Toxicity and efficacy of salvage carbon 11-choline positron emission tomography/computed tomography-guided radiation therapy in patients with lymph node recurrence of prostate cancer

Autor: Italo Dell'Oca, Elena Busnardo, Paola Mangili, Margarita Kirienko, Luigi Gianolli, Andrei Fodor, Claudio Fiorino, Elena Incerti, Cesare Cozzarini, Marcella Pasetti, Riccardo Calandrino, Maria Picchio, Nadia Di Muzio, G. Berardi
Přispěvatelé: Fodor, Andrei, Berardi, Genoveffa, Fiorino, Claudio, Picchio, Maria, Busnardo, Elena, Kirienko, Margarita, Incerti, Elena, Dell'Oca, Italo, Cozzarini, Cesare, Mangili, Paola, Pasetti, Marcella, Calandrino, Riccardo, Gianolli, Luigi, Di Muzio, Nadia G
Jazyk: angličtina
Rok vydání: 2017
Předmět:
Biochemical recurrence
Male
medicine.medical_specialty
medicine.medical_treatment
Urology
salvage radiation therapy
Multimodal Imaging
Tomotherapy
030218 nuclear medicine & medical imaging
Choline
03 medical and health sciences
Prostate cancer
0302 clinical medicine
Retrospective Studie
Positron Emission Tomography Computed Tomography
medicine
Humans
Lymph node
Retrospective Studies
Aged
Aged
80 and over
Salvage Therapy
11C- Choline PET/CT
Genitourinary system
business.industry
Hazard ratio
Prostatic Neoplasms
lymph node recurrence
Lymphatic Metastasi
Middle Aged
medicine.disease
prostate cancer
Radiation therapy
medicine.anatomical_structure
Treatment Outcome
030220 oncology & carcinogenesis
Lymphatic Metastasis
Toxicity
Prostatic Neoplasm
Radiology
Radiotherapy
Intensity-Modulated
Neoplasm Recurrence
Local
business
Nuclear medicine
Human
Radiotherapy
Image-Guided
Popis: Objective: To report the 3-year toxicity and outcomes of carbon 11 (11C)-choline-positron emission tomography (PET)/computed tomography (CT)-guided radiotherapy (RT), delivered via helical tomotherapy (HTT; Tomotherapy® Hi-Art II® Treatment System, Accuray Inc., Sunnyvale, CA, USA) after lymph node (LN) relapses in patients with prostate cancer. Patients and Methods: From January 2005 to March 2013, 81 patients with biochemical recurrence after surgery, with or without adjuvant/salvage RT or radical RT, and with evidence of LN 11C-choline-PET/CT pathological uptake, underwent HTT (median [range] prostate-specific antigen level 2.59 [0.61–187] ng/mL). Of the 81 patients, 72 were treated at the pelvic and/or lumbar-aortic LN chain with HTT at 51.8 Gy/28 fr and with simultaneous integrated boost to a median dose of 65.5 Gy on the pathological uptake sites detected by 11C-choline-PET/CT. Nine patients were treated without simultaneous integrated boost (50–65.5 Gy, 25–30 fr). Results: With a median (range) follow-up of 36 (9–116) months, 91.4% of the patients had a PSA reduction 3 months after HTT. The 3-year overall, local relapse-free and clinical relapse-free survival rates were 80.0, 89.8 and 61.8%, respectively. The 3-year actuarial incidences of ≥grade 2 rectal and ≥grade 2 genitourinary toxicity were 6.6% (±2.9%) and 26.3% (±5.5%), respectively. A PSA nadir of ≥0.26 ng/mL (hazard ratio [HR] 3.6, 95% confidence interval [CI] 1.7–7.7; P = 0.001), extrapelvic 11C-choline-PET/CT-positive LN location (HR 2.4, 95% CI 0.9–6.4; P = 0.07), RT previous to HTT (HR 2.7; 95% CI 1.07–6.9, P = 0.04) and number of positive LNs (HR 1.13, 95% CI 1.04–1.22; P = 0.003) were the main predictors of clinical relapse after HTT. Conclusions: 11C-choline-PET/CT-guided HTT is safe and effective in the treatment of LN relapses of prostate cancer in previously treated patients.
Databáze: OpenAIRE
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