Patterns of failure after radical prostatectomy in prostate cancer - implications for radiation therapy planning after (68)Ga-PSMA-PET imaging

TY - JOUR

T1 - Patterns of failure after radical prostatectomy in prostate cancer - implications for radiation therapy planning after (68)Ga-PSMA-PET imaging

T2 - Eur J Nucl Med Mol Imaging

AU - Schiller, K.

AU - Sauter, K.

AU - Dewes, S.

AU - Eiber, M.

AU - Maurer, T.

AU - Gschwend, J.

AU - Combs, S. E.

AU - Habl, G.

N1 - 1619-7089 Schiller, Kilian Sauter, K Dewes, S Eiber, M Maurer, T Gschwend, J Combs, S E Habl, G Journal Article Germany Eur J Nucl Med Mol Imaging. 2017 Sep;44(10):1656-1662. doi: 10.1007/s00259-017-3746-9. Epub 2017 Jun 23.

PY - 2017

Y1 - 2017

N2 - BACKGROUND: Salvage radiotherapy (SRT) after radical prostatectomy (RPE) and lymphadenectomy (LAE) is the appropriate radiotherapy option for patients with persistent/ recurrent prostate cancer (PC). (68)Ga-PSMA-PET imaging has been shown to accurately detect PC lesions in a primary setting as well as for local recurrence or for lymph node (LN) metastases. OBJECTIVE: In this study we evaluated the patterns of recurrence after RPE in patients with PC, putting a highlight on the differentiation between sites that would have been covered by a standard radiation therapy (RT) field in consensus after the RTOG consensus and others that would have not. METHODS AND MATERIALS: Thirty-one out of 83 patients (37%) with high-risk PC were the subject of our study. Information from (68)Ga-PSMA-PET imaging was used to individualize treatment plans to include suspicious lesions as well as possibly boost sites with tracer uptake in LN or the prostate bed. For evaluation, (68)Ga-PSMA-PET-positive LN were contoured in a patient dataset with a standard lymph drainage (RTOG consensus on CTV definition of pelvic lymph nodes) radiation field depicting color-coded nodes that would have been infield or outfield of that standard lymph drainage field and thereby visualizing typical patterns of failure of a "blind" radiation therapy after RPE and LAE. RESULTS: Compared to negative conventional imaging (CT/MRI), lesions suspicious for PC were detected in 27/31 cases (87.1%) by (68)Ga-PSMA-PET imaging, which resulted in changes to the radiation concept. There were 16/31 patients (51.6%) that received a simultaneous integrated boost (SIB) to a subarea of the prostate bed (in only three cases this dose escalation would have been planned without the additional knowledge of (68)Ga-PSMA-PET imaging) and 18/31 (58.1%) to uncommon (namely presacral, paravesical, pararectal, preacetabular and obturatoric) LN sites. Furthermore, 14 patients (45.2%) had a changed TNM staging result by means of (68)Ga-PSMA-PET imaging. CONCLUSION: Compared to conventional CT or MRI staging, (68)Ga-PSMA-PET imaging detects more PC lesions and, thus, significantly influences radiation planning in recurrent prostate cancer patients enabling individually tailored treatment.

AB - BACKGROUND: Salvage radiotherapy (SRT) after radical prostatectomy (RPE) and lymphadenectomy (LAE) is the appropriate radiotherapy option for patients with persistent/ recurrent prostate cancer (PC). (68)Ga-PSMA-PET imaging has been shown to accurately detect PC lesions in a primary setting as well as for local recurrence or for lymph node (LN) metastases. OBJECTIVE: In this study we evaluated the patterns of recurrence after RPE in patients with PC, putting a highlight on the differentiation between sites that would have been covered by a standard radiation therapy (RT) field in consensus after the RTOG consensus and others that would have not. METHODS AND MATERIALS: Thirty-one out of 83 patients (37%) with high-risk PC were the subject of our study. Information from (68)Ga-PSMA-PET imaging was used to individualize treatment plans to include suspicious lesions as well as possibly boost sites with tracer uptake in LN or the prostate bed. For evaluation, (68)Ga-PSMA-PET-positive LN were contoured in a patient dataset with a standard lymph drainage (RTOG consensus on CTV definition of pelvic lymph nodes) radiation field depicting color-coded nodes that would have been infield or outfield of that standard lymph drainage field and thereby visualizing typical patterns of failure of a "blind" radiation therapy after RPE and LAE. RESULTS: Compared to negative conventional imaging (CT/MRI), lesions suspicious for PC were detected in 27/31 cases (87.1%) by (68)Ga-PSMA-PET imaging, which resulted in changes to the radiation concept. There were 16/31 patients (51.6%) that received a simultaneous integrated boost (SIB) to a subarea of the prostate bed (in only three cases this dose escalation would have been planned without the additional knowledge of (68)Ga-PSMA-PET imaging) and 18/31 (58.1%) to uncommon (namely presacral, paravesical, pararectal, preacetabular and obturatoric) LN sites. Furthermore, 14 patients (45.2%) had a changed TNM staging result by means of (68)Ga-PSMA-PET imaging. CONCLUSION: Compared to conventional CT or MRI staging, (68)Ga-PSMA-PET imaging detects more PC lesions and, thus, significantly influences radiation planning in recurrent prostate cancer patients enabling individually tailored treatment.

KW - Aged Edetic Acid/analogs & derivatives Humans Male Middle Aged Neoplasm Staging Oligopeptides Positron-Emission Tomography Prostatectomy Prostatic Neoplasms/diagnostic imaging/pathology/radiotherapy/surgery Radiotherapy Planning, Computer-Assisted Treatme

U2 - 10.1007/s00259-017-3746-9

DO - 10.1007/s00259-017-3746-9

M3 - SCORING: Journal article

VL - 44

SP - 1656

EP - 1662

JO - EUR J NUCL MED MOL I

JF - EUR J NUCL MED MOL I

SN - 1619-7070

IS - 10

ER -