evidence of hypofractionated RT in the adjuvant and salvage settings for prostate cancer. Evidence acquisition We reviewed relevant literature, with a particular focus on recent studies employing hypofractionated RT. Evidence synthesis Hypofractionated RT in the adjuvant or salvage setting is not a standard option for prostate cancer RT outside of an investigational trial. While smaller studies show conflicting data regarding toxicity, initial evidence from larger clinical trials appears to demonstrate that hypofractionated postoperative RT is as effective and safe as conventionally fractionated courses. Conclusions With the growing acceptance of hypofractionation across other cancer sites and the rise of extreme hypofractionation for definitive prostate cancer treatment, hypofractionated postoperative therapy for prostate cancer is poised to become an option, as it may reduce the burden on men and treatment centers while maintaining clinical efficacy and safety. Prospective trials are currently ongoing to address efficacy and safety concerns. Patient summary Postoperative radiotherapy is a potentially curative treatment for patients with high-risk disease or recurrence after surgery. Shortening of the treatment regimen with the availability of modern treatment delivery techniques in conjunction with the integration of molecular imaging information to refine treatment volumes may improve therapeutic benefit without increasing toxicity.
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Abstract
PURPOSE OF REVIEW Rapid advances in imaging of the prostate have facilitated the development of focal therapy and provided a non-invasive method of estimating tumour volume. Focal therapy relies on an accurate estimate of tumour volume for patient selection and treatment planning so that the optimal energy dose can be delivered to the target area(s) of the prostate while minimising toxicity to surrounding structures. This review provides an overview of different imaging modalities which may be used to optimise tumour volume assessment and critically evaluates the published evidence for each modality. RECENT FINDINGS Multi-parametric MRI (mp-MRI) has become the standard tool for patient selection and guiding focal therapy treatment. The current evidence suggests that mp-MRI may underestimate tumour volume, although there is a large variability in results. There remain significant methodological challenges associated with pathological processing and accurate co-registration of histopathological data with mp-MRI. Advances in different ultrasound modalities are showing promise but there has been limited research into tumour volume estimation. The role of PSMA PET/CT is still evolving and further investigation is needed to establish if this is a viable technique for prostate tumour volumetric assessment. mp-MRI provides the necessary tumour volume information required for selecting patients and guiding focal therapy treatment. The potential for underestimation of tumour volume should be taken into account and an additional margin applied to ensure adequate treatment coverage. At present, there are no other viable image-based alternatives although advances in new technologies may refine volume estimations in the future.
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Abstract
PURPOSE OF REVIEW In recent years, a large number of reports have been published on prostate-specific membrane antigen (PSMA)/PET in prostate cancer (PCa). This review highlights advances in PSMA PET in PCa during the past year. RECENT FINDINGS PSMA PET/computed tomography (CT) is useful in detection of biochemical recurrence, especially at low prostate-specific antigen (PSA) values. The detection rate of PSMA PET is influenced by PSA level. For primary PCa, PSMA PET/CT shows promise for tumour localization in the prostate, especially in combination with multiparametric MRI (mpMRI). For primary staging, PSMA PET/CT can be used in intermediate and high-risk PCa. Intraoperative PSMA radioligand guidance seems promising for detection of malignant lymph nodes. While the use of PSMA PET/MRI in primary localized disease is limited to high and intermediate-risk patients and localized staging, in the recurrence setting, PET/MRI can be particularly helpful when the lesions are subtle. PSMA PET/CT is superior to choline PET/CT and other conventional imaging modalities. SUMMARY Molecular imaging with PSMA PET continues to pave the way for personalized medicine in PCa.However, large prospective clinical studies are still needed to fully evaluate the role of PSMA PET/CT and PET/MRI in the clinical workflow of PCa.
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Ceci F, Fanti S, Walz J. Local and Systemic Staging by Modern Imaging Modalities in Prostate Cancer. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Castellucci P, Ceci F, Fanti S. Imaging of Prostate Cancer Using 11C-Choline PET/Computed Tomography. Urol Clin North Am 2018; 45:481-487. [PMID: 30031467 DOI: 10.1016/j.ucl.2018.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article reviews the role of 11C-choline-PET/computed tomography (CT) in patients with prostate cancer for diagnosis, staging, and restaging the disease in case of biochemical recurrence after primary treatment. The main application of this imaging procedure is restaging of the disease in case of biochemical recurrence. 11C-Choline-PET/CT proved its value for metastases-directed salvage therapies and for monitoring therapy response in castration-resistant patients. Prostate-specific antigen and prostate-specific antigen kinetics values confirmed their correlation with 11C-choline PET/CT sensitivity.11C-CholinePET/CT, despite low sensitivity to stage disease or in case of biochemical failure with low PSA levels, has an important impact on the management of patients with prostate cancer.
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Affiliation(s)
- Paolo Castellucci
- Service of Nuclear Medicine, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Francesco Ceci
- Service of Nuclear Medicine, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy.
| | - Stefano Fanti
- Service of Nuclear Medicine, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
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Schlenter M, Berneking V, Krenkel B, Mottaghy FM, Vögeli TA, Eble MJ, Pinkawa M. Intensity-modulated radiotherapy of prostate cancer with simultaneous integrated boost after molecular imaging with 18F-choline-PET/CT. Strahlenther Onkol 2018; 194:638-645. [DOI: 10.1007/s00066-018-1282-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 02/07/2018] [Indexed: 10/17/2022]
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Ceci F, Fanti S, Walz J. Local and Systemic Staging by Modern Imaging Modalities in Prostate Cancer. Urol Oncol 2018. [DOI: 10.1007/978-3-319-42603-7_69-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Li R, Ravizzini GC, Gorin MA, Maurer T, Eiber M, Cooperberg MR, Alemozzaffar M, Tollefson MK, Delacroix SE, Chapin BF. The use of PET/CT in prostate cancer. Prostate Cancer Prostatic Dis 2017; 21:4-21. [PMID: 29230009 DOI: 10.1038/s41391-017-0007-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 07/28/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Positron emission tomography/computed tomography (PET/CT) has recently emerged as a promising diagnostic imaging platform for prostate cancer. Several radiolabelled tracers have demonstrated efficacy for cancer detection in various clinical settings. In this review, we aim to illustrate the diverse use of PET/CT with different tracers for the detection of prostate cancer. METHODS We searched MEDLINE using the terms 'prostate cancer', 'PET', 'PET/CT' and 'PET/MR'). The current review was limited to 18F-NaF PET/CT, choline-based PET/CT, fluciclovine PET/CT and PSMA-targeted PET/CT, as these modalities have been the most widely adopted. RESULTS NaF PET/CT has shown efficacy in detecting bone metastases with high sensitivity, but relatively low specificity. Currently, choline PET/CT has been the most extensively studied modality. Although having superior specificity, choline PET/CT suffers from low sensitivity, especially at low PSA levels. Nevertheless, choline PET/CT was found to significantly improve upon conventional imaging modalities (CIM) in the detection of metastatic lesions at biochemical recurrence (BCR). Newer methods using fluciclovine and PSMA-targeted radiotracers have preliminarily demonstrated great promise in primary and recurrent staging of prostate cancer. However, their superior efficacy awaits confirmation in larger series. CONCLUSIONS PET/CT has emerged as a promising staging modality for both primary and recurrent prostate cancer. Newer tracers have increased detection accuracies for small, incipient metastatic foci. The clinical implications of these occult PET/CT detected disease foci require organized evaluation. Efforts should be aimed at defining their natural history as well as responsiveness and impact of metastasis-directed therapy.
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Affiliation(s)
- Roger Li
- Department of Urology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX, 77030, USA.
| | - Gregory C Ravizzini
- Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael A Gorin
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tobias Maurer
- Department of Urology, Technical University of Munich, Munich, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Technical University of Munich, Munich, Germany
| | | | | | | | - Scott E Delacroix
- Department of Urology, Louisiana State University, New Orleans, LA, USA
| | - Brian F Chapin
- Department of Urology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX, 77030, USA
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Ballas LK, de Castro Abreu AL, Quinn DI. What Medical, Urologic, and Radiation Oncologists Want from Molecular Imaging of Prostate Cancer. J Nucl Med 2017; 57:6S-12S. [PMID: 27694176 DOI: 10.2967/jnumed.115.170142] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 08/15/2016] [Indexed: 12/25/2022] Open
Abstract
As molecular imaging better delineates the state of prostate cancer, clinical management will evolve. The currently licensed imaging modalities are limited by lack of specificity or sensitivity for the extent of cancer and for predicting outcome in response to therapy. Clinicians want molecular imaging that-by being more reliable in tailoring treatment and monitoring response for each patient-will become a key facet of precision medicine, surgery, and radiation therapy. Identifying patients who are candidates for specific or novel treatments is important, but equally important is the finding that a given patient may not be a good candidate for single-modality therapy. This article presents prostate cancer scenarios in which managing clinicians would welcome molecular imaging innovations to help with decision making. The potential role of newer techniques that may help fill this wish list is discussed.
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Affiliation(s)
- Leslie K Ballas
- Department of Radiation Oncology, Keck School of Medicine at USC, USC Norris Comprehensive Cancer Center and Hospital, Los Angeles, California
| | - Andre Luis de Castro Abreu
- Department of Urology, Keck School of Medicine at USC, USC Norris Comprehensive Cancer Center and Hospital, Los Angeles, California; and
| | - David I Quinn
- Division of Medical Oncology, Department of Medicine, Keck School of Medicine at USC, USC Norris Comprehensive Cancer Center and Hospital, Los Angeles, California
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Castellucci P, Ceci F, Fanti S. Imaging of Prostate Cancer Using 11C-Choline PET/Computed Tomography. PET Clin 2017; 12:137-143. [PMID: 28267448 DOI: 10.1016/j.cpet.2016.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This article reviews the role of 11C-choline-PET/computed tomography (CT) in patients with prostate cancer for diagnosis, staging, and restaging the disease in case of biochemical recurrence after primary treatment. The main application of this imaging procedure is restaging of the disease in case of biochemical recurrence. 11C-Choline-PET/CT proved its value for metastases-directed salvage therapies and for monitoring therapy response in castration-resistant patients. Prostate-specific antigen and prostate-specific antigen kinetics values confirmed their correlation with 11C-choline PET/CT sensitivity.11C-CholinePET/CT, despite low sensitivity to stage disease or in case of biochemical failure with low PSA levels, has an important impact on the management of patients with prostate cancer.
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Affiliation(s)
- Paolo Castellucci
- Service of Nuclear Medicine, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Francesco Ceci
- Service of Nuclear Medicine, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy.
| | - Stefano Fanti
- Service of Nuclear Medicine, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
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13
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Chan J, Carver A, Brunt JNH, Vinjamuri S, Syndikus I. Effect of androgen deprivation therapy on intraprostatic tumour volume identified on 18F choline PET/CT for prostate dose painting radiotherapy. Br J Radiol 2016; 90:20160818. [PMID: 27993093 DOI: 10.1259/bjr.20160818] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Prostate dose painting radiotherapy requires the accurate identification of dominant intraprostatic lesions (DILs) to be used as boost volumes; these can be identified on multiparametric MRI (mpMRI) or choline positron emission tomography (PET)/CT. Planning scans are usually performed after 2-3 months of androgen deprivation therapy (ADT). We examine the effect of ADT on choline tracer uptake and boost volumes identified on choline PET/CT. METHODS Fluoroethylcholine (18F choline) PET/CT was performed for dose painting radiotherapy planning in patients with intermediate- to high-risk prostate cancer. Initially, they were performed at planning. Owing to low visual tracer uptake, PET/CT for subsequent patients was performed at staging. We compared these two approaches on intraprostatic lesions obtained on PET using both visual and automatic threshold methods [prostate maximum standardized uptake value (SUVmax) 60%] when compared with mpMRI. RESULTS PET/CT was performed during ADT in 11 patients (median duration of 85 days) and before ADT in 29 patients. ADT significantly reduced overall prostate volume by 17%. During ADT, prostate SUVmax was lower although it did not reach statistical significance (4.2 vs 6.6, p = 0.06); three patients had no visually identifiable PET DIL; and visually defined PET DILs were significantly smaller than corresponding mpMRI DILs (p = 0.03). However, all patients scanned before ADT had at least one visually identifiable PET DIL, with no significant size difference between MRI and visually defined PET DILs. In both groups, threshold PET produced larger DILs than visual PET. Both PET methods have moderate sensitivity (0.50-0.68) and high specificity (0.85-0.98) for identifying MRI-defined disease. CONCLUSION For visual contouring of boost volumes in prostate dose painting radiotherapy, 18F choline PET/CT should be performed before ADT. For threshold contouring of boost volumes using our PET/CT scanning protocol, threshold levels of above 60% prostate SUVmax may be more suitable. Additional use of PET with MRI for radiotherapy planning can significantly change the overall boost volumes compared with using MRI alone. Advances in knowledge: For prostate dose painting radiotherapy, the additional use of 18F choline PET with MRI can significantly change the overall boost volumes, and PET should be performed before hormone therapy, especially if boost volumes are visually identified.
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Affiliation(s)
- Joachim Chan
- 1 Radiotherapy Department, Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, UK
| | - Antony Carver
- 1 Radiotherapy Department, Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, UK
| | - John N H Brunt
- 1 Radiotherapy Department, Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, UK
| | - Sobhan Vinjamuri
- 2 Nuclear Medicine Department, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Isabel Syndikus
- 1 Radiotherapy Department, Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, UK
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14
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Pathmanathan AU, Alexander EJ, Huddart RA, Tree AC. The delineation of intraprostatic boost regions for radiotherapy using multimodality imaging. Future Oncol 2016; 12:2495-2511. [PMID: 27322113 DOI: 10.2217/fon-2016-0129] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Dose escalation to the prostate improves tumor control but at the expense of increased rectal toxicity. Modern imaging can be used to detect the most common site of recurrence, the intraprostatic lesion (IPL), which has led to the concept of focusing dose escalation to the IPL in order to improve the therapeutic ratio. Imaging must be able to detect lesions with adequate sensitivity and specificity to accurately delineate the IPL. This information must be carefully integrated into the radiotherapy planning process to ensure the dose is targeted to the IPL. This review will consider the role and challenges of multiparametric MRI and PET computed tomography in delineating a tumor boost to be delivered by external beam radiotherapy.
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Affiliation(s)
| | - Emma J Alexander
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT, UK
| | - Robert A Huddart
- The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
| | - Alison C Tree
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT, UK
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15
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Walsh S, Roelofs E, Kuess P, Lambin P, Jones B, Georg D, Verhaegen F. A validated tumor control probability model based on a meta-analysis of low, intermediate, and high-risk prostate cancer patients treated by photon, proton, or carbon-ion radiotherapy. Med Phys 2016; 43:734-47. [PMID: 26843237 DOI: 10.1118/1.4939260] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE A fully heterogeneous population averaged mechanistic tumor control probability (TCP) model is appropriate for the analysis of external beam radiotherapy (EBRT). This has been accomplished for EBRT photon treatment of intermediate-risk prostate cancer. Extending the TCP model for low and high-risk patients would be beneficial in terms of overall decision making. Furthermore, different radiation treatment modalities such as protons and carbon-ions are becoming increasingly available. Consequently, there is a need for a complete TCP model. METHODS A TCP model was fitted and validated to a primary endpoint of 5-year biological no evidence of disease clinical outcome data obtained from a review of the literature for low, intermediate, and high-risk prostate cancer patients (5218 patients fitted, 1088 patients validated), treated by photons, protons, or carbon-ions. The review followed the preferred reporting item for systematic reviews and meta-analyses statement. Treatment regimens include standard fractionation and hypofractionation treatments. Residual analysis and goodness of fit statistics were applied. RESULTS The TCP model achieves a good level of fit overall, linear regression results in a p-value of <0.000 01 with an adjusted-weighted-R(2) value of 0.77 and a weighted root mean squared error (wRMSE) of 1.2%, to the fitted clinical outcome data. Validation of the model utilizing three independent datasets obtained from the literature resulted in an adjusted-weighted-R(2) value of 0.78 and a wRMSE of less than 1.8%, to the validation clinical outcome data. The weighted mean absolute residual across the entire dataset is found to be 5.4%. CONCLUSIONS This TCP model fitted and validated to clinical outcome data, appears to be an appropriate model for the inclusion of all clinical prostate cancer risk categories, and allows evaluation of current EBRT modalities with regard to tumor control prediction.
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Affiliation(s)
- Seán Walsh
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center (MUMC+), Maastricht 6229 ET, The Netherlands and Department of Oncology, Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford OX3 7DQ, United Kingdom
| | - Erik Roelofs
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center (MUMC+), Maastricht 6229 ET, The Netherlands
| | - Peter Kuess
- Department of Radiation Oncology and Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna 1090, Austria
| | - Philippe Lambin
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center (MUMC+), Maastricht 6229 ET, The Netherlands
| | - Bleddyn Jones
- Department of Oncology, Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford OX3 7DQ, United Kingdom
| | - Dietmar Georg
- Department of Radiation Oncology and Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna 1090, Austria
| | - Frank Verhaegen
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center (MUMC+), Maastricht 6229 ET, The Netherlands and Medical Physics Unit, Department of Oncology, McGill University, Montréal, Québec H4A 3J1, Canada
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Barrio M, Fendler WP, Czernin J, Herrmann K. Prostate specific membrane antigen (PSMA) ligands for diagnosis and therapy of prostate cancer. Expert Rev Mol Diagn 2016; 16:1177-1188. [DOI: 10.1080/14737159.2016.1243057] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Martin Barrio
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Wolfgang P. Fendler
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Johannes Czernin
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ken Herrmann
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
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17
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PET imaging in prostate cancer, state of the art: a review of 18F-choline and 11C-choline PET/CT applications. Clin Transl Imaging 2016. [DOI: 10.1007/s40336-016-0191-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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18
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Evangelista L, Briganti A, Fanti S, Joniau S, Reske S, Schiavina R, Stief C, Thalmann GN, Picchio M. New Clinical Indications for 18 F/ 11 C-choline, New Tracers for Positron Emission Tomography and a Promising Hybrid Device for Prostate Cancer Staging: A Systematic Review of the Literature. Eur Urol 2016; 70:161-175. [DOI: 10.1016/j.eururo.2016.01.029] [Citation(s) in RCA: 135] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 01/20/2016] [Indexed: 01/05/2023]
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19
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Amzalag G, Rager O, Tabouret-Viaud C, Wissmeyer M, Sfakianaki E, de Perrot T, Ratib O, Miralbell R, Giovacchini G, Garibotto V, Zilli T. Target Definition in Salvage Radiotherapy for Recurrent Prostate Cancer: The Role of Advanced Molecular Imaging. Front Oncol 2016; 6:73. [PMID: 27065024 PMCID: PMC4814800 DOI: 10.3389/fonc.2016.00073] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 03/14/2016] [Indexed: 12/28/2022] Open
Abstract
Salvage radiotherapy (SRT) represents the main treatment option for relapsing prostate cancer in patients after radical prostatectomy. Several open questions remain unanswered in terms of target volumes definition and delivered doses for SRT: the effective dose necessary to achieve biochemical control in the SRT setting may be different if the tumor recurrence is micro- or macroscopic. At the same time, irradiation of only the prostatic bed or of the whole pelvis will depend on the localization of the recurrence, local or locoregional. In the “theragnostic imaging” era, molecular imaging using positron emission tomography (PET) constitutes a useful tool for clinicians to define the site of the recurrence, the extent of disease, and individualize salvage treatments. The best option currently available in clinical routine is the combination of radiolabeled choline PET imaging and multiparametric magnetic resonance imaging (MRI), associating the nodal and distant metastases identification based on PET with the local assessment by MRI. A new generation of targeted tracers, namely, prostate-specific membrane antigen, show promising results, with a contrast superior to choline imaging and a higher detection rate even for low prostate-specific antigen levels; validation studies are ongoing. Finally, imaging targeting bone remodeling, using whole-body SPECT–CT, is a relevant complement to molecular/metabolic PET imaging when bone involvement is suspected.
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Affiliation(s)
- Gaël Amzalag
- Division of Nuclear Medicine, Hospital of Neuchâtel, Neuchâtel, Switzerland; Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, Switzerland
| | - Olivier Rager
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital , Geneva , Switzerland
| | - Claire Tabouret-Viaud
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital , Geneva , Switzerland
| | - Michael Wissmeyer
- Division of Nuclear Medicine, Hospital of Neuchâtel, Neuchâtel, Switzerland; Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, Switzerland
| | - Electra Sfakianaki
- Division of Radiology, Geneva University Hospital , Geneva , Switzerland
| | - Thomas de Perrot
- Division of Radiology, Geneva University Hospital , Geneva , Switzerland
| | - Osman Ratib
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, Switzerland; Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Raymond Miralbell
- Faculty of Medicine, Geneva University, Geneva, Switzerland; Division of Radiation-Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Giampiero Giovacchini
- Department of Radiology and Nuclear Medicine, Stadtspital Triemli , Zurich , Switzerland
| | - Valentina Garibotto
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, Switzerland; Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Thomas Zilli
- Faculty of Medicine, Geneva University, Geneva, Switzerland; Division of Radiation-Oncology, Geneva University Hospital, Geneva, Switzerland
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20
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Abstract
Although many PET tracers are in use, FDG still is the most widely used in clinical oncology practice. FDG therefore deserves an in-depth discussion, which is even more interesting because of the huge increase in the molecular biology of glucose metabolism. Obviously, other tracers are of increasing importance as well, and these will be discussed in short.
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Affiliation(s)
- Dirk De Ruysscher
- Radiation Oncology, University Hospitals Leuven/KU Leuven, Louvain, Belgium.
- Maastricht University Medical Center, GROW, Maastro clinic, Louvain, Belgium.
| | - Karin Haustermans
- Radiation Oncology, University Hospitals Leuven/KU Leuven, Louvain, Belgium
| | - Daniela Thorwarth
- Section for Biomedical Physics, University Hospital for Radiation Oncology Tübingen, Tübingen, Germany
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21
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Ouyang Q, Duan Z, Lei J, Jiao G. Comparison of meta-analyses among elastosonography (ES) and positron emission tomography/computed tomography (PET/CT) imaging techniques in the application of prostate cancer diagnosis. Tumour Biol 2015; 37:2999-3007. [PMID: 26415734 DOI: 10.1007/s13277-015-4113-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 09/20/2015] [Indexed: 10/23/2022] Open
Abstract
The early diagnosis of prostate cancer (PCa) appears to be of vital significance for the provision of appropriate treatment programs. Even though several sophisticated imaging techniques such as positron emission tomography/computed tomography (PET/CT) and elastosonography (ES) have already been developed for PCa diagnosis, the diagnostic accuracy of these imaging techniques is still controversial to some extent. Therefore, a comprehensive meta-analysis in this study was performed to compare the accuracy of various diagnostic imaging methods for PCa, including 11C-choline PET/CT, 11C-acetate PET/CT, 18F-fluorocholine PET/CT, 18F-fluoroglucose PET/CT, transrectal real-time elastosonography (TRTE), and shear-wave elastosonography (SWE). The eligible studies were identified through systematical searching for the literature in electronic databases including PubMed, Cochrane, and Web of Science. On the basis of the fixed-effects model, the pooled sensitivity (SEN), specificity (SPE), and area under the receiver operating characteristics curve (AUC) were calculated to estimate the diagnostic accuracy of 11C-choline PET/CT, 11C-acetate PET/CT, 18F-fluorocholine (FCH) PET/CT, 18F-fluoroglucose (FDG) PET/CT, TRTE, and SWE. All the statistical analyses were conducted with R language Software. The present meta-analysis incorporating a total of 82 studies demonstrated that the pooled sensitivity of the six imaging techniques were sorted as follows: SWE > 18F-FCH PET/CT > 11C-choline PET/CT > TRTE > 11C-acetate PET/CT > 18F-FDG PET/CT; the pooled specificity were also compared: SWE > 18F-FCH PET/CT > 11C-choline PET/CT > TRTE > 18F-FDG PET/CT > 11C-acetate PET/CT; finally, the pooled diagnostic accuracy of the six imaging techniques based on AUC were ranked as below: SWE > 18F-FCH PET/CT > 11C-choline PET/CT > TRTE > 11C-acetate PET/CT > 18F-FDG PET/CT. SWE and 18F-FCH PET/CT imaging could offer more assistance in the early diagnosis of PCa than any other studied imaging techniques. However, the diagnostic ranking of the six imaging techniques might not be applicable to the clinical phase due to the shortage of stratified analysis.
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Affiliation(s)
- Qiaohong Ouyang
- Department of Nuclear Medicine, The First Affiliated Hospital of Chinese PLA General Hospital, No. 51 Fucheng Road, Beijing, 100048, China.
| | - Zhongxiang Duan
- Department of Nuclear Medicine, The First Affiliated Hospital of Chinese PLA General Hospital, No. 51 Fucheng Road, Beijing, 100048, China
| | - Jixiao Lei
- Department of Nuclear Medicine, The First Affiliated Hospital of Chinese PLA General Hospital, No. 51 Fucheng Road, Beijing, 100048, China
| | - Guangli Jiao
- Department of Nuclear Medicine, The First Affiliated Hospital of Chinese PLA General Hospital, No. 51 Fucheng Road, Beijing, 100048, China
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22
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Abstract
An early and correct diagnosis together with accurate staging of prostate cancer is necessary in order to plan the most appropriate treatment strategy. Morphological imaging modalities such as transrectal ultrasonography (TRUS), CT, and MRI can have some limitations regarding their accuracy for primary diagnosis and staging of prostate cancer; for instance, they have limited specificity in differentiating cancer from benign prostatic conditions and, by using size as the only criterion to characterize lymph node metastases, they might not be accurate enough for tumour characterization. In this scenario, PET-CT with (11)C-labelled or (18)F-labelled choline derivatives provides morphological and functional characterization and could overcome the limitations of the conventional imaging techniques. PET-CT is one of the most investigated molecular imaging modalities for prostate cancer diagnosis and staging. Currently, the main investigations on the role of PET-CT in the diagnosis and staging of prostate cancer have been performed on a retrospective basis and this type of analysis might be one of the main reasons why different results regarding its diagnostic accuracy have been reported.
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Chang JH, Lim Joon D, Davis ID, Lee ST, Hiew CY, Esler S, Gong SJ, Wada M, Clouston D, O'Sullivan R, Goh YP, Bolton D, Scott AM, Khoo V. Comparison of [(11)C]choline Positron Emission Tomography With T2- and Diffusion-Weighted Magnetic Resonance Imaging for Delineating Malignant Intraprostatic Lesions. Int J Radiat Oncol Biol Phys 2015; 92:438-45. [PMID: 25864171 DOI: 10.1016/j.ijrobp.2015.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 01/30/2015] [Accepted: 02/02/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study was to compare the accuracy of [(11)C]choline positron emission tomography (CHOL-PET) with that of the combination of T2-weighted and diffusion-weighted (T2W/DW) magnetic resonance imaging (MRI) for delineating malignant intraprostatic lesions (IPLs) for guiding focal therapies and to investigate factors predicting the accuracy of CHOL-PET. METHODS AND MATERIALS This study included 21 patients who underwent CHOL-PET and T2W/DW MRI prior to radical prostatectomy. Two observers manually delineated IPL contours for each scan, and automatic IPL contours were generated on CHOL-PET based on varying proportions of the maximum standardized uptake value (SUV). IPLs identified on prostatectomy specimens defined reference standard contours. The imaging-based contours were compared with the reference standard contours using Dice similarity coefficient (DSC), and sensitivity and specificity values. Factors that could potentially predict the DSC of the best contouring method were analyzed using linear models. RESULTS The best automatic contouring method, 60% of the maximum SUV (SUV60) , had similar correlations (DSC: 0.59) with the manual PET contours (DSC: 0.52, P=.127) and significantly better correlations than the manual MRI contours (DSC: 0.37, P<.001). The sensitivity and specificity values were 72% and 71% for SUV60; 53% and 86% for PET manual contouring; and 28% and 92% for MRI manual contouring. The tumor volume and transition zone pattern could independently predict the accuracy of CHOL-PET. CONCLUSIONS CHOL-PET is superior to the combination of T2W/DW MRI for delineating IPLs. The accuracy of CHOL-PET is insufficient for gland-sparing focal therapies but may be accurate enough for focal boost therapies. The transition zone pattern is a new classification that may predict how well CHOL-PET delineates IPLs.
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Affiliation(s)
- Joe H Chang
- Radiation Oncology Centre, Austin Health, Victoria, Australia; University of Melbourne, Victoria, Australia
| | - Daryl Lim Joon
- Radiation Oncology Centre, Austin Health, Victoria, Australia
| | - Ian D Davis
- Monash University Eastern Health Clinical School, Victoria, Australia
| | - Sze Ting Lee
- University of Melbourne, Victoria, Australia; Centre for PET, Austin Health, Victoria, Australia; Ludwig Institute for Cancer Research, Victoria, Australia
| | - Chee-Yan Hiew
- Department of Radiology, Austin Health, Victoria, Australia
| | - Stephen Esler
- Department of Radiology, Austin Health, Victoria, Australia
| | | | - Morikatsu Wada
- Radiation Oncology Centre, Austin Health, Victoria, Australia
| | | | | | - Yin P Goh
- Diagnostic Imaging, Monash Health, Victoria, Australia
| | - Damien Bolton
- Department of Urology, Austin Health, Victoria, Australia
| | - Andrew M Scott
- University of Melbourne, Victoria, Australia; Centre for PET, Austin Health, Victoria, Australia; Ludwig Institute for Cancer Research, Victoria, Australia
| | - Vincent Khoo
- Radiation Oncology Centre, Austin Health, Victoria, Australia; University of Melbourne, Victoria, Australia; Royal Marsden Hospital, National Health Service Foundation Trust, London, United Kingdom; Department of Medical Imaging and Radiation Sciences, Monash University, Victoria, Australia.
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24
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Tsien C, Cao Y, Chenevert T. Clinical applications for diffusion magnetic resonance imaging in radiotherapy. Semin Radiat Oncol 2015; 24:218-26. [PMID: 24931097 DOI: 10.1016/j.semradonc.2014.02.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
In this article, we review the clinical applications of diffusion magnetic resonance imaging (MRI) in the radiotherapy treatment of several key clinical sites, including those of the central nervous system, the head and neck, the prostate, and the cervix. Diffusion-weighted MRI (DWI) is an imaging technique that is rapidly gaining widespread acceptance owing to its ease and wide availability. DWI measures the mobility of water within tissue at the cellular level without the need of any exogenous contrast agent. For radiotherapy treatment planning, DWI improves upon conventional imaging techniques, by better characterization of tumor tissue properties required for tumor grading, diagnosis, and target volume delineation. Because DWI is also a sensitive marker for alterations in tumor cellularity, it has potential clinical applications in the early assessment of treatment response following radiation therapy.
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Affiliation(s)
- Christina Tsien
- Department of Radiation Oncology, University of Michigan Hospital and Health Systems, Ann Arbor, MI.
| | - Yue Cao
- Department of Radiation Oncology, University of Michigan Hospital and Health Systems, Ann Arbor, MI
| | - Thomas Chenevert
- Department of Radiology, University of Michigan Hospital and Health Systems, Ann Arbor, MI
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25
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Nirmal TJ, Kekre NS. Management of urological malignancies: Has positron emission tomography/computed tomography made a difference? Indian J Urol 2015; 31:22-7. [PMID: 25624571 PMCID: PMC4300566 DOI: 10.4103/0970-1591.145296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Positron emission tomography/computed tomography (PET/CT) technology has been a significant, but expensive addition to the oncologist's armamentarium. The aim of this review was to determine the clinical utility of PET/CT in urological oncology, its impact on disease outcome and cost-effectiveness. We searched MedLine and peer reviewed journals for all relevant literature available online from the year 2000 until January 2014 regarding the use of PET/CT in the management of urological malignancies. (11)C-choline PET/CT has emerged as a powerful tool for assessment of biochemical relapse in prostate cancer. Use of novel radiotracers like (124)I-girentuximab has shown promise in the diagnosis of clear cell renal carcinoma. Fluorodeoxyglucose PET has a proven role in seminoma for the evaluation of postchemotherapy residual masses and has shown encouraging results when used for detection of metastasis in renal, bladder, and penile cancer. Introduction of novel radiotracers and advanced technology has led to a wider application of PET/CT in urological oncology. However, testicular seminoma aside, its impact on disease outcome and cost-effectiveness still needs to be established.
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Affiliation(s)
- Thampi John Nirmal
- Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nitin S Kekre
- Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India
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26
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De Bari B, Alongi F, Lestrade L, Giammarile F. Choline-PET in prostate cancer management: The point of view of the radiation oncologist. Crit Rev Oncol Hematol 2014; 91:234-47. [DOI: 10.1016/j.critrevonc.2014.04.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 03/12/2014] [Accepted: 04/17/2014] [Indexed: 12/26/2022] Open
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Alber M, Thorwarth D. Multi-modality functional image guided dose escalation in the presence of uncertainties. Radiother Oncol 2014; 111:354-9. [PMID: 24880742 DOI: 10.1016/j.radonc.2014.04.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 03/22/2014] [Accepted: 04/27/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND PURPOSE In order to increase local tumour control by radiotherapy without increasing toxicity, it appears promising to harness functional imaging (FI) to guide dose to sub-volumes of the target with a high tumour load and perhaps de-escalate dose to low risk volumes, in order to maximise the efficiency of the deposited radiation dose. METHODS AND MATERIALS A number of problems have to be solved to make focal dose escalation (FDE) efficient and safe: (1) how to combine ambiguous information from multiple imaging modalities; (2) how to take into account uncertainties of FI based tissue classification; (3) how to account for geometric uncertainties in treatment delivery; (4) how to add complementary FI modalities to an existing scheme. A generic optimisation concept addresses these points and is explicitly designed for clinical efficacy and for lowering the implementation threshold to FI-guided FDE. It combines classic tumour control probability modelling with a multi-variate logistic regression model of FI accuracy and an uncomplicated robust optimisation method. RESULTS Its key elements are (1) that dose is deposited optimally when it achieves equivalent expected effect everywhere in the target volume and (2) that one needs to cap the certainty about the absence of tumour anywhere in the target region. For illustration, an example of a PET/MR-guided FDE in prostate cancer is given. CONCLUSIONS FDE can be safeguarded against FI uncertainties, at the price of a limit on the sensible dose escalation.
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Affiliation(s)
- Markus Alber
- Department of Oncology, Aarhus University, Denmark.
| | - Daniela Thorwarth
- Department for Radiation Oncology, Eberhard Karls University Tübingen, Germany
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28
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de Perrot T, Rager O, Scheffler M, Lord M, Pusztaszeri M, Iselin C, Ratib O, Vallee JP. Potential of hybrid ¹⁸F-fluorocholine PET/MRI for prostate cancer imaging. Eur J Nucl Med Mol Imaging 2014; 41:1744-55. [PMID: 24841413 DOI: 10.1007/s00259-014-2786-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 04/15/2014] [Indexed: 01/17/2023]
Abstract
PURPOSE To report the first results of hybrid (18)F-fluorocholine PET/MRI imaging for the detection of prostate cancer. METHODS This analysis included 26 consecutive patients scheduled for prostate PET/MRI before radical prostatectomy. The examinations were performed on a hybrid whole-body PET/MRI scanner. The MR acquisitions which included T2-weighted, diffusion-weighted and dynamic contrast-enhanced sequences were followed during the same session by whole-body PET scans. Parametric maps were constructed to measure normalized T2-weighted intensity (nT2), apparent diffusion coefficient (ADC), volume transfer constant (K (trans)), extravascular extracellular volume fraction (v e) and standardized uptake values (SUV). With pathology as the gold standard, ROC curves were calculated using logistic regression for each parameter and for the best combination with and without PET to obtain a MR model versus a PETMR model. RESULTS Of the 26 patients initially selected, 3 were excluded due to absence of an endorectal coil (2 patients) or prosthesis artefacts (1 patient). In the whole prostate, the area under the curve (AUC) for SUVmax, ADC, nT2, K (trans) and v e were 0.762, 0.756, 0.685, 0.611 and 0.529 with a best threshold at 3.044 for SUVmax and 1.075 × 10(-3) mm(2)/s for ADC. The anatomical distinction between the transition zone and the peripheral zone showed the potential of the adjunctive use of PET. In the peripheral zone, the AUC of 0.893 for the PETMR model was significantly greater (p = 0.0402) than the AUC of 0.84 for the MR model only. In the whole prostate, no relevant correlation was observed between ADC and SUVmax. The SUVmax was not affected by the Gleason score. CONCLUSION The performance of a hybrid whole-body (18)F-fluorocholine PET/MRI scan in the same session combined with a prostatic MR examination did not interfere with the diagnostic accuracy of the MR sequences. The registration of the PET data and the T2 anatomical MR sequence data allowed precise localization of hypermetabolic foci in the prostate. While in the transition zone the adenomatous hyperplasia interfered with cancer detection by PET, the quantitative analysis tool performed well for cancer detection in the peripheral zone.
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Affiliation(s)
- Thomas de Perrot
- Division of Radiology, Geneva University Hospitals and University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Genève 14, Switzerland,
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29
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Rakheja R, Chandarana H, Ponzo F, Seltzer AL, Beltran LS, Geppert C, Friedman KP. Fluorodeoxyglucose positron emission tomography/magnetic resonance imaging: current status, future aspects. PET Clin 2013; 9:237-52. [PMID: 25030285 DOI: 10.1016/j.cpet.2013.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Simultaneous positron emission tomography (PET)/magnetic resonance (MR) imaging is a promising novel technology for oncology diagnosis and staging and neurologic and cardiac applications. Our institution's current research protocol results in a total imaging time of approximately 45 to 70 minutes with simultaneous PET/MR imaging, making this a feasible total body imaging protocol. Further development of MR-based attenuation correction will improve PET quantification. Quantitatively accurate multiparametric PET/MR data sets will likely improve diagnosis of disease and help guide and monitor the therapies for individualized patient care.
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Affiliation(s)
- Rajan Rakheja
- Department of Nuclear Medicine/Radiology, Royal University Hospital, Saskatoon, Saskatchewan, Canada.
| | - Hersh Chandarana
- Department of Radiology, New York University School of Medicine, 550 First Avenue, New York, NY, USA
| | - Fabio Ponzo
- Department of Radiology, New York University School of Medicine, 550 First Avenue, New York, NY, USA
| | - Alexandra L Seltzer
- Department of Radiology, New York University School of Medicine, 550 First Avenue, New York, NY, USA
| | - Luis S Beltran
- Department of Radiology, New York University School of Medicine, 550 First Avenue, New York, NY, USA
| | | | - Kent P Friedman
- Department of Radiology, New York University School of Medicine, 550 First Avenue, New York, NY, USA
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30
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Biological optimization of simultaneous boost on intra-prostatic lesions (DILs): Sensitivity to TCP parameters. Phys Med 2013; 29:592-8. [DOI: 10.1016/j.ejmp.2012.10.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 10/01/2012] [Accepted: 10/04/2012] [Indexed: 11/20/2022] Open
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31
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Kitajima K, Murphy RC, Nathan MA, Sugimura K. Update on positron emission tomography for imaging of prostate cancer. Int J Urol 2013; 21:12-23. [PMID: 23991644 DOI: 10.1111/iju.12250] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 07/10/2013] [Indexed: 12/11/2022]
Abstract
Prostate cancer is the most common non-cutaneous malignancy among men in the Western world, and continues to be a major health problem. Imaging has recently become more important in the clinical management of prostate cancer patients, including diagnosis, staging, choice of optimal treatment strategy, treatment follow up and restaging. Positron emission tomography, a functional and molecular imaging technique, has opened a new field in clinical oncological imaging. The most common positron emission tomography radiotracer, 18F-fluorodeoxyglucose, has been limited in imaging of prostate cancer. Recently, however, other positron emission tomography tracers, such as 11C-acetate and 11C- or (18) F-choline, have shown promising results. In the present review article, we overview the potential and current use of positron emission tomography or positron emission tomography/computed tomography imaging employing the four most commonly used positron emission tomography radiotracers, 18F-fluorodeoxyglucose, 11C-acetate and 11C- or 18F-choline, for imaging evaluation of prostate cancer.
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Affiliation(s)
- Kazuhiro Kitajima
- Department of Radiology, Kobe University School of Medicine, Kobe, Japan
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32
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Bauman G, Haider M, Van der Heide UA, Ménard C. Boosting imaging defined dominant prostatic tumors: a systematic review. Radiother Oncol 2013; 107:274-81. [PMID: 23791306 DOI: 10.1016/j.radonc.2013.04.027] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 04/08/2013] [Accepted: 04/21/2013] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Dominant cancer foci within the prostate are associated with sites of local recurrence post radiotherapy. In this systematic review we sought to address the question: "what is the clinical evidence to support differential boosting to an imaging defined GTV volume within the prostate when delivered by external beam or brachytherapy". MATERIALS AND METHODS A systematic review was conducted to identify clinical series reporting the use of radiation boosts to imaging defined GTVs. RESULTS Thirteen papers describing 11 unique patient series and 833 patients in total were identified. Methods and details of GTV definition and treatment varied substantially between series. GTV boosts were on average 8 Gy (range 3-35 Gy) for external beam, or 150% for brachytherapy (range 130-155%) and GTV volumes were small (<10 ml). Reported toxicity rates were low and may reflect the modest boost doses, small volumes and conservative DVH constraints employed in most studies. Variability in patient populations, study methodologies and outcomes reporting precluded conclusions regarding efficacy. CONCLUSIONS Despite a large cohort of patients treated differential boosts to imaging defined intra-prostatic targets, conclusions regarding optimal techniques and/or efficacy of this approach are elusive, and this approach cannot be considered standard of care. There is a need to build consensus and evidence. Ongoing prospective randomized trials are underway and will help to better define the role of differential prostate boosts based on imaging defined GTVs.
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Affiliation(s)
- Glenn Bauman
- Department of Oncology, London Health Sciences Centre and University of Western Ontario and Western University, Canada.
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33
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Kitajima K, Murphy RC, Nathan MA. Choline PET/CT for imaging prostate cancer: an update. Ann Nucl Med 2013; 27:581-91. [PMID: 23632880 DOI: 10.1007/s12149-013-0731-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 04/16/2013] [Indexed: 11/28/2022]
Abstract
Whole-body positron emission tomography/computed tomography (PET/CT) with [(11)C]- and [(18)F]-labeled choline derivates has emerged as a promising molecular imaging modality for the evaluation of prostate cancer. (11)C- and (18)F-choline PET/CT are used successfully for restaging prostate cancer in patients with biochemical recurrence of disease after definitive therapy, especially when the serum prostate-specific antigen level is >1.0 ng/mL. (11)C- and (18)F-choline PET/CT have more limited roles for the initial staging of prostate cancer and for the detection of tiny lymph node metastases due to the low spatial resolution inherent to PET. Overall, these modalities are most useful in patients with a high pre-test suspicion of metastatic disease. The following is a review of the current clinical roles of (11)C- and (18)F-choline PET/CT in the management of prostate cancer.
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Affiliation(s)
- Kazuhiro Kitajima
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
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Abstract
Hybrid PET/magnetic resonance (MR) imaging, which combines the excellent anatomic information and functional MR imaging parameters with the metabolic and molecular information obtained with PET, may be superior to PET/computed tomography or MR imaging alone for a wide range of disease conditions. This review highlights potential clinical applications in neurologic, cardiovascular, and musculoskeletal disease conditions, with special attention to applications in oncologic imaging.
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Comparative studies of radiolabeled choline positron emission tomography, histology of primary tumor and other imaging modalities in prostate cancer: a systematic review and meta-analysis. Clin Transl Imaging 2013. [DOI: 10.1007/s40336-013-0016-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Thorwarth D, Leibfarth S, Mönnich D. Potential role of PET/MRI in radiotherapy treatment planning. Clin Transl Imaging 2013. [DOI: 10.1007/s40336-013-0006-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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