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Santamaria R, Zaffaroni M, Vincini MG, Colombi L, Gaeta A, Mastroleo F, Corrao G, Zerini D, Villa R, Mazzola GC, Alessi S, Luzzago S, Mistretta FA, Musi G, De Cobelli O, Gandini S, Kuncman L, Cattani F, Ceci F, Petralia G, Marvaso G, Jereczek-Fossa BA. Image-Guided Stereotactic Body Radiotherapy on Detectable Prostate Bed Recurrence after Prostatectomy in RT-Naïve Patients. Life (Basel) 2024; 14:870. [PMID: 39063623 PMCID: PMC11277978 DOI: 10.3390/life14070870] [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: 05/29/2024] [Revised: 07/02/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Purpose or Objective-The aim of the study is to evaluate the efficacy and safety of SBRT on detectable prostate bed recurrence in RT-naïve prostate cancer patients. MATERIALS AND METHODS Eighty-six patients who underwent SBRT for macroscopic bed recurrence after prostatectomy were retrospectively included. Patients were treated based on mpMRI or choline/PSMA PET. RESULTS The median time to biochemical relapse (BCR) after RP was 46 months, with a median PSA at restaging of 1.04 ng/mL. Forty-six patients were staged with mpMRI and choline/PSMA PET, while ten and thirty were treated based on PET and MRI only, respectively. Only one late G ≥ 2 GI toxicity was observed. With a median BCR follow-up of 14 months, twenty-nine patients experienced a BCR with a median PSA at recurrence of 1.66 ng/mL and a median survival free from the event of 40.1 months. The median time to BCR was 17.9 months. Twenty-seven patients had clinical relapse (CR), with a median CR follow-up of 16.27 months and a median time to CR of 23.0 months. Biochemical recurrence-free survival at one and two years was 88% and 66%, respectively, while clinical recurrence-free survival at one and two years was 92% and 82%, respectively. Regarding local relapses, seven were in the field of treatment, while eight of them were outside the field of treatment. CONCLUSIONS Data showed that SBRT targeting only the macroscopic bed recurrence instead of the whole prostate bed is safe and effective. Additional data and longer follow-ups will provide a clearer indication of the appropriate treatment and staging methodology for these patients.
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Affiliation(s)
- Riccardo Santamaria
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (R.S.); (M.Z.); (L.C.); (F.M.); (G.C.); (D.Z.); (R.V.); (G.C.M.); (G.M.); (B.A.J.-F.)
| | - Mattia Zaffaroni
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (R.S.); (M.Z.); (L.C.); (F.M.); (G.C.); (D.Z.); (R.V.); (G.C.M.); (G.M.); (B.A.J.-F.)
| | - Maria Giulia Vincini
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (R.S.); (M.Z.); (L.C.); (F.M.); (G.C.); (D.Z.); (R.V.); (G.C.M.); (G.M.); (B.A.J.-F.)
| | - Lorenzo Colombi
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (R.S.); (M.Z.); (L.C.); (F.M.); (G.C.); (D.Z.); (R.V.); (G.C.M.); (G.M.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (S.L.); (F.A.M.); (G.M.); (O.D.C.); (F.C.); (G.P.)
| | - Aurora Gaeta
- Department of Experimental Oncology, European Institute of Oncology IRCCS, 20139 Milan, Italy; (A.G.); (S.G.)
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, 20126 Milan, Italy
| | - Federico Mastroleo
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (R.S.); (M.Z.); (L.C.); (F.M.); (G.C.); (D.Z.); (R.V.); (G.C.M.); (G.M.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (S.L.); (F.A.M.); (G.M.); (O.D.C.); (F.C.); (G.P.)
| | - Giulia Corrao
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (R.S.); (M.Z.); (L.C.); (F.M.); (G.C.); (D.Z.); (R.V.); (G.C.M.); (G.M.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (S.L.); (F.A.M.); (G.M.); (O.D.C.); (F.C.); (G.P.)
| | - Dario Zerini
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (R.S.); (M.Z.); (L.C.); (F.M.); (G.C.); (D.Z.); (R.V.); (G.C.M.); (G.M.); (B.A.J.-F.)
| | - Riccardo Villa
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (R.S.); (M.Z.); (L.C.); (F.M.); (G.C.); (D.Z.); (R.V.); (G.C.M.); (G.M.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (S.L.); (F.A.M.); (G.M.); (O.D.C.); (F.C.); (G.P.)
| | - Giovanni Carlo Mazzola
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (R.S.); (M.Z.); (L.C.); (F.M.); (G.C.); (D.Z.); (R.V.); (G.C.M.); (G.M.); (B.A.J.-F.)
| | - Sarah Alessi
- Division of Radiology, European Institute of Oncology IRCCS, 20139 Milan, Italy;
| | - Stefano Luzzago
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (S.L.); (F.A.M.); (G.M.); (O.D.C.); (F.C.); (G.P.)
- Division of Urology, European Institute of Oncology IRCCS, 20139 Milan, Italy
| | - Francesco Alessandro Mistretta
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (S.L.); (F.A.M.); (G.M.); (O.D.C.); (F.C.); (G.P.)
- Division of Urology, European Institute of Oncology IRCCS, 20139 Milan, Italy
| | - Gennaro Musi
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (S.L.); (F.A.M.); (G.M.); (O.D.C.); (F.C.); (G.P.)
- Division of Urology, European Institute of Oncology IRCCS, 20139 Milan, Italy
| | - Ottavio De Cobelli
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (S.L.); (F.A.M.); (G.M.); (O.D.C.); (F.C.); (G.P.)
- Division of Urology, European Institute of Oncology IRCCS, 20139 Milan, Italy
| | - Sara Gandini
- Department of Experimental Oncology, European Institute of Oncology IRCCS, 20139 Milan, Italy; (A.G.); (S.G.)
| | - Lukasz Kuncman
- Department of Radiotherapy, Medical University of Lodz, 90-419 Lodz, Poland;
- Department of External Beam Radiotherapy, Nicolaus Copernicus Multidisciplinary Centre for Oncology and Traumatology, 93-513 Lodz, Poland
| | - Federica Cattani
- Medical Physics Unit, European Institute of Oncology IRCCS, 20139 Milan, Italy;
| | - Francesco Ceci
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (S.L.); (F.A.M.); (G.M.); (O.D.C.); (F.C.); (G.P.)
- Division of Nuclear Medicine, European Institute of Oncology IRCCS, 20139 Milan, Italy
| | - Giuseppe Petralia
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (S.L.); (F.A.M.); (G.M.); (O.D.C.); (F.C.); (G.P.)
- Division of Radiology, European Institute of Oncology IRCCS, 20139 Milan, Italy;
| | - Giulia Marvaso
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (R.S.); (M.Z.); (L.C.); (F.M.); (G.C.); (D.Z.); (R.V.); (G.C.M.); (G.M.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (S.L.); (F.A.M.); (G.M.); (O.D.C.); (F.C.); (G.P.)
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (R.S.); (M.Z.); (L.C.); (F.M.); (G.C.); (D.Z.); (R.V.); (G.C.M.); (G.M.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (S.L.); (F.A.M.); (G.M.); (O.D.C.); (F.C.); (G.P.)
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Dirix P, Dal Pra A, Khoo V, Carrie C, Cozzarini C, Fonteyne V, Ghadjar P, Gomez-Iturriaga A, Schmidt-Hegemann NS, Panebianco V, Zapatero A, Bossi A, Wiegel T. ESTRO ACROP consensus recommendation on the target volume definition for radiation therapy of macroscopic prostate cancer recurrences after radical prostatectomy. Clin Transl Radiat Oncol 2023; 43:100684. [PMID: 37808453 PMCID: PMC10556584 DOI: 10.1016/j.ctro.2023.100684] [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: 09/22/2023] [Accepted: 09/22/2023] [Indexed: 10/10/2023] Open
Abstract
Background The European Society for Radiotherapy & Oncology (ESTRO) Advisory Committee for Radiation Oncology Practice (ACROP) panel on prostate bed delineation reflected on macroscopic local recurrences in patients referred for postoperative radiotherapy (PORT), a challenging situation without standardized approach, and decided to propose a consensus recommendation on target volume selection and definition. Methods An ESTRO ACROP contouring consensus panel consisting of 12 radiation oncologists and one radiologist, all with subspecialty expertise in prostate cancer, was established. Participants were asked to delineate the prostate bed clinical target volumes (CTVs) in two separate clinically relevant scenarios: a local recurrence at the seminal vesicle bed and one apically at the level of the anastomosis. Both recurrences were prostate-specific membrane antigen (PSMA)-avid and had an anatomical correlate on magnetic resonance imaging (MRI). Participants also answered case-specific questionnaires addressing detailed recommendations on target delineation. Discussions via electronic mails and videoconferences for final editing and consensus were performed. Results Contouring of the two cases confirmed considerable variation among the panelists. Finally, however, a consensus recommendation could be agreed upon. Firstly, it was proposed to always delineate the entire prostate bed as clinical target volume and not the local recurrence alone. The panel judged the risk of further microscopic disease outside of the visible recurrence too high to safely exclude the rest of the prostate bed from the CTV. A focused, "stereotactic" approach should be reserved for re-irradiation after previous PORT. Secondly, the option of a focal boost on the recurrence was discussed. Conclusion Radiation oncologists are increasingly confronted with macroscopic local recurrences visible on imaging in patients referred for postoperative radiotherapy. It was recommended to always delineate and irradiate the entire prostate bed, and not the local recurrence alone, whatever the exact location of that recurrence. Secondly, specific dose-escalation on the macroscopic recurrence should only be considered if an anatomic correlate is visible. Such a focal boost is probably feasible, provided that OAR constraints are prioritized. Possible dose is also dependent on the location of the recurrence. Its potential benefit should urgently be investigated in prospective clinical trials.
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Affiliation(s)
- Piet Dirix
- Department of Radiation Oncology, Iridium Network, Antwerp, Belgium
| | - Alan Dal Pra
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, USA
- University of Bern, Bern University Hospital, Bern, Switzerland
| | - Vincent Khoo
- Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| | | | - Cesare Cozzarini
- Department of Radiotherapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Valérie Fonteyne
- Department of Radiotherapy-Oncology, Ghent University Hospital, Ghent, Belgium
| | - Pirus Ghadjar
- Department of Radiation Oncology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany
| | - Alfonso Gomez-Iturriaga
- Radiation Oncology, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Spain
| | | | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Almudena Zapatero
- Department of Radiation Oncology, La Princesa University Hospital, Health Reasearch Institute Princesa, Madrid, Spain
| | - Alberto Bossi
- Radiation Oncology, Centre Charlebourg, La Garenne Colombe, France
| | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
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Le Guevelou J, Magne N, Counago F, Magsanoc JM, Vermeille M, De Crevoisier R, Benziane-Ouaritini N, Ost P, Niazi T, Supiot S, Sargos P. Stereotactic body radiation therapy after radical prostatectomy: current status and future directions. World J Urol 2023; 41:3333-3344. [PMID: 37725131 DOI: 10.1007/s00345-023-04605-7] [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] [Received: 07/18/2023] [Accepted: 08/28/2023] [Indexed: 09/21/2023] Open
Abstract
PURPOSE Around 40% of men with intermediate-risk or high-risk prostate cancer will experience a biochemical recurrence after radical prostatectomy (RP). The aim of this review is to describe both toxicity and oncological outcomes following stereotactic body radiation therapy (SBRT) delivered to the prostate bed (PB). METHOD In april 2023, we performed a systematic review of studies published in MEDLINE or ClinicalTrials.gov according to Preferred Reporting Items for Systematic Reviews, using the keywords "stereotactic radiotherapy" AND "postoperative" AND "prostate cancer". RESULTS A total of 14 studies assessing either adjuvant or salvage SBRT to the whole PB or macroscopic local recurrence (MLR) within the PB, and SBRT on radiorecurrent MLR within the PB were included. Doses delivered to either whole PB or MLR between 30 to 40 Gy are associated with a low rate of late grade ≥ 2 genitourinary (GU) toxicity, ranging from 2.2 to 15.1%. Doses above 40 Gy are associated with increased rate of late GU toxicity, raising up to 38%. Oncological outcomes should be interpreted with caution, due to both short follow-up, heterogeneous populations and androgen deprivation therapy (ADT) use. CONCLUSION PB or MLR SBRT delivered at doses up to 40 Gy appears safe with relatively low late severe GU toxicity rates. Caution is needed with dose-escalated RT schedules above 40 Gy. Further prospective trials are eagerly awaited in this disease setting.
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Affiliation(s)
| | - Nicolas Magne
- Department of Radiotherapy, Institut Bergonié, Bordeaux, France
| | - Felipe Counago
- Radiation Oncology Department, GenesisCare Madrid Clinical Director, San Francisco de Asis and La Milagrosa Hospitals, National Chair of Research and Clinical Trials, GenesisCare, Madrid, Spain
| | | | - Matthieu Vermeille
- Radiation Oncology Department, Genolier Swiss Radio-Oncology Network, Genolier, Switzerland
| | | | | | - Piet Ost
- Radiation Oncology Department, Iridium Network, Antwerp, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Tamim Niazi
- Department of Radiation Oncology, Jewish General Hospital, Montreal, QC, Canada
| | - Stéphane Supiot
- Radiation Oncology Department, Institut de Cancérologie de L'Ouest, Nantes, France
| | - Paul Sargos
- Department of Radiotherapy, Institut Bergonié, Bordeaux, France.
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4
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Benziane-Ouaritini N, Zilli T, Giraud A, Ingrosso G, Di Staso M, Trippa F, Pommier P, Meyer E, Francolini G, Schick U, Pasquier D, Marc Cosset J, Magne N, Martin E, Gnep K, Renard-Penna R, Anger E, Achard V, Giraud N, Aristei C, Ferrari V, Pasquier C, Zaine H, Osman O, Detti B, Perennec T, Mihoci I, Supiot S, Latorzeff I, Sargos P. Prostatectomy Bed Image-guided Dose-escalated Salvage Radiotherapy (SPIDER): An International Multicenter Retrospective Study. Eur Urol Oncol 2023:S2588-9311(23)00067-6. [PMID: 37059627 DOI: 10.1016/j.euo.2023.02.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 02/13/2023] [Accepted: 02/22/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Management of macroscopic local recurrence (MLR) after radical prostatectomy is a challenging situation with no standardized approach. OBJECTIVE The objective of our study was to assess the efficacy and safety of functional image-guided salvage radiotherapy (SRT) in patients with MLR in the prostate bed. DESIGN, SETTING, AND PARTICIPANTS In this international multicenter retrospective study across 16 European centers, eligible patients were initially treated by radical prostatectomy (RP) with or without pelvic lymph node dissection for localized or locally advanced adenocarcinoma of the prostate. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Prostate-specific antigen (PSA) measured 4 wk after RP was <0.1 ng/ml. All patients presented a biochemical relapse after RP defined by an increase in PSA level of ≥0.2 ng/ml on two successive measures. Only patients with an MLR lesion in the prostatectomy bed visualized on functional imaging (multiparametric magnetic resonance imaging, positron emission tomography/computed tomography [PET/CT] choline, or PET/CT prostate-specific membrane antigen) were eligible. Patients with lymph node, bone, or visceral dissemination at restaging imaging (CT and/or bone scintigraphy and/or magnetic resonance imaging and/or PET) were excluded. Dose escalation was defined as a dose of >66 Gy prescribed to the prostate bed or to MLR. Toxicities were classified using the Common Terminology Criteria for Adverse Events scale, version 4.03. The primary endpoint was progression-free survival (PFS). Secondary outcomes were metastasis-free survival (MPFS), biochemical progression-free survival, and overall survival. Genitourinary (GU) and gastrointestinal (GI) toxicities were analyzed. RESULTS AND LIMITATIONS Between January 2000 and December 2019, 310 patients received at least one dose escalation on MLR and 25 patients did not receive any dose escalation. The median PSA level before SRT was 0.63 ng/ml (interquartile range [IQR], 0.27-1.7). The median follow-up was 54 mo (IQR, 50-56). Five-year PFS and MPFS were 70% (95% confidence interval [CI]: [64; 75]) and 84% (95% CI: [78; 88]), respectively. Grade ≥2 GU and GI late toxicities were observed in 43 (12%) and 11 (3%) patients, respectively. When the prescribed dose on the MLR lesion was ≥72 Gy, an improvement in 5-yr PFS was found for patients received at least one dose escalation (73% [95% CI: 65-79]) vs 60% [95% CI: 48; 70]; p = 0.03). CONCLUSIONS In this contemporary study integrating functional imaging data, we found potential efficacy of SRT with dose escalation ≥72 Gy for patients with MLR in the prostate bed and with an acceptable toxicity profile. Prospective data exploring this MLR dose escalation strategy are awaited. PATIENT SUMMARY In this report, we looked at the outcomes from salvage radiotherapy for prostate cancer and macroscopic relapse in a large European population. We found that outcomes varied with prostate-specific antigen at relapse, Gleason score, and dose escalation. We found potential efficacy of salvage radiotherapy with dose escalation for macroscopic relapse in the prostate bed, with an acceptable toxicity profile.
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Affiliation(s)
| | - Thomas Zilli
- Department of Radiotherapy, University of Geneva, Geneva, Switzerland
| | - Antoine Giraud
- Department of Radiotherapy, Bergonie Institute, Bordeaux, France
| | - Gianluca Ingrosso
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Mario Di Staso
- Department of Clinical Medicine Life Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Fabio Trippa
- Department of Radiotherapy, Saint Maria Hospital, Terni, Italy
| | - Pascal Pommier
- Department of Radiotherapy, Centre Léon Bérard, Lyon, France
| | - Emmanuel Meyer
- Department of Radiotherapy, Centre Francois Baclesse, Caen, France
| | | | - Ulrike Schick
- Department of Radiotherapy, Morvan Hospital Brest, France
| | - David Pasquier
- Department of Radiotherapy, Oscar Lambret Cancer Centre, Lille, France
| | | | - Nicolas Magne
- Department of Radiotherapy, St Etienne University, St Etienne, France
| | - Etienne Martin
- Department of Radiotherapy, Georges-François Leclerc Centre, Dijon, France
| | - Kémara Gnep
- Department of Radiotherapy, Eugene Marquis Cancer Institute, Rennes, France
| | - Raphaelle Renard-Penna
- Department of Radiology, Sorbonne University, AP-HP, Hopital Pitié-Salpétrière Hospital, Paris, France
| | - Ewen Anger
- Department of Radiotherapy, Eugene Marquis Cancer Institute, Rennes, France
| | - Vérane Achard
- Department of Radiotherapy, University of Geneva, Geneva, Switzerland
| | - Nicolas Giraud
- Department of Radiotherapy, Bergonie Institute, Bordeaux, France
| | | | - Victoria Ferrari
- Department of Medical Oncology, Antoine-Lacassagne Centre, Nice, France
| | - Corentin Pasquier
- Department of Radiotherapy, University Hospital Centre Toulouse, Toulouse, France
| | - Hind Zaine
- Department of Radiotherapy, Oscar Lambret Cancer Centre, Lille, France
| | - Osman Osman
- Department of Radiotherapy, Centre Léon Bérard, Lyon, France
| | | | - Tanguy Perennec
- Department of Radiotherapy, Institute of Cancer Research Western France, St Herblain, France
| | - Inga Mihoci
- Department of Clinical Medicine Life Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Stéphane Supiot
- Department of Radiotherapy, Institute of Cancer Research Western France, St Herblain, France
| | - Igor Latorzeff
- Department of Radiotherapy, Pasteur Clinic, Toulouse, France
| | - Paul Sargos
- Department of Radiotherapy, Bergonie Institute, Bordeaux, France.
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Horsley PJ, Koo CM, Eade T, Hsiao E, Emmett L, Brown C, Kneebone A, Hruby G. Mapping of Local Recurrences After Radical Prostatectomy Using 68-Gallium-Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography: Implications for Postprostatectomy Radiation Therapy Clinical Target Volumes. Int J Radiat Oncol Biol Phys 2023; 115:106-117. [PMID: 35716849 DOI: 10.1016/j.ijrobp.2022.05.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/23/2022] [Accepted: 05/28/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Our objective is to describe the distribution of local recurrences after radical prostatectomy (RP) as delineated using 68-Gallium-prostate-specific membrane antigen positron emission tomography/computed tomography (68Ga-PSMA PET/CT) to identify areas where current consensus guideline clinical target volumes (CTVs) are insufficient or excessive and to identify predictors of recurrence location within the fossa. METHODS AND MATERIALS Retrospective review of databases from 2 tertiary referral centers was performed to identify patients who underwent 68Ga-PSMA PET/CT for biochemical recurrence after RP. Those with a component of local recurrence were included for further analysis. The epicenter of each recurrence was defined relative to reference points in 3 axes, categorized into 1 of 7 levels in the superior/inferior axis relative to the vesicourethral anastomosis, and recorded as within or outside the Faculty of Radiation Oncology Genito-urinary Group (FROGG) and Radiation Therapy Oncology Group consensus CTVs. Univariate and multivariate analysis was performed to identify predictors of recurrence location based on clinical and histopathologic variables. RESULTS One thousand forty-nine 68Ga-PSMA PET/CT scans were reviewed. One hundred forty sites of local recurrence were identified on 132 scans. Relative to the vesicourethral anastomosis, 13 (9%), 31 (22%), 17 (12%), 24 (17%), 27 (19%), 20 (14%), and 8 (6%) recurrences occurred >5 mm inferior; within 5 mm above or below; and 6 to 15 mm, 16 to 25 mm, 26 to 35 mm, 36 to 45 mm, and >45 mm superiorly, respectively. Thirteen (9%) and 2 (1.4%) recurrences occurred beyond the FROGG and Radiation Therapy Oncology Group consensus CTVs, respectively, with all below the inferior CTV margin. CONCLUSIONS In the largest study to date mapping local recurrences after RP in 3-dimensions, we provide several insights to inform future contouring guidelines; in particular, 9% of recurrences occurred inferior to the FROGG CTV.
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Affiliation(s)
- Patrick J Horsley
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
| | - Chung Mo Koo
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Thomas Eade
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, New South Wales, Australia; GenesisCare, Sydney, New South Wales, Australia; University of Sydney, Camperdown, New South Wales, Australia
| | - Edward Hsiao
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Louise Emmett
- Department of Nuclear Medicine and Theranostics, St. Vincent's Hospital, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia
| | - Chris Brown
- NHMRC Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Andrew Kneebone
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, New South Wales, Australia; GenesisCare, Sydney, New South Wales, Australia; University of Sydney, Camperdown, New South Wales, Australia
| | - George Hruby
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, New South Wales, Australia; GenesisCare, Sydney, New South Wales, Australia; University of Sydney, Camperdown, New South Wales, Australia
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Renard-Penna R, Zhang-Yin J, Montagne S, Aupin L, Bruguière E, Labidi M, Latorzeff I, Hennequin C. Targeting Local Recurrence After Surgery With MRI Imaging for Prostate Cancer in the Setting of Salvage Radiation Therapy. Front Oncol 2022; 12:775387. [PMID: 35242702 PMCID: PMC8887697 DOI: 10.3389/fonc.2022.775387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/05/2022] [Indexed: 11/18/2022] Open
Abstract
Magnetic resonance imaging (MRI) is being increasingly used for imaging suspected recurrence in prostate cancer therapy. Functional MRI with diffusion and perfusion imaging has the potential to demonstrate local recurrence even at low PSA value. Detection of recurrence can modify the management of postprostatectomy biochemical recurrence. MRI scan acquired before salvage radiotherapy is useful for the localization of recurrent tumors and also in the delineation of the target volume. The objective of this review is to assess the role and potential impact of MRI in targeting local recurrence after surgery for prostate cancer in the setting of salvage radiation therapy.
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Affiliation(s)
- Raphaële Renard-Penna
- Academic Department of Radiology, Hôpital Pitié-Salpétrière, Assistance Publique des Hôpitaux de Paris, Paris, France.,Sorbonne University, Paris, France
| | - Jules Zhang-Yin
- Nuclear Medicine Department, Tenon Hospital, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France
| | - Sarah Montagne
- Academic Department of Radiology, Hôpital Pitié-Salpétrière, Assistance Publique des Hôpitaux de Paris, Paris, France.,Sorbonne University, Paris, France
| | - Laurene Aupin
- Academic Department of Radiology, Hôpital Pitié-Salpétrière, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Eric Bruguière
- Department of Imaging, Clinique Pasteur, Toulouse, France
| | - Mouna Labidi
- Department of Oncology, Saint-Louis Hospital, Université de Paris, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Igor Latorzeff
- Department of Radiotherapy, Clinique Pasteur, Toulouse, France
| | - Christophe Hennequin
- Department of Oncology, Saint-Louis Hospital, Université de Paris, Assistance Publique des Hôpitaux de Paris, Paris, France
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7
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A Prospective Study Assessing the Post-Prostatectomy Detection Rate of a Presumed Local Failure at mpMR with Either 64CuCl 2 or 64CuPSMA PET/CT. Cancers (Basel) 2021; 13:cancers13215564. [PMID: 34771726 PMCID: PMC8582802 DOI: 10.3390/cancers13215564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/17/2021] [Accepted: 10/20/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary The role of PET/CT with two novel tracers was investigated in prostate cancer patients with both a biochemical failure after surgery and a presumed local failure at multiparametric MR. Overall, both PET tracers detected only about 50% of local failures. Therefore, multiparametric MR remains the exam of choice to investigate the prostatic fossa in patients who fail surgery. Abstract Background: We aimed assess the detection rate (DR) of positron emission tomography/computed tomography with two novel tracers in patients referred for salvage radiotherapy (sRT) with a presumed local recurrence at multiparametric magnetic resonance (mpMR) after radical prostatectomy (RP). Methods: The present prospective study was conducted at a single institution between August 2017 and June 2020. Eligibility criteria were undetectable PSA after RP; subsequent biochemical recurrence (two consecutive PSA rises to 0.2 ng/mL or greater); a presumed local failure at mpMR; no distant metastases at 18F-fluorocholine PET/CT (CH/PET); no previous history of androgen deprivation therapy. Patients were offered both 64CuCl2 PET/CT (CU/PET) and 64Cu-PSMA PET/CT (PSMA/PET) before sRT. After image co-registration, PET findings were compared to mpMR ones in terms of DR and independent predictors of DR investigated at logistic regression. Results: A total of 62 patients with 72 nodules at mpMR were accrued. Compared to mpMR (DR = 100%, 95%CI: 94.9–100%), DRs were 47.2% (95%CI: 36.1–58.6%) and 54.4% (95%CI: 42.7–65.7%) for CU/PET and PSMA/PET, respectively (p < 0.001 for both). Both experimental PET/CT performed particularly poorly at PSA levels consistent with early sRT. Conclusions: The two novel radiotracers are inferior to mpMR in restaging the prostatic fossa for sRT planning purposes, particularly in the context of early salvage radiotherapy.
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8
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Sardaro A, Turi B, Bardoscia L, Ferrari C, Rubini G, Calabrese A, Ammirati F, Grillo A, Leo A, Lorusso F, Santorsola A, Stabile Ianora AA, Scardapane A. The Role of Multiparametric Magnetic Resonance in Volumetric Modulated Arc Radiation Therapy Planning for Prostate Cancer Recurrence After Radical Prostatectomy: A Pilot Study. Front Oncol 2021; 10:603994. [PMID: 33585223 PMCID: PMC7874055 DOI: 10.3389/fonc.2020.603994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/26/2020] [Indexed: 12/25/2022] Open
Abstract
Background and Purpose Volumetric modulated arc radiotherapy (RT) has become pivotal in the treatment of prostate cancer recurrence (RPC) to optimize dose distribution and minimize toxicity, thanks to the high-precision delineation of prostate bed contours and organs at risk (OARs) under multiparametric magnetic resonance (mpMRI) guidance. We aimed to assess the role of pre-treatment mpMRI in ensuring target volume coverage and normal tissue sparing. Material and Methods Patients with post-prostatectomy RPC eligible for salvage RT were prospectively recruited to this pilot study. Image registration between planning CT scan and T2w pre-treatment mpMRI was performed. Two sets of volumes were outlined, and DWI images/ADC maps were used to facilitate precise gross tumor volume (GTV) delineation on morphological MRI scans. Two rival plans (mpMRI-based or not) were drawn up. Results Ten patients with evidence of RPC after prostatectomy were eligible. Preliminary data showed lower mpMRI-based clinical target volumes than CT-based RT planning (p = 0.0003): median volume difference 17.5 cm3. There were no differences in the boost volume coverage nor the dose delivered to the femoral heads and penile bulb, but median rectal and bladder V70Gy was 4% less (p = 0.005 and p = 0.210, respectively) for mpMRI-based segmentation. Conclusions mpMRI provides high-precision target delineation and improves the accuracy of RT planning for post-prostatectomy RPC, ensures better volume coverage with better OARs sparing and allows non-homogeneous dose distribution, with an aggressive dose escalation to the GTV. Randomized phase III trials and wider datasets are needed to fully assess the role of mpMRI in optimizing therapeutic strategies.
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Affiliation(s)
- Angela Sardaro
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Barbara Turi
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Policlinico, Bari, Italy
| | - Lilia Bardoscia
- Radiation Therapy Unit, Department of Oncology and Advanced Technology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cristina Ferrari
- Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Giuseppe Rubini
- Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Angela Calabrese
- Department of Radiology, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Federica Ammirati
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Antonietta Grillo
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Policlinico, Bari, Italy
| | - Annamaria Leo
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Policlinico, Bari, Italy
| | | | - Antonio Santorsola
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Policlinico, Bari, Italy
| | - Antonio Amato Stabile Ianora
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Arnaldo Scardapane
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari "Aldo Moro", Bari, Italy
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9
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Chin S, Fatimilehin A, Walshaw R, Argarwal A, Mistry H, Elliott T, Logue J, Wylie J, Choudhury A. Ten-Year Outcomes of Moderately Hypofractionated Salvage Postprostatectomy Radiation Therapy and External Validation of a Contemporary Multivariable Nomogram for Biochemical Failure. Int J Radiat Oncol Biol Phys 2020; 107:288-296. [PMID: 31987961 DOI: 10.1016/j.ijrobp.2020.01.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/06/2020] [Accepted: 01/10/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Although high-level evidence supports moderately hypofractionated radiation therapy for definitive prostate treatment, there is less evidence for its use in the postprostatectomy setting. We externally validated a contemporary nomogram predicting biochemical failure (BF) after salvage radiation therapy (SRT) and report long-term disease control outcomes for hypofractionated SRT to the prostate bed. METHODS AND MATERIALS A retrospective review was performed for 112 patients treated with hypofractionated SRT (52.5 Gy in 20 fractions using 3-dimensional conformal radiation therapy) for pT2-4R0-1N0/XM0 prostate adenocarcinoma, with postoperative prostate-specific antigen (PSA) greater than 0.1 ng/mL or rising. Freedom from BF (FFBF), distant metastasis, cancer-specific mortality, and overall survival were analyzed from commencement of radiation therapy. Cox regression was performed on FFBF to account for covariates. BF was defined as a PSA ≥0.4 ng/mL and rising after SRT. Early SRT was defined as SRT commencing at a pre-SRT PSA of ≤0.2 ng/mL. RESULTS Median follow-up was 10.0 years (interquartile range, 9.3-10.7 years), median pre-SRT PSA was 0.4 ng/mL, and androgen deprivation therapy was used in 14% of patients. The 5/10-year FFBF, distant metastasis, cancer-specific mortality, and overall survival were 68%/51%, 7%/16%, 5%/11%, and 90%/75%, respectively. FFBF for early SRT compared with late SRT was 81% versus 66% at 5 years and 68% versus 49% at 10 years. On multivariable analysis, pre-SRT PSA, International Society of Urologic Pathology grade group, seminal vesicle invasion, and androgen deprivation therapy use were associated with FFBF. The nomogram c-index was 0.67, and it overestimated FFBF by 10% and 15% at 5 and 10 years, respectively, with confidence intervals overlapping the line of unity. CONCLUSIONS Hypofractionated SRT provides long-term disease control outcomes comparable to conventionally fractionated radiation therapy. Early SRT provides improved disease control, with two-thirds of patients with pre-SRT PSA of ≤0.2 ng/mL free of BF at 10 years. We performed the first external validation of the Tendulkar salvage nomogram, which showed a robust model performance.
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Affiliation(s)
- Stephen Chin
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom; Rural Clinical School, University of New South Wales, Coffs Harbour, New South Wales, Australia
| | - Abiola Fatimilehin
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Richard Walshaw
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
| | - Arjun Argarwal
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Hitesh Mistry
- Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom; Division of Pharmacy, The University of Manchester, Manchester, United Kingdom
| | - Tony Elliott
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - John Logue
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - James Wylie
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Ananya Choudhury
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom.
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10
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Francolini G, Jereczek-Fossa BA, Di Cataldo V, Simontacchi G, Marvaso G, Zerella MA, Gentile P, Bianciardi F, Allegretta S, Detti B, Masi L, Lo Russo M, Livi L. Stereotactic radiotherapy for prostate bed recurrence after prostatectomy, a multicentric series. BJU Int 2019; 125:417-425. [PMID: 31608534 DOI: 10.1111/bju.14924] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the safety and effectiveness of stereotactic salvage radiotherapy (SSRT) in RT-naïve patients affected by macroscopic prostate bed recurrence. PATIENTS AND METHODS Consecutive patients treated for prostate bed macroscopic recurrence in three different Italian institutes were reviewed. Patients were treated with SSRT, with a total dose of 30-40 Gy in five fractions, the mean pre-SSRT PSA level was 2.3 ng/mL. Two different PSA thresholds were defined and biochemical recurrence-free survival (BCRFS) was reported, in order to better express outcome: BCRFS1 (a PSA level increase of >10% compared to the pre-SSRT value) and BCRFS2 (a PSA level increase of >0.2 ng/mL for patients with a PSA nadir of <0.2 ng/mL or two consecutive PSA level increases of >25% compared to nadir in patients with a PSA nadir of <0.2 ng/mL). RESULTS In all, 90 patients were treated, with a mean (range) follow-up of 21.2 (2-64) months, and 17 of these patients (19%) had concomitant androgen-deprivation therapy (ADT) during SSRT. Complete biochemical response, defined as a PSA nadir of <0.2 ng/mL, was obtained in 39 of the 90 patients (43.3%). Considering BCRFS1, 25 patients (27.8%) had BCR, with an actuarial median BCRFS1 time of 36.4 months. For BCRFS2, BCR was reported in 32 patients (35.5%), with an actuarial median BCRFS2 time of 24.3 months. There was no Grade >2 toxicity. CONCLUSIONS SSRT was found to yield significant biochemical control and allowed ADT delay despite adverse features.
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Affiliation(s)
- Giulio Francolini
- Radiation Oncology Unit, University of Florence, Florence, Italy.,CyberKnife Center, L'Istituto Fiorentino di Cura e Assistenza (IFCA), Florence, Italy
| | - Barbara Alicja Jereczek-Fossa
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.,Division of Radiotherapy, European Institute of Oncology (IEO), L'Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Vanessa Di Cataldo
- Radiation Oncology Unit, University of Florence, Florence, Italy.,CyberKnife Center, L'Istituto Fiorentino di Cura e Assistenza (IFCA), Florence, Italy
| | - Gabriele Simontacchi
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giulia Marvaso
- Division of Radiotherapy, European Institute of Oncology (IEO), L'Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Maria Alessia Zerella
- Division of Radiotherapy, European Institute of Oncology (IEO), L'Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Piercarlo Gentile
- University of Pittsburgh Medical Center (UPMC) San Pietro Fatebenefratelli (FBF), Rome, Italy
| | - Federico Bianciardi
- University of Pittsburgh Medical Center (UPMC) San Pietro Fatebenefratelli (FBF), Rome, Italy
| | - Sara Allegretta
- University of Pittsburgh Medical Center (UPMC) San Pietro Fatebenefratelli (FBF), Rome, Italy
| | - Beatrice Detti
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Laura Masi
- Department of Medical Physics and Radiation Oncology, IFCA, Florence, Italy
| | - Monica Lo Russo
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Lorenzo Livi
- Department of Biomedical, Experimental, and Clinical Sciences 'Mario Serio', University of Florence, Florence, Italy
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11
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Couñago F, Díaz Gavela AA, Sancho G, Ortiz I, Marcos FJ, Recio M, Fernández J, Cano R, Jiménez M, Thuissard IJ, Sanz-Rosa D, Castro Nováis J, Pardo E, Molina Y, Pérez García H, Del Cerro E. Multiparametric magnetic resonance imaging-guided salvage radiotherapy in prostate cancer. Rep Pract Oncol Radiother 2019; 24:472-480. [PMID: 31452628 DOI: 10.1016/j.rpor.2019.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/12/2019] [Accepted: 07/10/2019] [Indexed: 10/26/2022] Open
Abstract
Aim To analyse the efficacy and toxicity of postprostatectomy SRT in patients with a BCR evaluated with mpMRI. Background Multiparametric magnetic resonance imaging (mpMRI) has the ability to detect the site of pelvic recurrence in patients with biochemical recurrence (BCR) after radical prostatectomy (RP). However, we do not know the oncological outcomes of mpMRI-guided savage radiotherapy (SRT). Results Local, lymph node, and pelvic bone recurrence was observed in 13, 4 and 2 patients, respectively. PSA levels were significantly lower in patients with negative mpMRI (0.4 ng/mL [0.4]) vs. positive mpMRI (2.2 ng/mL [4.1], p = 0.003). Median planning target volume doses in patients with visible vs. non-visible recurrences were 76 Gy vs. 70 Gy. Overall, mean follow-up was 41 months (6-81). Biochemical relapse-free survival (bRFS) at 3 years was 82.3% and 82.5%, respectively, for the negative and positive mpMRI groups (p = 0.800). Three-year rates of late grade ≥2 urinary and rectal toxicity were 14.8% and 1.9%, respectively; all but one patient recovered without sequelae. Conclusion SRT to the macroscopic recurrence identified by mpMRI is a feasible and well-tolerated option. In this study, there were no differences in bRFS between MRI-positive and MRI-negative patients, indicating effective targeting of MRI-positive lesions.
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Affiliation(s)
- Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud, Madrid 28223, Spain.,Department of Radiation Oncology, Hospital La Luz, Madrid 28003, Spain.,Universidad Europea, Madrid 28670, Spain
| | - Ana Aurora Díaz Gavela
- Department of Radiation Oncology, Hospital Universitario Quirónsalud, Madrid 28223, Spain.,Department of Radiation Oncology, Hospital La Luz, Madrid 28003, Spain.,Universidad Europea, Madrid 28670, Spain
| | - Gemma Sancho
- Department of Radiation Oncology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona 08041, Spain
| | - Irene Ortiz
- Department of Radiation Oncology, Hospital Universitario Son Espases, Palma de Mallorca 07120, Spain
| | - Francisco José Marcos
- Department of Radiation Oncology, Hospital Universitario Quirónsalud, Madrid 28223, Spain.,Department of Radiation Oncology, Hospital La Luz, Madrid 28003, Spain.,Universidad Europea, Madrid 28670, Spain
| | - Manuel Recio
- Department of Radiology, Hospital Universitario Quirónsalud, Madrid 28223, Spain
| | - Julio Fernández
- Department of Radiology, Hospital Universitario Quirónsalud, Madrid 28223, Spain
| | - Raquel Cano
- Department of Radiology, Hospital Universitario Quirónsalud, Madrid 28223, Spain
| | - Mar Jiménez
- Department of Radiology, Hospital Universitario Quirónsalud, Madrid 28223, Spain
| | | | - David Sanz-Rosa
- Clinical Department, Faculty of Biomedicine, Universidad Europea, Madrid 28670, Spain
| | - Juan Castro Nováis
- Department of Medical Physics, Hospital Universitario Quirónsalud, Madrid 28223, Spain
| | - Eduardo Pardo
- Department of Medical Physics, Hospital Universitario Quirónsalud, Madrid 28223, Spain
| | - Yolanda Molina
- Department of Medical Physics, Hospital Universitario Quirónsalud, Madrid 28223, Spain
| | - Hugo Pérez García
- Department of Medical Physics, Hospital Universitario Quirónsalud, Madrid 28223, Spain
| | - Elia Del Cerro
- Department of Radiation Oncology, Hospital Universitario Quirónsalud, Madrid 28223, Spain.,Department of Radiation Oncology, Hospital La Luz, Madrid 28003, Spain.,Universidad Europea, Madrid 28670, Spain
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12
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Recurrent prostate cancer after radical prostatectomy: restaging performance of 18F-choline hybrid PET/MRI. Med Oncol 2019; 36:67. [PMID: 31190232 DOI: 10.1007/s12032-019-1291-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 06/07/2019] [Indexed: 10/26/2022]
Abstract
To evaluate the diagnostic performance of a whole-body 18F-choline (FCH) hybrid PET/MRI for prostate cancer patients at biochemical relapse after radical prostatectomy (RP) compared to pelvic multiparametric MRI (mpMRI), one of the standard imaging modality for this patient population. From 2010 to 2016, 58 whole-body FCH PET/MRI studies with mpMRI acquisitions were performed in 53 prostate cancer patients relapsing after curative RP. Median PSA and PSA doubling time (PSA DT) at PET study were 1.5 ng/ml and 6.5 months, respectively. The overall positivity rate of FCH PET/MRI was 58.6% (n = 34), dropping to 44% in patients with a PSA ≤ 2 ng/ml (n = 36). Median PSA values in positive and negative PET/MRI studies were 2.2 ng/ml and 0.8 ng/ml, respectively, with no differences in PSA DT (6.5 vs. 6.6 months). A PSA value ≥ 1.5 ng/ml was a significant predictor of positivity on PET/MRI studies. Compared to PET, mpMRI identified more local relapses (17 vs. 14, p = 0.453) while PET outperformed whole-body Dixon MRI for regional (16 vs. 9, p = 0.016) and distant (12 vs. 6, p = 0.031) metastases. Compared to pelvic mpMRI, the treatment approach turned out to be influenced more frequently using whole-body FCH hybrid PET/MRI studies (58.6% vs. 38%). In prostate cancer patients with biochemical recurrence after RP, whole-body FCH PET/MRI achieved a higher detection rate of nodal/distant metastases compared to pelvic mpMRI alone, increasing the change of treatment strategy by more than 20%.
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13
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Emmett L, Metser U, Bauman G, Hicks RJ, Weickhardt A, Davis ID, Punwani S, Pond G, Chua S, Ho B, Johnston E, Pouliot F, Scott AM. Prospective, Multisite, International Comparison of 18F-Fluoromethylcholine PET/CT, Multiparametric MRI, and 68Ga-HBED-CC PSMA-11 PET/CT in Men with High-Risk Features and Biochemical Failure After Radical Prostatectomy: Clinical Performance and Patient Outcomes. J Nucl Med 2019; 60:794-800. [PMID: 30442757 PMCID: PMC6581227 DOI: 10.2967/jnumed.118.220103] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 11/01/2018] [Indexed: 12/28/2022] Open
Abstract
A significant proportion of men with rising prostate-specific antigen (PSA) levels after radical prostatectomy (RP) fail prostate fossa (PF) salvage radiation treatment (SRT). This study was done to assess the ability of 18F-fluoromethylcholine (18F-FCH) PET/CT (hereafter referred to as 18F-FCH), 68Ga-HBED-CC PSMA-11 PET/CT (hereafter referred to as PSMA), and pelvic multiparametric MRI (hereafter referred to as pelvic MRI) to identify men who will best benefit from SRT. Methods: Prospective, multisite imaging studies were carried out in men who had rising PSA levels after RP, high-risk features, and negative/equivocal conventional imaging results and who were being considered for SRT. 18F-FCH (91/91), pelvic MRI (88/91), and PSMA (31/91) (Australia) were all performed within 2 wk. Imaging was interpreted by experienced local/central interpreters who were masked with regard to other imaging results, with consensus being reached for discordant interpretations. Expected management was documented before and after imaging, and data about all treatments and PSA levels were collected for 3 y. The treatment response to SRT was defined as a reduction in PSA levels of >50% without androgen deprivation therapy. Results: The median Gleason score, PSA level at imaging, and PSA doubling time were 8, 0.42 (interquartile range, 0.29-0.93) ng/mL, and 5.0 (interquartile range, 3.3-7.6) months. Recurrent prostate cancer was detected in 28% (25/88) by pelvic MRI, 32% (29/91) by 18F-FCH, and 42% (13/31) by PSMA. This recurrence was found within the PF in 21.5% (19/88), 13% (12/91), and 19% (6/31) and at sites outside the PF (extra-PF) in 8% (7/88), 19% (17/91), and 32% (10/31) by MRI, 18F-FCH, and PSMA, respectively (P < 0.004). A total of 94% (16/17) of extra-PF sites on 18F-FCH were within the pelvic MRI field. Intrapelvic extra-PF disease was detected in 90% (9/10) by PSMA and in 31% (5/16) by MRI. 18F-FCH changed management in 46% (42/91), and MRI changed management in 24% (21/88). PSMA provided additional management changes over 18F-FCH in 23% (7/31). The treatment response to SRT was higher in men with negative results or disease confined to the PF than in men with extra-PF disease (18F-FCH 73% [32/44] versus 33% [3/9] [P < 0.02], pelvic MRI 70% [32/46] versus 50% [2/4] [P was not significant], and PSMA 88% [7/8] versus 14% [1/7] [P < 0.005]). Men with negative imaging results (MRI, 18F-FCH, or PSMA) had high (78%) SRT response rates. Conclusion:18F-FCH and PSMA had high detection rates for extra-PF disease in men with negative/equivocal conventional imaging results and rising PSA levels after RP. These findings affected management and treatment responses, suggesting an important role for PET in triaging men being considered for curative SRT.
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Affiliation(s)
- Louise Emmett
- St. Vincent's Hospital, Sydney, New South Wales, Australia
| | - Ur Metser
- University of Toronto, Toronto, Ontario, Canada
| | - Glenn Bauman
- London Health Sciences Centre, London, Ontario, Canada
| | - Rodney J Hicks
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Andrew Weickhardt
- Olivia Newton-John Cancer Research Institute, La Trobe University, Melbourne, Australia and Austin Health, University of Melbourne, Melbourne, Australia
| | - Ian D Davis
- Monash University Eastern Health Clinical School, Box Hill, Victoria, Australia
| | | | - Greg Pond
- McMaster University, Hamilton, Ontario, Canada
| | - Sue Chua
- Royal Marsden Hospital, London, United Kingdom; and
| | - Bao Ho
- St. Vincent's Hospital, Sydney, New South Wales, Australia
| | | | | | - Andrew M Scott
- Olivia Newton-John Cancer Research Institute, La Trobe University, Melbourne, Australia and Austin Health, University of Melbourne, Melbourne, Australia
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14
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Sharma V, Nehra A, Colicchia M, Westerman ME, Kawashima A, Froemming AT, Kwon ED, Mynderse LA, Karnes RJ. Multiparametric Magnetic Resonance Imaging Is an Independent Predictor of Salvage Radiotherapy Outcomes After Radical Prostatectomy. Eur Urol 2018; 73:879-887. [DOI: 10.1016/j.eururo.2017.11.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 11/14/2017] [Indexed: 01/09/2023]
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15
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Couñago F, Recio M, Maldonado A, Del Cerro E, Díaz-Gavela AA, Thuissard IJ, Sanz-Rosa D, Marcos FJ, Olaciregui K, Mateo M, Cerezo L. Evaluation of tumor recurrences after radical prostatectomy using 18F-Choline PET/CT and 3T multiparametric MRI without endorectal coil: a single center experience. Cancer Imaging 2016; 16:42. [PMID: 27927229 PMCID: PMC5142428 DOI: 10.1186/s40644-016-0099-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 12/01/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND To evaluate and compare the utility of 18F-fluorocholine (18F-CH) PET/CT versus 3-Tesla multiparametric MRI (mpMRI) without endorectal coil to detect tumor recurrences in patients with biochemical relapse following radical prostatectomy (RP). Secondarily, to identify possible prognostic variables associated with mpMRI and 18F-CH PET/CT findings. METHODS Retrospective study of 38 patients who developed biochemical recurrence after RP between the years 2011 and 2015 at our institution. PET/CT and mpMRI were both performed within 30 days of each other in all patients. The PET/CT was reviewed by a nuclear medicine specialist while the mpMRI was assessed by a radiologist, both of whom were blinded to outcomes. RESULTS The median prostate-specific antigen (PSA) value pre-MRI/PET-CT was 0.9 ng/mL (interquartile range 0.4-2.2 ng/mL). There were no differences in the detection rate between 18F-CH PET/CT and mpMRI for local recurrence (LR), lymph node recurrence (LNR) and bone metastases (BM). Separately, mpMRI and 18F-CH PET/CT were positive for recurrence in 55.2% and 52.6% of cases, respectively, and in 65.7% of cases when findings from both modalities were considered together. The detection of LR was better with combined mpMRI and choline PET/CT versus choline PET/CT alone (34.2% vs 18.4%, p = 0.04). Salvage treatment was modified in 22 patients (57.8%) based on the imaging findings. PSA values on the day of biochemical failure were significantly associated with mpMRI positivity (adjusted odds ratio (OR): 30.9; 95% confidence interval (CI): 1.5-635.8). Gleason score > 7 was significantly associated with PET/CT positivity (OR: 13.9; 95% CI: 1.5-125.6). A significant association was found between PSA doubling time (PSADT) (OR: 1.3; 95% CI: 1.0-1.7), T stage (OR: 21.1; 95% CI: 1.6-272.1), and LR. CONCLUSIONS Multiparametric MRI and 18F-CH PET/CT yield similar detection rates for LR, LNR and pelvic BM. The combination of both imaging techniques provides a better LR detection versus choline PET/CT alone. The initially planned salvage treatment was modified in 57.8% of patients due to imaging findings. In addition to PSA values, Gleason score, T stage, and PSADT may provide valuable data to identify those patients that are most likely to benefit from undergoing both imaging procedures.
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Affiliation(s)
- Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quiron Madrid, Calle Diego de Velazquez, 1, 28223, Pozuelo de Alarcón, Madrid, Spain.
| | - Manuel Recio
- Department of Radiology, Hospital Universitario Quiron, Madrid, Spain
| | - Antonio Maldonado
- Department of Nuclear Medicine, Hospital Universitario Quiron, Madrid, Spain
| | - Elia Del Cerro
- Department of Radiation Oncology, Hospital Universitario Quiron Madrid, Calle Diego de Velazquez, 1, 28223, Pozuelo de Alarcón, Madrid, Spain
| | - Ana Aurora Díaz-Gavela
- Department of Radiation Oncology, Hospital Universitario Quiron Madrid, Calle Diego de Velazquez, 1, 28223, Pozuelo de Alarcón, Madrid, Spain
| | - Israel J Thuissard
- School of Doctoral Studies and Research, Universidad Europea de Madrid, Madrid, Spain
| | - David Sanz-Rosa
- School of Doctoral Studies and Research, Universidad Europea de Madrid, Madrid, Spain
| | - Francisco José Marcos
- Department of Radiation Oncology, Hospital Universitario Quiron Madrid, Calle Diego de Velazquez, 1, 28223, Pozuelo de Alarcón, Madrid, Spain
| | - Karmele Olaciregui
- Clinical Department, School of Biomedical Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - María Mateo
- Hospital Universitario Quiron, Madrid, Spain
| | - Laura Cerezo
- Department of Radiation Oncology, Hospital Universitario La Princesa, Madrid, Spain
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