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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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Ferrari M, Renard J, Pereira Mestre R, Bosetti DG, Stoffel F, Treglia G. Change of management by using hybrid imaging with radiolabelled choline in biochemical recurrent prostate cancer: a systematic review and a meta-analysis. Clin Transl Imaging 2021. [DOI: 10.1007/s40336-020-00407-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Metser U, Chua S, Ho B, Punwani S, Johnston E, Pouliot F, Tau N, Hawsawy A, Anconina R, Bauman G, Hicks RJ, Weickhardt A, Davis ID, Pond G, Scott AM, Tunariu N, Sidhu H, Emmett L. The Contribution of Multiparametric Pelvic and Whole-Body MRI to Interpretation of 18F-Fluoromethylcholine or 68Ga-HBED-CC PSMA-11 PET/CT in Patients with Biochemical Failure After Radical Prostatectomy. J Nucl Med 2019; 60:1253-1258. [PMID: 30902875 DOI: 10.2967/jnumed.118.225185] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 01/30/2019] [Indexed: 12/24/2022] Open
Abstract
Our purpose was to assess whether the addition of data from multiparametric pelvic MRI (mpMR) and whole-body MRI (wbMR) to the interpretation of 18F-fluoromethylcholine (18F-FCH) or 68Ga-HBED-CC PSMA-11 (68Ga-PSMA) PET/CT (=PET) improves the detection of local tumor recurrence or of nodal and distant metastases in patients after radical prostatectomy with biochemical failure. Methods: The current analysis was performed as part of a prospective, multicenter trial on 18F-FCH or 68Ga-PSMA PET, mpMR, and wbMR. Eligible men had an elevated level of prostate-specific antigen (PSA) (>0.2 ng/mL) and high-risk features (Gleason score > 7, PSA doubling time < 10 mo, or PSA > 1.0 ng/mL) with negative or equivocal conventional imaging results. PET was interpreted with mpMR and wbMR in consensus by 2 radiologists and compared with prospective interpretation of PET or MRI alone. Performance measures of each modality (PET, MRI, and PET/mpMR-wbMR) were compared for each radiotracer and each individual patient (for 18F-FCH, or 68Ga-PSMA for patients who had 68Ga-PSMA PET) and to a composite reference standard. Results: There were 86 patients with PET (18F-FCH [n = 76] and/or 68Ga-PSMA [n = 26]) who had mpMR and wbMR. Local tumor recurrence was detected in 20 of 76 (26.3%) on 18F-FCH PET/mpMR, versus 11 of 76 (14.5%) on 18F-FCH PET (P = 0.039), and in 11 of 26 (42.3%) on 68Ga-PSMA PET/mpMR, versus 6 of 26 (23.1%) on 68Ga-PSMA PET (P = 0.074). Per patient, PET/mpMR was more often positive for local tumor recurrence than PET (P = 0.039) or mpMR (P = 0.019). There were 20 of 86 patients (23.3%) with regional nodal metastases on both PET/wbMR and PET (P = 1.0) but only 12 of 86 (14%) on wbMR (P = 0.061). Similarly, there were more nonregional metastases detected on PET/wbMR than on PET (P = 0.683) or wbMR (P = 0.074), but these differences did not reach significance. Compared with the composite reference standard for the detection of disease beyond the prostatic fossa, PET/wbMR, PET, and wbMR had sensitivity of 50%, 50%, and 8.3%, respectively, and specificity of 97.1%, 97.1%, and 94.1%, respectively. Conclusion: Interpretation of PET/mpMR resulted in a higher detection rate for local tumor recurrence in the prostatic bed in men with biochemical failure after radical prostatectomy. However, the addition of wbMR to 18F-FCH or 68Ga-PSMA PET did not improve detection of regional or distant metastases.
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Affiliation(s)
- Ur Metser
- University of Toronto, Toronto, Canada
| | - Sue Chua
- Royal Marsden Hospital, London, United Kingdom
| | - Bao Ho
- St. Vincent's Hospital, Sydney, Australia
| | | | | | | | - Noam Tau
- University of Toronto, Toronto, Canada
| | | | | | | | | | | | - Ian D Davis
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia; and
| | - Greg Pond
- McMaster University, Hamilton, Ontario Canada
| | | | | | - Harbir Sidhu
- University College London, London, United Kingdom
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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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Couñago F, Sancho G, Catalá V, Hernández D, Recio M, Montemuiño S, Hernández JA, Maldonado A, del Cerro E. Magnetic resonance imaging for prostate cancer before radical and salvage radiotherapy: What radiation oncologists need to know. World J Clin Oncol 2017; 8:305-319. [PMID: 28848697 PMCID: PMC5554874 DOI: 10.5306/wjco.v8.i4.305] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/30/2017] [Accepted: 06/12/2017] [Indexed: 02/06/2023] Open
Abstract
External beam radiotherapy (EBRT) is one of the principal curative treatments for patients with prostate cancer (PCa). Risk group classification is based on prostate-specific antigen (PSA) level, Gleason score, and T-stage. After risk group determination, the treatment volume and dose are defined and androgen deprivation therapy is prescribed, if appropriate. Traditionally, imaging has played only a minor role in T-staging due to the low diagnostic accuracy of conventional imaging strategies such as transrectal ultrasound, computed tomography, and morphologic magnetic resonance imaging (MRI). As a result, a notable percentage of tumours are understaged, leading to inappropriate and imprecise EBRT. The development of multiparametric MRI (mpMRI), an imaging technique that combines morphologic studies with functional diffusion-weighted sequences and dynamic contrast-enhanced imaging, has revolutionized the diagnosis and management of PCa. As a result, mpMRI is now used in staging PCa prior to EBRT, with possible implications for both risk group classification and treatment decision-making for EBRT. mpMRI is also being used in salvage radiotherapy (SRT), the treatment of choice for patients who develop biochemical recurrence after radical prostatectomy. In the clinical context of biochemical relapse, it is essential to accurately determine the site of recurrence - pelvic (local, nodal, or bone) or distant - in order to select the optimal therapeutic management approach. Studies have demonstrated the value of mpMRI in detecting local recurrences - even in patients with low PSA levels (0.3-0.5 ng/mL) - and in diagnosing bone and nodal metastasis. The main objective of this review is to update the role of mpMRI prior to radical EBRT or SRT. We also consider future directions for the use and development of MRI in the field of radiation oncology.
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