Premium
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
Author(s) -
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
Publication year - 2017
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.13510
Subject(s) - medicine , prostate cancer , tomotherapy , positron emission tomography , hazard ratio , nuclear medicine , biochemical recurrence , lymph node , radiation therapy , salvage therapy , radiology , urology , cancer , confidence interval , prostatectomy , chemotherapy
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 LN s ( 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.