68Ga-PSMA-PET/CT-directed IGRT/SBRT for oligometastases of recurrent prostate cancer after initial surgery.

Autor:	Marzec, J., Becker, J., Paulsen, F., Wegener, D., Olthof, S.-C., Pfannenberg, C., Schwenck, J., Bedke, J., Stenzl, A., Nikolaou, K., la Fougère, C., Zips, D., Müller, A.-C.
Předmět:	ANDROGEN drugs PROSTATE tumors treatment POSTOPERATIVE care GALLIUM isotopes RADIOTHERAPY CANCER relapse PROSTATE-specific antigen RADICAL prostatectomy COMPUTED tomography RADIOISOTOPES RADIOSURGERY PROSTATE tumors TREATMENT effectiveness RETROSPECTIVE studies METASTASIS SURGICAL complications LONGITUDINAL method PROSTATE-specific membrane antigen EMISSION-computed tomography RADIATION doses SURVIVAL analysis (Biometry)
Zdroj:	Acta Oncologica; Feb2020, Vol. 59 Issue 2, p149-156, 8p, 2 Charts, 3 Graphs
Abstrakt:	Background: We evaluated efficacy and toxicity of 68Ga-PSMA-Positron Emission Tomography/Computed Tomography (PET/CT)-directed stereotactic body radiotherapy and image-guided radiotherapy (SBRT/IGRT) for oligometastases of prostate cancer recurrences after previous surgery. Methods: Nineteen patients were analyzed within a prospective PET-registry study (064/2013BO1) and retrospectively analyzed (807/2017BO2) fulfilling the following inclusion criteria: biochemical recurrence after radical prostatectomy, ≤five 68Ga-PSMA-PET/CT positive lesions. Biochemical control was evaluated with EORTC (European Organization for Research and Treatment of Cancer)- and Phenix-definitions. Toxicity was scored according to CTCAE-criteria v. 4.03. Results: A total of 38 oligometastases (19 patients, 2 with re-treatment) were treated with SBRT/IGRT from October 2014 to July 2017. 68Ga-PSMA-PET/CT-positive lesions were detected on average 39 months (5–139) after prostatectomy (pT2b-3b pN0-1 cM0). Mean PSA (Prostate-specific antigen)-level at time of imaging reached 2.2 ng/mL (range 0.2–10.1). PET/CT-positive lesions were treated with different fractionation schedules reaching biological equivalent doses (BED) of 116.7–230.0 Gy. Concomitant androgen deprivation therapy (ADT) was given in seven patients. After a median follow-up of 17 months (4–42) all patients were alive. Estimated 1-year PSA- control (n = 19) reached 80.8% (Phenix) and 67.5% (EORTC). A PSA-decline (≥50%) was detected in 16/19 patients after radiotherapy. Higher graded G3+-acute toxicity did not occur. Temporary late G3-proctitis was detected in one patient. Conclusions: Reaching of nadir ≤0.1 or 0.2 ng/mL was associated by improved DMFS (distant metastases free survival) and could serve as a surrogate endpoint for RT of oligometastases after initial prostatectomy. Short term effects of 68Ga-PSMA-PET/CT-based ablative radiotherapy for oligometastases demonstrated an acceptable toxicity profile and favorable biochemical response. [ABSTRACT FROM AUTHOR]
Databáze:	Complementary Index
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