Interim Results of a Prospective Prostate-Specific Membrane Antigen-Directed Focal Stereotactic Reirradiation Trial for Locally Recurrent Prostate Cancer
| Autor: | Andrew Kneebone, Kathryn Szymura, Carol Kwong, Julia Hunter, Sarah Bergamin, George Hruby, Andrew Le, Thomas Eade, Jeremy T. Booth, Chris Brown, Geoffrey Schembri, Edward C. Hsiao |
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| Rok vydání: | 2020 |
| Předmět: |
Glutamate Carboxypeptidase II
Male Cancer Research medicine.medical_specialty Time Factors Radiosurgery 030218 nuclear medicine & medical imaging Re-Irradiation 03 medical and health sciences 0302 clinical medicine Prostate Positron Emission Tomography Computed Tomography Biopsy Glutamate carboxypeptidase II medicine Humans Radiology Nuclear Medicine and imaging Prospective Studies Radiation Injuries Aged Aged 80 and over Salvage Therapy Radiation medicine.diagnostic_test Genitourinary system business.industry Rectal Ulcer Prostatic Neoplasms Middle Aged Magnetic Resonance Imaging medicine.anatomical_structure Treatment Outcome Oncology Positron emission tomography 030220 oncology & carcinogenesis Toxicity Cohort Antigens Surface Feasibility Studies Radiology Dose Fractionation Radiation Neoplasm Recurrence Local business |
| Zdroj: | International journal of radiation oncology, biology, physics. 108(5) |
| ISSN: | 1879-355X |
| Popis: | Purpose To report the feasibility, toxicity, and preliminary outcomes (metabolic and biochemical) of 68Ga-prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT)–directed focal prostate reirradiation using linear accelerator (LINAC)–based stereotactic body radiation treatment (SBRT). Methods and Materials From March 2016 to March 2019, 25 patients were enrolled in a prospective single institution trial (ACTRN12617000035325). Eligibility criteria included patients with biopsy proven isolated prostate recurrence after definitive irradiation, with concordant multiparametric MRI and 68Ga-PSMA PET/CT findings, and a prostate-specific antigen of less than 15 ng/mL at the time of recurrence. The study included a sequential dose escalation component with the first 18 patients receiving 36 Gy in 6 fractions on alternate days with subsequent patients receiving 38 Gy in 6 fractions assuming acceptable toxicity. Results Median age was 72 years (range, 62-83) with a median time between first radiation treatment and salvage SBRT of 8.3 years (range, 4.5- 13.6). Median prostate-specific antigen at reirradiation was 4.1 (range, 1.1-16.6). The median follow-up was 25 months (range, 13-46). Acute grade 1 and 2 genitourinary (GU) toxicity occurred in 6 (24%) and 1 (4%) men, respectively. Acute grade 1 gastrointestinal (GI) toxicity occurred in 8% with one acute grade 3 GI toxicity (4%) due to a rectal ulcer overlying the hydrogel. Late grade 1 and 2 GU toxicity occurred in 28% and 4%. Late grade 1 GI toxicity occurred in 8% with no grade 2 or greater toxicity. Twenty-four patients have undergone per-protocol 12-month 68Ga-PSMA PET/CT, of which 23 (92%) demonstrated a complete metabolic response. Biochemical freedom from failure was 80% at 2 years with 3 out of 4 of the biochemical failures exhibiting recurrent local disease. Conclusions PSMA-directed salvage focal reirradiation to the prostate using linear accelerator–based SBRT is feasible and safe. Toxicity was low, with very favorable short term local and biochemical control in a carefully selected cohort of patients. |
| Databáze: | OpenAIRE |
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