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Selles EG, Subiela JD, Maldonado A, Lopez F, Moreno BS, León BDD, Dos Santos VG, Ovide JA, Polledo LEO, Gonzalez D, Guerrero F, Revilla FJB, Kishan AU, Calais J, Counago F. Clinical Usefulness of PSMA PET/CT Imaging in Patients with Suspected Recurrence of Prostate Cancer after Primary RT with PSA below the Phoenix Criteria Threshold: Systematic Review and Meta-Analysis. Int J Radiat Oncol Biol Phys 2023; 117:e387. [PMID: 37785303 DOI: 10.1016/j.ijrobp.2023.06.2506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To assess the detection rate and the patterns of PSMA PET/CT uptake in patients with suspected prostate cancer recurrence after primary radiotherapy with serum PSA levels below the accepted Phoenix definition criteria for biochemical recurrence. MATERIALS/METHODS The meta-analysis was performed according to the PRISMA statement. Studies providing data on patients with suspected prostate cancer recurrence after primary radiotherapy with serum PSA levels below the accepted Phoenix definition criteria were included. RESULTS Atotal of 5 studies included a total of 1334 patients, of which 489 patients with suspected BCR and serum PSA levels below the Phoenix criteria were included. The PSMA PET/CT detection rate (DR) was 60% for PSA <0.5 ng/mL, 76% for PSA 0.5-1 ng/mL, 81.03% for PSA 1-2 ng/mL, and 89.5% for PSA>2. No significant differences were found in the locations of PSMA-PET/CT uptake among those with PSA ≤2 ng/mL, compared with those meeting the Phoenix criteria. The PSMA-PET/CT uptake of local-only recurrence was more likely in patients with PSA <2 ng/mL (local-only recurrence PSA >2 ng/mL [40.07%] vs PSA <2 ng/mL [58.10%]), RR: 0.718 (95% CI: 0.579-0.892). Lymph node, bone, and visceral metastasis detection rates could be extracted from 3 studies (432 patients). For lymph nodes, the DR was 46% (95% CI: 38-54) in patients outside the Phoenix criteria threshold, and 50% (95% CI: 39-62) in patients with PSA>2 ng/mL. The DR for bone metastases was 19% (95% CI: 12-28) in patients outside the Phoenix criteria threshold, and 25% (95% CI: 19-31) in patients with PSA>2 ng/mL. The DR for visceral metastases was 3% (95% CI: 0-7) in patients outside the Phoenix criteria threshold, and 2% (95% CI: 0-4) in patients with PSA>2 ng/mL. The potentially salvageable disease was considered when all evidence of avid disease could be safely treated with local therapy. This data could be extracted from two studies (343 patients). A higher proportion of disease potentially amenable to salvage therapy was reported in patients outside the Phoenix criteria threshold [salvageable disease: PSA ≤2 ng/mL: 69% (95% CI: 57-80), and PSA >2 ng/mL: 61% (95% CI: 55-66). The pooled risk ratio meta-analysis showed no statistically significant differences between the two previous groups RR: 0.91 (95% CI: 0.75-1.10). CONCLUSION PSMAPET/CT can detect prostate cancer recurrence in patients with PSA levels below the Phoenix criteria threshold (reaching up to 80%). Local-only recurrence detection by PSMA PET/CT was more likely in patients with PSA <2 ng/mL. The data from the present meta-analysis shows that a critical review of the Phoenix criteria in the era of PSMA PET/CT might be warranted. Nevertheless, the lack of anatomopathological validation and the retrospective nature of the studies are some of our limitations.
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Affiliation(s)
- E Gomis Selles
- Radiation Oncology Department, University Hospital Virgen del Rocío, Biomedical Institute of Seville (IBIS)/CSIC/University of Seville, Seville, Spain
| | - J D Subiela
- Department of Urology, Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain, Madrid, Spain
| | - A Maldonado
- University Hospital Quironsalud Madrid/La Luz Hospital, Madrid, Spain
| | - F Lopez
- Radiation Oncology Department, University Hospital Ramon y Cajal, Madrid, Spain
| | | | - B D Delgado León
- Radiation Oncology Department, University Hospital Virgen del Rocío, Biomedical Institute of Seville (IBIS)/CSIC/University of Seville, Seville, Spain
| | - V Gomez Dos Santos
- Department of Urology, Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain
| | - J Aumatell Ovide
- Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Spain, Barcelona, Spain
| | - L E Ortega Polledo
- Department of Urology, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Alcalá de Henares-Madrid, Madrid, Spain
| | - D Gonzalez
- Department of Urology, Clínica Universidad de Navarra, Madrid, Spain
| | - F Guerrero
- Department of Urology, University Hospital 12 de Octubre, Madrid, Spain
| | - F J Burgos Revilla
- Department of Urology, Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain, Madrid, Spain
| | - A U Kishan
- Department of Urology, University of California, Los Angeles, Los Angeles, CA
| | - J Calais
- Ahmanson Translational Theranostics Division, UCLA Nuclear Medicine, Los Angeles, CA
| | - F Counago
- San Francisco de Asís and La Milagrosa Hospitals. National Chair of Research. GenesisCare Spain, Madrid, Spain
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Nieto-Guerrero Gómez JM, Silva Vega GP, Cacicedo J, Delgado León BD, Herrero Rivera D, Praena Fernández JM, Rivin Del Campo E, Ortiz Gordillo MJ, López Guerra JL. Impact of pre-radiation therapy quality of life in lung cancer survival: a prospective, intention-to-treat, multicenter study. Clin Transl Oncol 2020; 22:1635-1644. [PMID: 32072471 DOI: 10.1007/s12094-020-02310-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 01/21/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Lung cancer (LC) has a significant impact on patients' health-related quality of life (HRQoL). We investigate the correlations between pre-radiation therapy HRQoL and survival. MATERIALS AND METHODS A prospective, intention-to-treat, multicentre study of 437 patients with LC recruited at the radiation oncology departments of three different institutions was conducted between 2012 and 2016. QoL was assessed using the EORTC-QLQ-C30 (v3.0) and EORTC-QLQ-LC13 questionnaires. Global health status (GHS), physical (PF), role functioning (RF), emotional (EF), cognitive (CF), and social functioning (SF) as well as symptoms scores were evaluated in univariate and multivariate analyses. RESULTS The cohort consisted of 376 men (86%) and 61 women, with a median age of 66 years (range 31-88). Histology was: 72% (n = 315) non-small cell lung cancer and 28% small cell lung cancer. The most common stage was III (80%) and the median follow-up for alive patients was 30 months (range 7-76). Multivariate analysis showed that RF was associated with a lower risk of mortality (HR: 0.693; p = 0.008) and recurrence (HR: 0.737; p = 0.040). Additionally, lower scores on EF and PF were associated with higher mortality (HR: 0.696; p = 0.003 and HR: 0.765; p = 0.044, respectively). Appetite loss, constipation, and dysphagia were associated with a higher risk of mortality (HR: 1.985; p < 0.001, HR: 1.373; p = 0.036, and HR: 1.659; p = 0.002, respectively), while appetite loss was the only symptom associated with a higher risk of recurrence (HR: 1.525; p = 0.014). CONCLUSIONS Pre-radiation therapy scores on RF, EF, and PF and symptoms like appetite loss, dysphagia, and constipation were associated with the risk of mortality. This information could be added to other prognostic factors to guide our treatment decisions.
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Affiliation(s)
- J M Nieto-Guerrero Gómez
- Department of Radiation Oncology, Virgen del Rocío University Hospital, Manuel Siurot Avenue, s/n. 41013, Seville, Spain
| | - G P Silva Vega
- Department of Radiation Oncology, Virgen del Rocío University Hospital, Manuel Siurot Avenue, s/n. 41013, Seville, Spain.,Master of Cognitive and Behavioral Neuroscience, University of Granada, Granada, Spain
| | - J Cacicedo
- Department of Radiation Oncology, Cruces University Hospital, Bilbao, Spain
| | - B D Delgado León
- Department of Radiation Oncology, Virgen del Rocío University Hospital, Manuel Siurot Avenue, s/n. 41013, Seville, Spain
| | - D Herrero Rivera
- Department of Medical Oncology, Virgen del Rocío University Hospital, Seville, Spain
| | | | - E Rivin Del Campo
- Department of Radiation Oncology, Tenon University Hospital, Hôpitaux Universitaires Est Parisien, Sorbonne University Medical Faculty, Paris, France
| | - M J Ortiz Gordillo
- Department of Radiation Oncology, Virgen del Rocío University Hospital, Manuel Siurot Avenue, s/n. 41013, Seville, Spain.,Instituto de Biomedicina de Sevilla (IBIS/HUVR/CSIC/Universidad de Sevilla), Seville, Spain
| | - J L López Guerra
- Department of Radiation Oncology, Virgen del Rocío University Hospital, Manuel Siurot Avenue, s/n. 41013, Seville, Spain. .,Instituto de Biomedicina de Sevilla (IBIS/HUVR/CSIC/Universidad de Sevilla), Seville, Spain.
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