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Background  In comparison to the conventional whole-prostate dose escalation, an integrated boost to the macroscopic malignant lesion might potentially improve tumor control rates without increasing toxicity. Quality of life after radiotherapy (RT) with vs. without  18 F-choline PET-CT detected simultaneous integrated boost (SIB) was prospectively evaluated in this study.    Methods  Whole body image acquisition in supine patient position followed 1 h after injection of 178-355MBq  18 F-choline. SIB was defined by a tumor-to-background uptake value ratio > 2 (GTV PET ). A dose of 76Gy was prescribed to the prostate (PTV prostate ) in 2Gy fractions, with or without SIB up to 80Gy. Patients treated with (n = 46) vs. without (n = 21) SIB were surveyed prospectively before (A), at the last day of RT (B) and a median time of two (C) and 19 month (D) after RT to compare QoL changes applying a validated questionnaire (EPIC - expanded prostate cancer index composite).    Results  With a median cut-off standard uptake value (SUV) of 3, a median GTV PET  of 4.0 cm 3  and PTV boost  (GTV PET  with margins) of 17.3 cm 3  was defined. No significant differences were found for patients treated with vs. without SIB regarding urinary and bowel QoL changes at times B, C and D (mean differences ≤3 points for all comparisons). Significantly decreasing acute urinary and bowel score changes (mean changes > 5 points in comparison to baseline level at time A) were found for patients with and without SIB. However, long-term urinary and bowel QoL (time D) did not differ relative to baseline levels - with mean urinary and bowel function score changes < 3 points in both groups (median changes = 0 points). Only sexual function scores decreased significantly (> 5 points) at time D.    Conclusions  Treatment planning with  18 F-choline PET-CT allows a dose escalation to a macroscopic intraprostatic lesion without significantly increasing toxicity.

radiation oncology

Dose-escalation using intensity-modulated radiotherapy for prostate cancer - evaluation of quality of life with and without 18F-choline PET-CT detected simultaneous integrated boost