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Sutera P, Song Y, Van der Eecken K, Shetty AC, English K, Hodges T, Chang J, Fonteyne V, Rana Z, Ren L, Mendes AA, Lumen N, Delrue L, Verbeke S, De Man K, Song DY, Pienta K, Feng FY, Joniau S, Lotan T, Lane B, Kiess A, Rowe S, Pomper M, DeWeese T, Deek M, Sweeney C, Ost P, Tran PT. Clinical and Genomic Differences Between Advanced Molecular Imaging-detected and Conventional Imaging-detected Metachronous Oligometastatic Castration-sensitive Prostate Cancer. Eur Urol 2023; 84:531-535. [PMID: 37173210 PMCID: PMC10636237 DOI: 10.1016/j.eururo.2023.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/29/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023]
Abstract
In metastatic castration-sensitive prostate cancer (mCSPC), disease volume plays an integral role in guiding treatment recommendations, including selection of docetaxel therapy, metastasis-directed therapy, and radiation to the prostate. Although there are multiple definitions of disease volume, they have commonly been studied in the context of metastases detected via conventional imaging (CIM). One such numeric definition of disease volume, termed oligometastasis, is heavily dependent on the sensitivity of the imaging modality. We performed an international multi-institutional retrospective review of men with metachronous oligometastatic CSPC (omCSPC), detected via either advanced molecular imaging alone (AMIM) or CIM. Patients were compared with respect to clinical and genomic features using the Mann-Whitney U test, Pearson's χ2 test, and Kaplan-Meier overall survival (OS) analyses with a log-rank test. A total of 295 patients were included for analysis. Patients with CIM-omCSPC had significantly higher Gleason grade group (p = 0.032), higher prostate-specific antigen at omCSPC diagnosis (8.0 vs 1.7 ng/ml; p < 0.001), more frequent pathogenic TP53 mutations (28% vs 17%; p = 0.030), and worse 10-yr OS (85% vs 100%; p < 0.001). This is the first report of clinical and biological differences between AMIM-detected and CIM-detected omCSPC. Our findings are particularly important for ongoing and planned clinical trials in omCSPC. PATIENT SUMMARY: Metastatic prostate cancer with just a few metastases only detected via newer scanning methods (called molecular imaging) is associated with fewer high-risk DNA mutations and better survival in comparison to metastatic cancer detected via conventional scan methods.
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Affiliation(s)
- Philip Sutera
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yang Song
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kim Van der Eecken
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium; Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Amol C Shetty
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Keara English
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Theresa Hodges
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jinhee Chang
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Valérie Fonteyne
- Department of Radiation Oncology, Ghent University Hospital, Belgium
| | - Zaker Rana
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lei Ren
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Adrianna A Mendes
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicolaas Lumen
- Department of Radiation Oncology, Ghent University Hospital, Belgium
| | - Louke Delrue
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Sofie Verbeke
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Kathia De Man
- Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Daniel Y Song
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA; James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kenneth Pienta
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA; James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Felix Y Feng
- Departments of Medicine, Urology and Radiation Oncology, University of California-San Francisco, San Francisco, CA, USA
| | - Steven Joniau
- Department of Radiation Oncology, Catholic University Leuven, Leuven, Belgium
| | - Tamara Lotan
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Barton Lane
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ana Kiess
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Steven Rowe
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Martin Pomper
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA; James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA; The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Theodore DeWeese
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew Deek
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Christopher Sweeney
- South Australian Immunogenomics Cancer Institute, University of Adelaide, Adelaide, Australia
| | - Piet Ost
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium; Department of Radiation Oncology, Iridium Network, Antwerp, Belgium.
| | - Phuoc T Tran
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA.
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Debacker JM, Maris L, Cordier F, Creytens D, Deron P, Descamps B, D'Asseler Y, De Man K, Keereman V, Libbrecht S, Schelfhout V, Van de Vijver K, Vanhove C, Huvenne W. Direct co-registration of [ 18F]FDG uptake and histopathology in surgically excised malignancies of the head and neck: a feasibility study. Eur J Nucl Med Mol Imaging 2023; 50:2127-2139. [PMID: 36854863 DOI: 10.1007/s00259-023-06153-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/13/2023] [Indexed: 03/02/2023]
Abstract
PURPOSE Recent technical advancements in PET imaging have improved sensitivity and spatial resolution. Consequently, clinical nuclear medicine will be confronted with PET images on a previously unfamiliar resolution. To better understand [18F]FDG distribution at submillimetric scale, a direct correlation of radionuclide-imaging and histopathology is required. METHODS A total of five patients diagnosed with a malignancy of the head and neck were injected with a clinical activity of [18F]FDG before undergoing surgical resection. The resected specimen was imaged using a preclinical high-resolution PET/CT, followed by slicing of the specimen. Multiple slices were rescanned using a micro-PET/CT device, and one of the slices was snap-frozen for frozen sections. Frozen sections were placed on an autoradiographic film, followed by haematoxylin and eosin staining to prepare them for histopathological assessment. The results from both autoradiography and histopathology were co-registered using an iterative co-registration algorithm, and regions of interest were identified to study radiotracer uptake. RESULTS The co-registration between the autoradiographs and their corresponding histopathology was successful in all specimens. The use of this novel methodology allowed direct comparison of autoradiography and histopathology and enabled the visualisation of uncharted heterogeneity in [18F]FDG uptake in both benign and malignant tissue. CONCLUSION We here describe a novel methodology enabling the direct co-registration of [18F]FDG autoradiography with the gold standard of histopathology in human malignant tissue. The future use of the current methodology could further increase our understanding of the distribution of radionuclides in surgically excised malignancies and hence, improve the integration of pathology and molecular imaging in a multiscale perspective. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05068687.
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Affiliation(s)
- Jens M Debacker
- Department of Head and Skin, Ghent University, Ghent, Belgium.
- Department of Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium.
- Department of Nuclear Medicine, UZ Brussel, Brussels, Belgium.
- In vivo Cellular and Molecular Imaging Laboratory (ICMI), Vrije Universiteit Brussel, Brussels, Belgium.
- Cancer Research Institute Ghent, Ghent, Belgium.
| | - Luna Maris
- Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
- XEOS Medical, Ghent, Belgium
| | - Fleur Cordier
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - David Creytens
- Cancer Research Institute Ghent, Ghent, Belgium
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Philippe Deron
- Department of Head and Skin, Ghent University, Ghent, Belgium
- Department of Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium
| | - Benedicte Descamps
- Cancer Research Institute Ghent, Ghent, Belgium
- Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
- INFINITY Lab, Ghent University, Ghent, Belgium
| | - Yves D'Asseler
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
- Department of Medical Imaging, Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Kathia De Man
- Department of Medical Imaging, Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Vincent Keereman
- Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
- XEOS Medical, Ghent, Belgium
| | - Sasha Libbrecht
- Department of Pathology, Antwerp University Hospital, Edegem, Belgium
| | - Vanessa Schelfhout
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
- Department of Medical Imaging, Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Koen Van de Vijver
- Cancer Research Institute Ghent, Ghent, Belgium
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Christian Vanhove
- Cancer Research Institute Ghent, Ghent, Belgium
- Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
- INFINITY Lab, Ghent University, Ghent, Belgium
| | - Wouter Huvenne
- Department of Head and Skin, Ghent University, Ghent, Belgium
- Department of Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium
- Cancer Research Institute Ghent, Ghent, Belgium
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Maris L, De Man K, Gryspeerdt F, Hoorens A, Keereman V, Kiekens A, Van den Broeck B, Van de Sande L, Vanhove C, Berrevoet F. 18F-FDG-PET-CT specimen imaging for perioperative visualization of pancreatic adenocarcinoma: a proof-of-concept study. European Journal of Surgical Oncology 2023. [DOI: 10.1016/j.ejso.2022.11.445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Lambert E, Lumen N, Fonteyne V, De Maeseneer D, Verbeke S, Villeirs G, De Man K, Van Praet C. The changing landscape of systemic therapy in the treatment of synchronous metastatic hormone-sensitive prostate cancer. Clin Genitourin Cancer 2022; 21:415.e1-415.e8. [DOI: 10.1016/j.clgc.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 10/30/2022] [Accepted: 11/02/2022] [Indexed: 11/15/2022]
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Deek MP, Van der Eecken K, Sutera P, Deek RA, Fonteyne V, Mendes AA, Decaestecker K, Kiess AP, Lumen N, Phillips R, De Bruycker A, Mishra M, Rana Z, Molitoris J, Lambert B, Delrue L, Wang H, Lowe K, Verbeke S, Van Dorpe J, Bultijnck R, Villeirs G, De Man K, Ameye F, Song DY, DeWeese T, Paller CJ, Feng FY, Wyatt A, Pienta KJ, Diehn M, Bentzen SM, Joniau S, Vanhaverbeke F, De Meerleer G, Antonarakis ES, Lotan TL, Berlin A, Siva S, Ost P, Tran PT. Long-Term Outcomes and Genetic Predictors of Response to Metastasis-Directed Therapy Versus Observation in Oligometastatic Prostate Cancer: Analysis of STOMP and ORIOLE Trials. J Clin Oncol 2022; 40:3377-3382. [PMID: 36001857 PMCID: PMC10166371 DOI: 10.1200/jco.22.00644] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/02/2022] [Accepted: 07/21/2022] [Indexed: 11/20/2022] Open
Abstract
Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.The initial STOMP and ORIOLE trial reports suggested that metastasis-directed therapy (MDT) in oligometastatic castration-sensitive prostate cancer (omCSPC) was associated with improved treatment outcomes. Here, we present long-term outcomes of MDT in omCSPC by pooling STOMP and ORIOLE and assess the ability of a high-risk mutational signature to risk stratify outcomes after MDT. The primary end point was progression-free survival (PFS) calculated using the Kaplan-Meier method. High-risk mutations were defined as pathogenic somatic mutations within ATM, BRCA1/2, Rb1, or TP53. The median follow-up for the whole group was 52.5 months. Median PFS was prolonged with MDT compared with observation (pooled hazard ratio [HR], 0.44; 95% CI, 0.29 to 0.66; P value < .001), with the largest benefit of MDT in patients with a high-risk mutation (HR high-risk, 0.05; HR no high-risk, 0.42; P value for interaction: .12). Within the MDT cohort, the PFS was 13.4 months in those without a high-risk mutation, compared with 7.5 months in those with a high-risk mutation (HR, 0.53; 95% CI, 0.25 to 1.11; P = .09). Long-term outcomes from the only two randomized trials in omCSPC suggest a sustained clinical benefit to MDT over observation. A high-risk mutational signature may help risk stratify treatment outcomes after MDT.
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Affiliation(s)
- Matthew P Deek
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kim Van der Eecken
- Department of Pathology and Human Structure and Repair, University of Ghent, Ghent, Belgium
| | - Philip Sutera
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rebecca A Deek
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Valérie Fonteyne
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Adrianna A Mendes
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Ana Ponce Kiess
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nicolaas Lumen
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Ryan Phillips
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | | | - Mark Mishra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - Zaker Rana
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - Jason Molitoris
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - Bieke Lambert
- Department of Radiology and Nuclear Medicine, Ghent University, and Department of Nuclear Medicine, AZ Maria-Middelares Ghent, Belgium
| | - Louke Delrue
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Hailun Wang
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kathryn Lowe
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sofie Verbeke
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Jo Van Dorpe
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Renée Bultijnck
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Geert Villeirs
- Department of Radiology and Nuclear Medicine, Ghent University, and Department of Nuclear Medicine, AZ Maria-Middelares Ghent, Belgium
| | - Kathia De Man
- Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Filip Ameye
- Department of Urology, AZ Maria-Middelares Ghent, Ghent, Belgium
| | - Daniel Y Song
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Theodore DeWeese
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Channing J Paller
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Felix Y Feng
- Departments of Medicine, Urology and Radiation Oncology, UCSF, San Francisco, CA
| | - Alexander Wyatt
- Department of Urologic Sciences, University of British Columbia, and Vancouver Prostate Centre, Vancouver, Canada
| | - Kenneth J Pienta
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
- James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, MD
| | - Maximillian Diehn
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Soren M Bentzen
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Steven Joniau
- Department of Urology, Catholic University Leuven, Leuven, Belgium
| | | | - Gert De Meerleer
- Department of Radiation Oncology, Catholic University Leuven, Leuven, Belgium
| | | | - Tamara L Lotan
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alejandro Berlin
- Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada
| | - Shankar Siva
- Department of Radiation Oncology, Peter MacCallum Cancer Center, Melbourne Australia
| | - Piet Ost
- Department of Radiation Oncology, Iridium Network, Antwerp, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Phuoc T Tran
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
- James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, MD
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Deek MP, Van der Eecken K, Sutera P, Deek RA, Fonteyne V, Mendes A, Lumen N, Phillips R, Delrue L, Verbeke S, De Man K, Song DY, Paller CJ, Joniau S, De Meerleer G, Lotan TL, Berlin A, Siva S, Ost P, Tran PT. Long-term outcomes and genetic predictors of response to metastasis-directed therapy versus observation in oligometastatic castration-sensitive prostate cancer: A pooled analysis of the STOMP and ORIOLE trials. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.5025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5025 Background: Prospective reports suggest metastasis directed therapy (MDT) in oligometastatic castration sensitive prostate cancer (omCSPC) is associated with improved treatment outcomes. Here we present long term outcomes of the phase II STOMP and ORIOLE trials and assess the ability of a high-risk (HiRi) mutational signature to provide prognostic and predictive information regarding MDT response. Methods: Patients with omCSPC (< 3 lesions) enrolled on STOMP (n = 62) and ORIOLE (n = 54) randomized to MDT or observation were pooled. The primary endpoint was progression-free survival (PFS) defined as either PSA or radiographic progression, initiation of androgen deprivation, or death. Secondary endpoint was radiographic PFS (rPFS) defined as radiographic progression or death. Both were calculated using the Kaplan-Meier method and stratified by treatment group. Next generation sequencing (NGS) was performed to identify a HiRi mutational signature defined as pathogenic mutations within ATM, BRCA1/2, Rb1, or TP53. Cox proportional hazards regressions were fit to calculate hazard ratios (HR) and assess the prognostic and predictive values of HiRi mutational status. Results: Median follow-up was 52.5 months. Median PFS was prolonged with MDT (11.9 months) compared to observation (5.9 months) with a pooled HR of 0.44 (95% CI, 0.29 – 0.66, p-value < 0.001). MDT was associated with PSA decrease in a majority of patients (84%) as compared to the observation group (41%). On NGS, the incidence of a pathogenic mutation in a HiRi gene was 24.3%. HiRi mutation was prognostic for PFS -- in those without a HiRi mutation median PFS was 11.9 months compared to 5.9 months in those with a HiRi mutation (HR of 1.74, p = 0.06). HiRi mutation was also prognostic for rPFS -- those without a high-risk mutation experienced median rPFS of 22.6 months compared to 10.0 months in those with a high-risk mutation (HR 2.62, p < 0.01). Tumors without a HiRi mutation treated with MDT experienced the longest PFS (13.4 months) while those with a HiRi randomized to observation experienced the shortest PFS (2.8 months). Stratifying by both treatment arms and HiRi status appeared to show a differential benefit to MDT, with those with HiRi mutations experiencing a larger relative magnitude of benefit to treatment: (HiRi mutation: HR of 0.05, p < 0.01; no HiRi mutation: HR of 0.42, p = 0.01; p interaction, 0.12) suggesting a HiRi mutational status can provide information regarding differential response to treatment. Conclusions: Long-term outcomes from the only two randomized trials in omCSPC suggest a sustained benefit to MDT over observation. A HiRi mutational signature appears prognostic for outcomes in omCSPC and those with HiRi might have a relatively larger magnitude of response to MDT. Future studies are needed to optimize patient selection. Clinical trial information: NCT02680587.
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Affiliation(s)
| | | | | | | | | | | | | | - Ryan Phillips
- Department of Radiation Oncology, The Mayo Clinic, Rochester, MN
| | - Louke Delrue
- Department of Radiology, Gent University Hospital, Gent, Belgium
| | - Sofie Verbeke
- Ghent University Hospital, Department of Pathology, Ghent, Belgium
| | - Kathia De Man
- Department of Nuclear Medicine, Ghent University Hospital, Gent, Belgium
| | - Daniel Y. Song
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | | | - Tamara L. Lotan
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alejandro Berlin
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Shankar Siva
- Department of Radiation Oncology Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Piet Ost
- Ghent University Hospital, Ghent, Belgium
| | - Phuoc T. Tran
- University of Maryland School of Medicine, Baltimore, MD
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Vandekerckhove E, Ameloot E, Hoorens A, De Man K, Berrevoet F, Geboes K. Intrapancreatic accessory spleen mimicking pancreatic NET: can unnecessary surgery be avoided? Acta Clin Belg 2021; 76:492-495. [PMID: 32394810 DOI: 10.1080/17843286.2020.1762351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Pancreatic nodules are frequently found incidentally and often pose a diagnostic and therapeutic challenge when surgery is considered. We present the case of a 66-year-old cirrhotic patient with a pancreatic nodule with signal intensity and contrast enhancement pattern suggestive for a non-functional neuroendocrine lesion. A 68Gallium-DOTATOC PET-CT scan revealed a correspondent focal tracer uptake in the pancreatic tail. After distal pancreatectomy, the specimen surprisingly revealed intrapancreatic splenic tissue. Nuclear imaging has previously been reported to produce a false-positive result for the presence of a neuroendocrine tumor when an intrapancreatic accessory spleen is present. This case reminds us of the diagnostic pitfalls in pancreatic nodules, to consider a broad differential diagnosis and to remain critical before referring the patient for surgery.
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Affiliation(s)
| | - Eline Ameloot
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Anne Hoorens
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Kathia De Man
- Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Frederik Berrevoet
- Department of Hepatobiliary Surgery, Ghent University Hospital, Ghent, Belgium
| | - Karen Geboes
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
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Verghote F, Poppe L, Verbeke S, Dirix P, Albersen M, De Meerleer G, Berghen C, Ost P, Villeirs G, De Visschere P, De Man K, De Maeseneer D, Rottey S, Van Praet C, Decaestecker K, Fonteyne V. Evaluating the impact of 18F-FDG-PET-CT on risk stratification and treatment adaptation for patients with muscle-invasive bladder cancer (EFFORT-MIBC): a phase II prospective trial. BMC Cancer 2021; 21:1113. [PMID: 34663254 PMCID: PMC8522089 DOI: 10.1186/s12885-021-08861-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/11/2021] [Indexed: 12/09/2022] Open
Abstract
Background The outcome of patients with muscle-invasive bladder cancer (MIBC) remains poor, despite aggressive treatments. Inadequate primary staging, classically performed by computed tomography (CT)-imaging, could lead to inappropriate treatment and might contribute to these poor results. Although not (yet) adapted by international guidelines, several reports have indicated the superiority of 18F-fluorodeoxyglucose-positron emission tomography-CT (18F-FDG-PET-CT) compared to CT in the detection of lymph node and distant metastases. Thereby the presence of extra-vesical disease on 18F-FDG-PET-CT has been correlated with a worse overall survival. This supports the hypothesis that 18F-FDG-PET-CT is useful in stratifying MIBC patients and that adapting the treatment plan accordingly might result in improved outcome. Methods EFFORT-MIBC is a multicentric prospective phase II trial aiming to include 156 patients. Eligible patients are patients with histopathology-proven MIBC or ≥ T3 on conventional imaging treated with MIBC radical treatment, without extra-pelvic metastases on conventional imaging (thoracic CT and abdominopelvic CT/ magnetic resonance imaging (MRI)). All patients will undergo radical local therapy and if eligible neo-adjuvant chemotherapy. An 18F-FDG-PET-CT will be performed in addition to and at the timing of the conventional imaging. In case of presence of extra-pelvic metastasis on 18F-FDG-PET-CT, appropriate intensification of treatment with metastasis-directed therapy (MDT) (in case of ≤3 metastases) or systemic immunotherapy (> 3 metastases) will be provided. The primary outcome is the 2-year overall survival rate. Secondary endpoints are progression-free survival, distant metastasis-free survival, disease-specific survival and quality of life. Furthermore, the added diagnostic value of 18F-FDG-PET-CT compared to conventional imaging will be evaluated and biomarkers in tumor specimen, urine and blood will be correlated with primary and secondary endpoints. Discussion This is a prospective phase II trial evaluating the impact of 18F-FDG-PET-CT in stratifying patients with primary MIBC and tailoring the treatment accordingly. We hypothesize that the information on the pelvic nodes can be used to guide local treatment and that the presence of extra-pelvic metastases enables MDT or necessitates the early initiation of immunotherapy leading to an improved outcome. Trial registration The Ethics Committee of the Ghent University Hospital (BC-07456) approved this study on 11/5/2020. The trial was registered on ClinicalTrials.gov (NCT04724928) on 21/1/2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08861-x.
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Affiliation(s)
- Flor Verghote
- Department of Radiotherapy-Oncology, Ghent University Hospital, Ghent, Belgium. .,Department of Human structure and Repair, Ghent University, Ghent, Belgium.
| | - Lindsay Poppe
- Department of Radiotherapy-Oncology, Ghent University Hospital, Ghent, Belgium.,Department of Human structure and Repair, Ghent University, Ghent, Belgium
| | - Sofie Verbeke
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Piet Dirix
- Department of Radiation-Oncology, Iridium Network, Antwerp, Belgium
| | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Gert De Meerleer
- Department of Radiotherapy-Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Charlien Berghen
- Department of Radiotherapy-Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Piet Ost
- Department of Human structure and Repair, Ghent University, Ghent, Belgium
| | - Geert Villeirs
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | | | - Kathia De Man
- Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Daan De Maeseneer
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Sylvie Rottey
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Charles Van Praet
- Department of Human structure and Repair, Ghent University, Ghent, Belgium.,Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Karel Decaestecker
- Department of Human structure and Repair, Ghent University, Ghent, Belgium.,Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Valérie Fonteyne
- Department of Radiotherapy-Oncology, Ghent University Hospital, Ghent, Belgium.,Department of Human structure and Repair, Ghent University, Ghent, Belgium
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9
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Lumen N, De Bleser E, Buelens S, Verla W, Poelaert F, Claeys W, Fonteyne V, Verbeke S, Villeirs G, De Man K, Rottey S, Van Praet C, Decaestecker K, Ost P. The Role of Cytoreductive Radical Prostatectomy in the Treatment of Newly Diagnosed Low-volume Metastatic Prostate Cancer. Results from the Local Treatment of Metastatic Prostate Cancer (LoMP) Registry. EUR UROL SUPPL 2021; 29:68-76. [PMID: 34337536 PMCID: PMC8317829 DOI: 10.1016/j.euros.2021.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 11/06/2022] Open
Abstract
Background Radiotherapy to the prostate (RTp) prolongs survival for patients with low-volume, newly diagnosed metastatic prostate cancer (ndmPC). Objective to evaluate whether cytoreductive radical prostatectomy (cRP) is equally beneficial as RTp in low-volume ndmPC. Design, setting, and participants A multicenter prospective registry was established in 2014 to observe patients with ndmPC. Eligible patients were offered cRP or RTp. For this study we selected only patients with low-volume ndmPC (n = 109). Of these, 48, 26, and 35 patients underwent cRP, RTp, and no local therapy (NLT), respectively. Median follow-up was 32 mo (interquartile range 16–49). Intervention cRP was compared with RTp and NLT. Outcome measurements and statistical analysis Overall survival (OS), cancer-specific survival (CSS), and local event–free survival (LEFS) were calculated using the Kaplan-Meier method. Factors prognostic for OS were identified using univariate and multivariate Cox regression analysis. Results and limitations The 2-yr OS was 93%, 100%, and 69%, and 2-yr CSS was 93%, 100%, and 75% for cRP, RTp, and NLT, respectively. The cRP and RTp groups had better OS compared to NLT and there was no significant difference between cRP and RTp. The 2-yr LEFS was 92%, 77%, and 60% for cRP, RTp, and NLT, respectively. The cRP group had better LEFS compared to RTp and NLT, and there was no significant difference between RTp and NLT. Advanced tumor stage, Eastern Cooperative Oncology Group performance status ≥2, and NLT were negative prognostic factors for OS. The main limitation is selection of fitter patients with less advanced tumors for cRP and the small sample size. Conclusions For selected patients with low-volume ndmPC, cRP is able to achieve similar OS and CSS to RTp. cRP is effective in preventing local events due to disease progression. Patient summary Patients with a low volume of newly diagnosed prostate cancer that has spread beyond the prostate gland might benefit from removal of the prostate, which we found was as effective as radiotherapy to the prostate in prolonging survival. Removal of the prostate is effective in preventing urinary problems caused by cancer progression.
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Affiliation(s)
- Nicolaas Lumen
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Elise De Bleser
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Sarah Buelens
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Wesley Verla
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Filip Poelaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Wietse Claeys
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Valérie Fonteyne
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Sofie Verbeke
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Geert Villeirs
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Kathia De Man
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Sylvie Rottey
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | | | | | - Piet Ost
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
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10
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Vlaemynck K, De Man M, De Man K, Hoorens A, Geboes K. Neuroendocrine tumor with diarrhea: not always the usual suspects - a case report of metastatic calcitoninoma with literature review. Acta Clin Belg 2021; 76:239-243. [PMID: 31900071 DOI: 10.1080/17843286.2020.1711668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We describe a case of a 59-year-old man without relevant past medical history, presenting with chronic diarrhea and weight loss. Extensive laboratory analysis, stool cultures and gastro- and ileocolonoscopy could not identify a diagnosis. Abdominal imaging revealed a mass in the uncinate process of the pancreas with mesenteric adenopathies and liver metastases. Fine needle aspiration was compatible with a pancreatic neuroendocrine tumor with low proliferative capacity (Ki-67 <1%). Immunohistochemical staining was positive for calcitonin and serum calcitonin levels were clearly elevated. Surprisingly, 18FDG PET-CT scan was positive, but no tracer uptake was seen on 68Gallium-DOTATOC PET-CT scan. Treatment with somatostatin analogues was not successful, but long-term tumor control could be obtained with Everolimus. However, no significant effect was seen on stool frequency despite additional treatment with multiple symptomatic therapies, liver-directed therapy with radio- and chemoembolization and additional external radiotherapy to the primary pancreatic tumor. Ondansetron, eventually, seems to be the only therapy, until now, causing a decrease in stool frequency.Functioning pancreatic calcitoninomas are considered to be a rare disease entity with few literature on optimal (nuclear) imaging and treatment. We discuss molecular insights regarding these aspects that can be of great interest to nuclear medicine physicians, pathologists, endocrinologists and gastroenterologists.
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Affiliation(s)
- Kenny Vlaemynck
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - Marc De Man
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - Kathia De Man
- Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Anne Hoorens
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Karen Geboes
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
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11
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De Jaeghere EA, Laloo F, Lippens L, Van Bockstal M, De Man K, Naert E, Van Dorpe J, Van de Vijver K, Tummers P, Makar A, De Visschere PJL, De Wever O, Amant F, Denys HG, Vandecasteele K. Splenic 18F-FDG uptake on baseline PET/CT is associated with oncological outcomes and tumor immune state in uterine cervical cancer. Gynecol Oncol 2020; 159:335-343. [PMID: 32859399 DOI: 10.1016/j.ygyno.2020.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 04/25/2020] [Accepted: 08/02/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The spleen represents an important contributor to tumor immune escape, but the relevance of increased splenic metabolic activity remains to be fully elucidated. METHODS We retrospectively measured the spleen-to-liver standard uptake value (SLR) on 18F-FDG PET/CT examinations of 92 consecutive patients with FIGO stage IB1 to IVA cervical cancer and integrated the results with survival, response to treatment, tumor immune infiltrate, and baseline characteristics. RESULTS SLRmax > 0.92 (p = .026) and SLRmean > 0.94 (p = .005) were significantly associated with decreased DFS in univariable analysis. Multivariable models were built using best subset selection; ΔSLRmax and either SLRmax or SLRmean were consistently selected, strongly reinforcing the association between SLR variables and DFS in relation to potential confounders (all models p ≤ .002). Independent associations were found for SLRmax using multivariable Cox regression models for DFS (all p ≤ .003). Further, uni- and multivariable analyses demonstrated the negative impact of higher SLR values on pathological complete response. A statistically significant higher proportion of patients with high SLRmax had a dense infiltrate of CD20+ (p = .036) and CD68+ (p = .015) immune cells, as well as PD-L1+ tumor cells (p = .019) as compared to those with low SLRmax. Finally, high SLRmax status was neither associated with systemic inflammatory markers (except for an increased white blood cell count; p = .038), nor with clinically overt infection. CONCLUSION This hypothesis-generating study provides the first evidence that increased splenic metabolic activity is a negative prognostic and predictive biomarker in locally advanced cervical cancer. In addition, it might help to discriminate immunologically 'hot' from 'cold' cervical tumors.
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Affiliation(s)
- Emiel A De Jaeghere
- Medical Oncology, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium; Laboratory of Experimental Cancer Research (LECR), Department of Human Structure and Repair, Ghent University, Ghent, Belgium; Cancer Research Institute Ghent (CRIG), Ghent, Belgium; Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium.
| | - Frederiek Laloo
- Radiology and Nuclear Medicine, Department of Diagnostic Sciences, Ghent University Hospital, Belgium
| | - Lien Lippens
- Medical Oncology, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium; Laboratory of Experimental Cancer Research (LECR), Department of Human Structure and Repair, Ghent University, Ghent, Belgium; Cancer Research Institute Ghent (CRIG), Ghent, Belgium; Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium
| | | | - Kathia De Man
- Radiology and Nuclear Medicine, Department of Diagnostic Sciences, Ghent University Hospital, Belgium
| | - Eline Naert
- Medical Oncology, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium; Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium
| | - Jo Van Dorpe
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium; Pathology, Department of Diagnostic Sciences, Ghent University Hospital, Belgium
| | - Koen Van de Vijver
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium; Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium; Pathology, Department of Diagnostic Sciences, Ghent University Hospital, Belgium
| | - Philippe Tummers
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium; Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium; Gynecology, Department of Human Structure and Repair, Ghent University Hospital, Belgium
| | - Amin Makar
- Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium; Gynecology, Department of Human Structure and Repair, Ghent University Hospital, Belgium
| | - Pieter J L De Visschere
- Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium; Radiology and Nuclear Medicine, Department of Diagnostic Sciences, Ghent University Hospital, Belgium
| | - Olivier De Wever
- Laboratory of Experimental Cancer Research (LECR), Department of Human Structure and Repair, Ghent University, Ghent, Belgium; Cancer Research Institute Ghent (CRIG), Ghent, Belgium; Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium
| | - Frédéric Amant
- Centers Gynecologic Oncology Amsterdam, Netherlands Cancer Institute and Amsterdam University Medical Center, Amsterdam, The Netherlands; Department of Oncology, KU Leuven, Leuven, Belgium
| | - Hannelore G Denys
- Medical Oncology, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium; Cancer Research Institute Ghent (CRIG), Ghent, Belgium; Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium
| | - Katrien Vandecasteele
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium; Gynecological Pelvic Oncology Network (GYPON), Ghent, Belgium; Radiation Oncology, Department of Human Structure and Repair, Ghent University Hospital, Belgium
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12
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Carron P, Renson T, de Hooge M, Lambert B, De Man K, Jans L, Elewaut D, Van den Bosch FE. Immunoscintigraphy in axial spondyloarthritis: a new imaging modality for sacroiliac inflammation. Ann Rheum Dis 2020; 79:844-846. [PMID: 32102796 DOI: 10.1136/annrheumdis-2020-216993] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/16/2020] [Accepted: 02/17/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Philippe Carron
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent University Hospital, Ghent, Belgium
| | - Thomas Renson
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent University Hospital, Ghent, Belgium
| | | | - Bieke Lambert
- Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Kathia De Man
- Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Lennart Jans
- Radiology, Ghent University Hospital, Ghent, Belgium
| | - Dirk Elewaut
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent University Hospital, Ghent, Belgium
| | - Filip E Van den Bosch
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent University Hospital, Ghent, Belgium
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13
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Piron S, De Man K, Schelfhout V, Van Laeken N, Kersemans K, Achten E, De Vos F, Ost P. Optimization of PET protocol and interrater reliability of 18F-PSMA-11 imaging of prostate cancer. EJNMMI Res 2020; 10:14. [PMID: 32095919 PMCID: PMC7040121 DOI: 10.1186/s13550-020-0593-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/16/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Several scan parameters for PET imaging with 18F-PSMA-11 such as dosage, acquisition time and scan duration were evaluated to determine the most appropriate scan protocol, as well as the effect of furosemide administration on lesion visualization. Forty-four patients were randomly assigned to a dosage group (2.0 ± 0.2 or 4.0 ± 0.4 MBq/kg 18F-PSMA-11). All patients received a full-body PET/CT 1 h and 3 h after radiotracer injection with a scan duration of 3 min/bed position. For comparison of the scan duration, images were reconstructed for 1.5 and 3 min/bed position. Patients were intravenously administered 0.5 mg/kg furosemide with a maximum dose of 40 mg. To evaluate the furosemide effect, 22 additional patients were recruited and received one full-body PET/CT 1 h after administration of 2.0 ± 0.2 MBq/kg 18F-PSMA-11 with a scan duration of 3 min/bed position. To this group, no furosemide was administered. Images were scored on image quality using a 7-point scale and each suspicious lesion was described. To assess interrater reliability, two nuclear physicians scored all scans independently and described all observed suspicious lesions. RESULTS The 4 MBq/kg group received for all reconstructed images (60 min p.i., 1.5 and 3 min/bed position and 180 min p.i., 1.5 and 3 min/bed position) the highest median image quality score compared to the 2 MBq/kg group (p values < 0.01). When comparing all reconstructed images, the highest image quality score was given to images at 60 min p.i., 3 min/bed position for both dosage groups (score 5 and 6 for 2 and 4 MBq/kg, respectively). The addition of furosemide administration decreased the interference score with one point (p = 0.01106) and facilitated the evaluation of lesions in proximity to the ureters. The interrater reliability for the comparison of each lesion separately after more than 40 18F-PSMA-11 scan readings showed an increasing κ value from 0.78 (95% CI, 0.65-0.92) to 0.94 (95% CI, 0.87-1). CONCLUSION Although the results indicate an administered activity of 4.0 ± 0.4 MBq/kg, preference will be given to 2.0 ± 0.2 MBq/kg due to the small difference in absolute score (max 1 point) and the ALARA principle. For evaluation of lesions in proximity to the ureters, the co-administration of a diuretic can be useful. The increase of the κ value from 0.78 to 0.94 suggests a learning curve in the interpretation of 18F-PSMA-11 images. TRIAL REGISTRATION Clinicaltrials.gov, NCT03573011. Retrospectively registered 28 June 2018.
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Affiliation(s)
- Sarah Piron
- Laboratory of Radiopharmacy, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium.
| | - Kathia De Man
- Department Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | | | - Nick Van Laeken
- Department Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Ken Kersemans
- Department Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Eric Achten
- Department Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Filip De Vos
- Laboratory of Radiopharmacy, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium
| | - Piet Ost
- Department Radiation Oncology, Ghent University Hospital, Ghent, Belgium
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14
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Ost P, Reynders D, Decaestecker K, Fonteyne V, Lumen N, De Bruycker A, Lambert B, Delrue L, Bultijnck R, Goetghebeur E, Villeirs G, De Man K, Ameye F, Billiet I, Joniau S, Vanhaverbeke F, de Meerleer G. Surveillance or metastasis-directed therapy for oligometastatic prostate cancer recurrence (STOMP): Five-year results of a randomized phase II trial. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.10] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10 Background: Multiple randomized phase II trials suggest that metastasis-directed therapy (MDT) for oligometastatic prostate cancer (PCa) improves progression-free survival, but the majority of trials lack longer follow-up. We present the updated 5-year results from the STOMP-trial. Methods: In this multicentre, randomised, phase II study, asymptomatic PCa patients were eligible in case of a biochemical recurrence following primary PCa treatment with curative intent and presenting with up to 3 extracranial on choline PET-CT and a serum testosterone levels > 50 ng/ml. Patients were randomly assigned (1:1) to either surveillance or MDT of all detected lesions. Randomisation was balanced dynamically on two factors: PSA doubling time (≤3 vs. > 3 months) and nodal vs non-nodal metastases. The primary endpoint was androgen deprivation therapy (ADT)-free survival. Castrate resistant prostate cancer-free survival (CRPC) was a secondary endpoint. Tests were performed two-sided; p values less than 0.20 were deemed significant. Results: The 5-year ADT-free survival was 8% for the surveillance group and 34% for the MDT group (Figure 1, hazard ratio 0.57 [80% CI: 0.38-0.84], log-rank p = 0.06). There was no significant difference in effect for the different stratification factors (interaction test). The 5-year CRPC-free survival was 53% for the surveillance group and 76% for the MDT group (hazard ratio 0.62 [80% CI: 0.35−1.09]; log−rank p = 0.27). At a median follow for survival of 5.3 years (IQR 4.3-6.3), the 5-year overall survival was 85%, with 6 out of 14 deaths attributed to prostate cancer. Conclusions: The updated STOMP trial outcomes confirm the earlier reported significant difference in ADT free survival in favor of the MDT group compared to surveillance. Prostate-cancer related mortality is low within the first 5 years of diagnosis of oligorecurrent prostate cancer. Clinical trial information: NCT01558427.
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Affiliation(s)
- Piet Ost
- Ghent University Hospital, Ghent, Belgium
| | | | | | | | | | | | - Bieke Lambert
- Department of Nuclear Medicine, AZ Maria-Middelares Ghent, Ghent, Belgium
| | - Louke Delrue
- Department of Radiology, Gent University Hospital, Gent, Belgium
| | - Renée Bultijnck
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Els Goetghebeur
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium
| | | | - Kathia De Man
- Department of Nuclear Medicine, Ghent University Hospital, Gent, Belgium
| | | | | | | | | | - Gert de Meerleer
- Department of Human Structure and Repair, Ghent University, Gent, Belgium
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De Bruycker A, De Bleser E, Decaestecker K, Fonteyne V, Lumen N, De Visschere P, De Man K, Delrue L, Lambert B, Ost P. Nodal Oligorecurrent Prostate Cancer: Anatomic Pattern of Possible Treatment Failure in Relation to Elective Surgical and Radiotherapy Treatment Templates. Eur Urol 2019; 75:826-833. [DOI: 10.1016/j.eururo.2018.10.044] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 10/19/2018] [Indexed: 02/03/2023]
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16
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Piron S, De Man K, Van Laeken N, D’Asseler Y, Bacher K, Kersemans K, Ost P, Decaestecker K, Deseyne P, Fonteyne V, Lumen N, Achten E, Brans B, De Vos F. Radiation Dosimetry and Biodistribution of 18F-PSMA-11 for PET Imaging of Prostate Cancer. J Nucl Med 2019; 60:1736-1742. [DOI: 10.2967/jnumed.118.225250] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 04/25/2019] [Indexed: 11/16/2022] Open
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17
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Kersemans K, De Man K, Courtyn J, Van Royen T, Piron S, Moerman L, Brans B, De Vos F. Automated radiosynthesis of Al[ 18 F]PSMA-11 for large scale routine use. Appl Radiat Isot 2018; 135:19-27. [DOI: 10.1016/j.apradiso.2018.01.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 12/15/2017] [Accepted: 01/09/2018] [Indexed: 01/19/2023]
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18
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Ost P, Reynders D, Decaestecker K, Fonteyne V, Lumen N, De Bruycker A, Lambert B, Delrue L, Bultijnck R, Claeys T, Goetghebeur E, Villeirs G, De Man K, Ameye F, Billiet I, Joniau S, Vanhaverbeke F, De Meerleer G. Surveillance or Metastasis-Directed Therapy for Oligometastatic Prostate Cancer Recurrence: A Prospective, Randomized, Multicenter Phase II Trial. J Clin Oncol 2017; 36:446-453. [PMID: 29240541 DOI: 10.1200/jco.2017.75.4853] [Citation(s) in RCA: 831] [Impact Index Per Article: 118.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose Retrospective studies suggest that metastasis-directed therapy (MDT) for oligorecurrent prostate cancer (PCa) improves progression-free survival. We aimed to assess the benefit of MDT in a randomized phase II trial. Patients and Methods In this multicenter, randomized, phase II study, patients with asymptomatic PCa were eligible if they had had a biochemical recurrence after primary PCa treatment with curative intent, three or fewer extracranial metastatic lesions on choline positron emission tomography-computed tomography, and serum testosterone levels > 50 ng/mL. Patients were randomly assigned (1:1) to either surveillance or MDT of all detected lesions (surgery or stereotactic body radiotherapy). Surveillance was performed with prostate-specific antigen (PSA) follow-up every 3 months, with repeated imaging at PSA progression or clinical suspicion for progression. Random assignment was balanced dynamically on the basis of two factors: PSA doubling time (≤ 3 v > 3 months) and nodal versus non-nodal metastases. The primary end point was androgen deprivation therapy (ADT)-free survival. ADT was started at symptomatic progression, progression to more than three metastases, or local progression of known metastases. Results Between August 2012 and August 2015, 62 patients were enrolled. At a median follow-up time of 3 years (interquartile range, 2.3-3.75 years), the median ADT-free survival was 13 months (80% CI, 12 to 17 months) for the surveillance group and 21 months (80% CI, 14 to 29 months) for the MDT group (hazard ratio, 0.60 [80% CI, 0.40 to 0.90]; log-rank P = .11). Quality of life was similar between arms at baseline and remained comparable at 3-month and 1-year follow-up. Six patients developed grade 1 toxicity in the MDT arm. No grade 2 to 5 toxicity was observed. Conclusion ADT-free survival was longer with MDT than with surveillance alone for oligorecurrent PCa, suggesting that MDT should be explored further in phase III trials.
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Affiliation(s)
- Piet Ost
- Piet Ost, Dries Reynders, Valérie Fonteyne, Aurélie De Bruycker, Bieke Lambert, Renée Bultijnck, Els Goetghebeur, Kathia De Man, and Gert De Meerleer, Ghent University, Ghent; Karel Decaestecker, Nicolaas Lumen, Louke Delrue, Tom Claeys, and Geert Villeirs, Ghent University Hospital, Ghent; Filip Ameye, AZ Maria Middelares, Ghent; Ignace Billiet, AZ Groeninge Kortrijk, Kortrijk; Steven Joniau, Catholic University Leuven, Leuven; and Friedl Vanhaverbeke, AZ Nikolaas, Sint-Niklass, Belgium
| | - Dries Reynders
- Piet Ost, Dries Reynders, Valérie Fonteyne, Aurélie De Bruycker, Bieke Lambert, Renée Bultijnck, Els Goetghebeur, Kathia De Man, and Gert De Meerleer, Ghent University, Ghent; Karel Decaestecker, Nicolaas Lumen, Louke Delrue, Tom Claeys, and Geert Villeirs, Ghent University Hospital, Ghent; Filip Ameye, AZ Maria Middelares, Ghent; Ignace Billiet, AZ Groeninge Kortrijk, Kortrijk; Steven Joniau, Catholic University Leuven, Leuven; and Friedl Vanhaverbeke, AZ Nikolaas, Sint-Niklass, Belgium
| | - Karel Decaestecker
- Piet Ost, Dries Reynders, Valérie Fonteyne, Aurélie De Bruycker, Bieke Lambert, Renée Bultijnck, Els Goetghebeur, Kathia De Man, and Gert De Meerleer, Ghent University, Ghent; Karel Decaestecker, Nicolaas Lumen, Louke Delrue, Tom Claeys, and Geert Villeirs, Ghent University Hospital, Ghent; Filip Ameye, AZ Maria Middelares, Ghent; Ignace Billiet, AZ Groeninge Kortrijk, Kortrijk; Steven Joniau, Catholic University Leuven, Leuven; and Friedl Vanhaverbeke, AZ Nikolaas, Sint-Niklass, Belgium
| | - Valérie Fonteyne
- Piet Ost, Dries Reynders, Valérie Fonteyne, Aurélie De Bruycker, Bieke Lambert, Renée Bultijnck, Els Goetghebeur, Kathia De Man, and Gert De Meerleer, Ghent University, Ghent; Karel Decaestecker, Nicolaas Lumen, Louke Delrue, Tom Claeys, and Geert Villeirs, Ghent University Hospital, Ghent; Filip Ameye, AZ Maria Middelares, Ghent; Ignace Billiet, AZ Groeninge Kortrijk, Kortrijk; Steven Joniau, Catholic University Leuven, Leuven; and Friedl Vanhaverbeke, AZ Nikolaas, Sint-Niklass, Belgium
| | - Nicolaas Lumen
- Piet Ost, Dries Reynders, Valérie Fonteyne, Aurélie De Bruycker, Bieke Lambert, Renée Bultijnck, Els Goetghebeur, Kathia De Man, and Gert De Meerleer, Ghent University, Ghent; Karel Decaestecker, Nicolaas Lumen, Louke Delrue, Tom Claeys, and Geert Villeirs, Ghent University Hospital, Ghent; Filip Ameye, AZ Maria Middelares, Ghent; Ignace Billiet, AZ Groeninge Kortrijk, Kortrijk; Steven Joniau, Catholic University Leuven, Leuven; and Friedl Vanhaverbeke, AZ Nikolaas, Sint-Niklass, Belgium
| | - Aurélie De Bruycker
- Piet Ost, Dries Reynders, Valérie Fonteyne, Aurélie De Bruycker, Bieke Lambert, Renée Bultijnck, Els Goetghebeur, Kathia De Man, and Gert De Meerleer, Ghent University, Ghent; Karel Decaestecker, Nicolaas Lumen, Louke Delrue, Tom Claeys, and Geert Villeirs, Ghent University Hospital, Ghent; Filip Ameye, AZ Maria Middelares, Ghent; Ignace Billiet, AZ Groeninge Kortrijk, Kortrijk; Steven Joniau, Catholic University Leuven, Leuven; and Friedl Vanhaverbeke, AZ Nikolaas, Sint-Niklass, Belgium
| | - Bieke Lambert
- Piet Ost, Dries Reynders, Valérie Fonteyne, Aurélie De Bruycker, Bieke Lambert, Renée Bultijnck, Els Goetghebeur, Kathia De Man, and Gert De Meerleer, Ghent University, Ghent; Karel Decaestecker, Nicolaas Lumen, Louke Delrue, Tom Claeys, and Geert Villeirs, Ghent University Hospital, Ghent; Filip Ameye, AZ Maria Middelares, Ghent; Ignace Billiet, AZ Groeninge Kortrijk, Kortrijk; Steven Joniau, Catholic University Leuven, Leuven; and Friedl Vanhaverbeke, AZ Nikolaas, Sint-Niklass, Belgium
| | - Louke Delrue
- Piet Ost, Dries Reynders, Valérie Fonteyne, Aurélie De Bruycker, Bieke Lambert, Renée Bultijnck, Els Goetghebeur, Kathia De Man, and Gert De Meerleer, Ghent University, Ghent; Karel Decaestecker, Nicolaas Lumen, Louke Delrue, Tom Claeys, and Geert Villeirs, Ghent University Hospital, Ghent; Filip Ameye, AZ Maria Middelares, Ghent; Ignace Billiet, AZ Groeninge Kortrijk, Kortrijk; Steven Joniau, Catholic University Leuven, Leuven; and Friedl Vanhaverbeke, AZ Nikolaas, Sint-Niklass, Belgium
| | - Renée Bultijnck
- Piet Ost, Dries Reynders, Valérie Fonteyne, Aurélie De Bruycker, Bieke Lambert, Renée Bultijnck, Els Goetghebeur, Kathia De Man, and Gert De Meerleer, Ghent University, Ghent; Karel Decaestecker, Nicolaas Lumen, Louke Delrue, Tom Claeys, and Geert Villeirs, Ghent University Hospital, Ghent; Filip Ameye, AZ Maria Middelares, Ghent; Ignace Billiet, AZ Groeninge Kortrijk, Kortrijk; Steven Joniau, Catholic University Leuven, Leuven; and Friedl Vanhaverbeke, AZ Nikolaas, Sint-Niklass, Belgium
| | - Tom Claeys
- Piet Ost, Dries Reynders, Valérie Fonteyne, Aurélie De Bruycker, Bieke Lambert, Renée Bultijnck, Els Goetghebeur, Kathia De Man, and Gert De Meerleer, Ghent University, Ghent; Karel Decaestecker, Nicolaas Lumen, Louke Delrue, Tom Claeys, and Geert Villeirs, Ghent University Hospital, Ghent; Filip Ameye, AZ Maria Middelares, Ghent; Ignace Billiet, AZ Groeninge Kortrijk, Kortrijk; Steven Joniau, Catholic University Leuven, Leuven; and Friedl Vanhaverbeke, AZ Nikolaas, Sint-Niklass, Belgium
| | - Els Goetghebeur
- Piet Ost, Dries Reynders, Valérie Fonteyne, Aurélie De Bruycker, Bieke Lambert, Renée Bultijnck, Els Goetghebeur, Kathia De Man, and Gert De Meerleer, Ghent University, Ghent; Karel Decaestecker, Nicolaas Lumen, Louke Delrue, Tom Claeys, and Geert Villeirs, Ghent University Hospital, Ghent; Filip Ameye, AZ Maria Middelares, Ghent; Ignace Billiet, AZ Groeninge Kortrijk, Kortrijk; Steven Joniau, Catholic University Leuven, Leuven; and Friedl Vanhaverbeke, AZ Nikolaas, Sint-Niklass, Belgium
| | - Geert Villeirs
- Piet Ost, Dries Reynders, Valérie Fonteyne, Aurélie De Bruycker, Bieke Lambert, Renée Bultijnck, Els Goetghebeur, Kathia De Man, and Gert De Meerleer, Ghent University, Ghent; Karel Decaestecker, Nicolaas Lumen, Louke Delrue, Tom Claeys, and Geert Villeirs, Ghent University Hospital, Ghent; Filip Ameye, AZ Maria Middelares, Ghent; Ignace Billiet, AZ Groeninge Kortrijk, Kortrijk; Steven Joniau, Catholic University Leuven, Leuven; and Friedl Vanhaverbeke, AZ Nikolaas, Sint-Niklass, Belgium
| | - Kathia De Man
- Piet Ost, Dries Reynders, Valérie Fonteyne, Aurélie De Bruycker, Bieke Lambert, Renée Bultijnck, Els Goetghebeur, Kathia De Man, and Gert De Meerleer, Ghent University, Ghent; Karel Decaestecker, Nicolaas Lumen, Louke Delrue, Tom Claeys, and Geert Villeirs, Ghent University Hospital, Ghent; Filip Ameye, AZ Maria Middelares, Ghent; Ignace Billiet, AZ Groeninge Kortrijk, Kortrijk; Steven Joniau, Catholic University Leuven, Leuven; and Friedl Vanhaverbeke, AZ Nikolaas, Sint-Niklass, Belgium
| | - Filip Ameye
- Piet Ost, Dries Reynders, Valérie Fonteyne, Aurélie De Bruycker, Bieke Lambert, Renée Bultijnck, Els Goetghebeur, Kathia De Man, and Gert De Meerleer, Ghent University, Ghent; Karel Decaestecker, Nicolaas Lumen, Louke Delrue, Tom Claeys, and Geert Villeirs, Ghent University Hospital, Ghent; Filip Ameye, AZ Maria Middelares, Ghent; Ignace Billiet, AZ Groeninge Kortrijk, Kortrijk; Steven Joniau, Catholic University Leuven, Leuven; and Friedl Vanhaverbeke, AZ Nikolaas, Sint-Niklass, Belgium
| | - Ignace Billiet
- Piet Ost, Dries Reynders, Valérie Fonteyne, Aurélie De Bruycker, Bieke Lambert, Renée Bultijnck, Els Goetghebeur, Kathia De Man, and Gert De Meerleer, Ghent University, Ghent; Karel Decaestecker, Nicolaas Lumen, Louke Delrue, Tom Claeys, and Geert Villeirs, Ghent University Hospital, Ghent; Filip Ameye, AZ Maria Middelares, Ghent; Ignace Billiet, AZ Groeninge Kortrijk, Kortrijk; Steven Joniau, Catholic University Leuven, Leuven; and Friedl Vanhaverbeke, AZ Nikolaas, Sint-Niklass, Belgium
| | - Steven Joniau
- Piet Ost, Dries Reynders, Valérie Fonteyne, Aurélie De Bruycker, Bieke Lambert, Renée Bultijnck, Els Goetghebeur, Kathia De Man, and Gert De Meerleer, Ghent University, Ghent; Karel Decaestecker, Nicolaas Lumen, Louke Delrue, Tom Claeys, and Geert Villeirs, Ghent University Hospital, Ghent; Filip Ameye, AZ Maria Middelares, Ghent; Ignace Billiet, AZ Groeninge Kortrijk, Kortrijk; Steven Joniau, Catholic University Leuven, Leuven; and Friedl Vanhaverbeke, AZ Nikolaas, Sint-Niklass, Belgium
| | - Friedl Vanhaverbeke
- Piet Ost, Dries Reynders, Valérie Fonteyne, Aurélie De Bruycker, Bieke Lambert, Renée Bultijnck, Els Goetghebeur, Kathia De Man, and Gert De Meerleer, Ghent University, Ghent; Karel Decaestecker, Nicolaas Lumen, Louke Delrue, Tom Claeys, and Geert Villeirs, Ghent University Hospital, Ghent; Filip Ameye, AZ Maria Middelares, Ghent; Ignace Billiet, AZ Groeninge Kortrijk, Kortrijk; Steven Joniau, Catholic University Leuven, Leuven; and Friedl Vanhaverbeke, AZ Nikolaas, Sint-Niklass, Belgium
| | - Gert De Meerleer
- Piet Ost, Dries Reynders, Valérie Fonteyne, Aurélie De Bruycker, Bieke Lambert, Renée Bultijnck, Els Goetghebeur, Kathia De Man, and Gert De Meerleer, Ghent University, Ghent; Karel Decaestecker, Nicolaas Lumen, Louke Delrue, Tom Claeys, and Geert Villeirs, Ghent University Hospital, Ghent; Filip Ameye, AZ Maria Middelares, Ghent; Ignace Billiet, AZ Groeninge Kortrijk, Kortrijk; Steven Joniau, Catholic University Leuven, Leuven; and Friedl Vanhaverbeke, AZ Nikolaas, Sint-Niklass, Belgium
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Huysse W, Lecouvet F, Castellucci P, Ost P, Lambrecht V, Artigas C, Denis ML, Man KD, Delrue L, Jans L, Bruycker AD, Vos FD, Meerleer GD, Decaestecker K, Fonteyne V, Lambert B. Prospective Comparison of F-18 Choline PET/CT Scan Versus Axial MRI for Detecting Bone Metastasis in Biochemically Relapsed Prostate Cancer Patients. Diagnostics (Basel) 2017; 7:diagnostics7040056. [PMID: 29039785 PMCID: PMC5745392 DOI: 10.3390/diagnostics7040056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 10/09/2017] [Accepted: 10/14/2017] [Indexed: 12/13/2022] Open
Abstract
We compared fluor-18 choline positron emission tomography/computed tomography (PET/CT) and axial skeleton magnetic resonance imaging (MRI) prospectively obtained for the detection of bone metastases in non-castrated patients with biochemically recurrent prostate cancer following primary treatment. PET/CT was performed 45 min post-injection of 3-4 MBq/kg F-18 methyl choline. MRI included T1- and fluid sensitive T2-weighted images of the spine and pelvis. Readers were initially blinded from other results and all scans underwent independent double reading. The best valuable comparator (BVC) defined the metastatic status. On the basis of the BVC, 15 out of 64 patients presented with 24 bone metastases. On a patient level, the sensitivity and specificity of MRI and PET were not significantly different. On a lesion level, the sensitivity of MRI was significantly better compared to PET, and the specificity did not differ significantly. In conclusion, axial MRI is an interesting screening tool for the detection of bone metastases because of its low probability of false negative results. However, F-18 choline PET is a valuable addition as it can overrule false positive MRI results and detect non-axial metastases.
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Affiliation(s)
- Wouter Huysse
- Department of Radiology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
| | - Frédéric Lecouvet
- Department of Radiology, Centre du Cancer and Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10/2942, B-1200 Brussels, Belgium.
| | - Paolo Castellucci
- Service of Nuclear Medicine, Policlinico Sant'Orsola-Malpighi, University of Bologna, 40126 Bologna, Italy.
| | - Piet Ost
- Department of Radiation Oncology and Experimental Cancer Research, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium.
| | - Valerie Lambrecht
- Department of Radiology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
| | - Carlos Artigas
- Nuclear Medicine, Institut Jules Bordet, Waterloolaan 121, 1000 Brussels, Belgium.
| | - Marie-Laurence Denis
- Department of Radiology, Centre du Cancer and Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10/2942, B-1200 Brussels, Belgium.
| | - Kathia De Man
- Department of Nuclear Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
| | - Louke Delrue
- Laboratory of Radiopharmacy, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium.
| | - Lennart Jans
- Department of Radiology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
| | - Aurélie De Bruycker
- Department of Radiation Oncology and Experimental Cancer Research, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium.
| | - Filip De Vos
- Radiology and Nuclear Medicine, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium.
| | - Gert De Meerleer
- Department of Radiation Oncology and Experimental Cancer Research, UZ Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Karel Decaestecker
- Department of Urology and Experimental Cancer Research, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
| | - Valerie Fonteyne
- Department of Radiation Oncology and Experimental Cancer Research, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium.
| | - Bieke Lambert
- Radiology and Nuclear Medicine, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium.
- Algemeen ziekenhuis Maria Middelares, Buitenring Sint-Denijs 30, 9000 Ghent, Belgium.
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De Bruycker A, Lambert B, Claeys T, Delrue L, Mbah C, De Meerleer G, Villeirs G, De Vos F, De Man K, Decaestecker K, Fonteyne V, Lumen N, Ameye F, Billiet I, Joniau S, Vanhaverbeke F, Duthoy W, Ost P. Prevalence and prognosis of low-volume, oligorecurrent, hormone-sensitive prostate cancer amenable to lesion ablative therapy. BJU Int 2017. [PMID: 28646594 DOI: 10.1111/bju.13938] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To describe the anatomical patterns of prostate cancer (PCa) recurrence after primary therapy and to investigate if patients with low-volume disease have a better prognosis as compared with their counterparts. MATERIALS AND METHODS Patients eligible for an 18-F choline positron-emission tomography (PET)-computed tomography (CT) were enrolled in a prospective cohort study. Eligible patients had asymptomatic biochemical recurrence after primary PCa treatment and testosterone levels >50 ng/mL. The number of lesions was counted per scan. Patients with isolated local recurrence (LR) or with ≤3 metastases (with or without LR) were considered to have low-volume disease and patients with >3 metastases to have high-volume disease. Descriptive statistics were used to report recurrences. Cox regression analysis was used to investigate the influence of prognostic variables on the time to developing castration-resistant PCa (CRPC). RESULTS In 208 patients, 625 sites of recurrence were detected in the lymph nodes (N1/M1a: 30%), the bone (18%), the prostate (bed; 11%), viscera (4%), or a combination of any of the previous (37%). In total, 153 patients (74%) had low-volume recurrence and 55 patients (26%) had high-volume recurrence. The 3-year CRPC-free survival rate for the whole cohort was 79% (95% confidence interval 43-55), 88% for low-volume recurrences and 50% for high-volume recurrences (P < 0.001). Longer PSA doubling time at time of recurrence and low-volume disease were associated with a longer time to CRPC. CONCLUSIONS Three out of four patients with PCa with a 18-F choline PET-CT-detected recurrence have low-volume disease, potentially amenable to local therapy. Patients with low-volume disease have a better prognosis as compared with their counterparts. Lymph node recurrence was the most dominant failure pattern.
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Affiliation(s)
- Aurélie De Bruycker
- Department of Radiation Oncology and Experimental Cancer Research, Ghent University, Gent, Belgium
| | - Bieke Lambert
- Department of Radiology and Nuclear Medicine, Ghent University, Gent, Belgium
| | - Tom Claeys
- Department of Urology, Ghent University Hospital, Gent, Belgium
| | - Louke Delrue
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | - Chamberlain Mbah
- Department of Radiation Oncology and Experimental Cancer Research, Ghent University, Gent, Belgium
| | - Gert De Meerleer
- Department of Radiation Oncology and Experimental Cancer Research, Ghent University, Gent, Belgium
| | - Geert Villeirs
- Department of Radiology and Nuclear Medicine, Ghent University, Gent, Belgium
| | - Filip De Vos
- Department of Radiopharmacy, Ghent University, Gent, Belgium
| | - Kathia De Man
- Department of Nuclear Medicine, Ghent University Hospital, Gent, Belgium
| | | | - Valérie Fonteyne
- Department of Radiation Oncology and Experimental Cancer Research, Ghent University, Gent, Belgium
| | - Nicolaas Lumen
- Department of Urology, Ghent University Hospital, Gent, Belgium
| | - Filip Ameye
- Department of Urology, AZ Maria-Middelares, Ghent, Belgium
| | | | - Steven Joniau
- Department of Urology, Catholic University, Leuven, Belgium
| | | | - Wim Duthoy
- Department of Radiotherapy, AZ Sint Lucas, Ghent, Belgium
| | - Piet Ost
- Department of Radiation Oncology and Experimental Cancer Research, Ghent University, Gent, Belgium
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Ost P, De Bruycker A, Claeys T, Delrue L, De Meerleer G, De Vos F, Decaestecker K, De Man K, Fonteyne V, Lumen N, Ameye F, Billiet I, Joniau S, Lambert B. Estimating the incidence of oligorecurrent and potentially salvageable prostate cancer on 18F-Choline PET-CT: Screening phase of the STOMP randomized phase II trial. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
153 Background: To identify sites and patterns of prostate cancer (PCa) recurrence following primary PCa treatment with 18F-choline PET/CT and estimate the number of patients potentially eligible for metastasis-directed therapy (MDT, defined as patients with up to 3 metastatic lesions). Methods: Between 7/7/2011 and 7/6/2016, 229 patients underwent a 18F-choline PET/CT for a biochemical PCa recurrence for potential inclusion in a randomized phase II-trial (STOMP). The trial randomizes patients with oligorecurrent (Orec) PCa between active surveillance (AS) and MDT. Patients were eligible for the trial in case of biochemical recurrence following primary prostate cancer treatment, up to 3 extracranial metastases and testosterone > 50 ng/ml. Patterns of recurrence were classified as local (prostate or prostate bed), distant (N1, M1a/b/c) or a combination of both. The number of lesions were counted per scan and patients with up to 3 distant lesions with or without a local recurrence were considered as ORec vs > 3 lesions as polyrecurrent (PRec). Results: A total number of 229 patients underwent 277 choline PET-CTs, resulting in 208 patients (91%) with a recurrence and 21 patients (9%) without any detectable recurrence. Twenty-two men (10%) had a local recurrence and 186 men (81%) had a distant recurrence, which was combined with a local recurrence in 17 men. Of the 186 patients, 131 (57%) were considered as ORec and 55 (24%) as PRec at median PSA values of 3.4 and 5.4 ng/ml, respectively (p < 0.003). ORec were categorized as N1: 16%, M1a: 8%, M1b: 13%, M1c: 2% or a combination of sites: 17% (Figure 1). Fifty-eight patients had 1 lesion (25%), 39 2 lesions (17%) and 34 3 lesions (15%). Men with ORec PCa were treated with AS, MDT or palliative ADT in respectively 27%, 27% and 1% of the cases. Sixty-two of ORec men (27%) agreed to be randomized in the STOMP-trial. PRec were categorized as N1: 2%, M1a: 1%, M1b: 3%, M1c: 1% or a combination: 17% (Figure 1). Thirteen patients had 4 lesion (6%), 9 5 lesions (4%) and 33 > 5 lesions (18%) Conclusions: Two out of three PCa recurrences on 18F-choline PET-CT are potentially salvageable with local therapy and/or metastasis-directed therapy. Clinical trial information: NCT01558427.
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Affiliation(s)
- Piet Ost
- Ghent University Hospital, Gent, Belgium
| | | | - Tom Claeys
- Ghent University Hospital, Gent, Belgium
| | - Louke Delrue
- Department of Radiology, Gent University Hospital, Gent, Belgium
| | - Gert De Meerleer
- Department of Radiotherapy, Gent University Hospital, Gent, Belgium
| | | | | | | | | | | | | | | | | | - Bieke Lambert
- Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
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Ma X, Liu HP, Sun LT, Song MT, Zhu XL, Sha S, Feng WT, Zhang DC, Zhang SF, Li B, Li JY, Qian DB, Xu SY, Gao DQ, Wang PZ, Ma LZ, Man KD, Xiao GQ, Zhao HW, Zhan WL. A progress report of 320 kV multi-discipline research platform for highly charged ions. ACTA ACUST UNITED AC 2009. [DOI: 10.1088/1742-6596/163/1/012104] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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