Rischke Hans Christian, Eiberger Ann-Kristin, Volegova-Neher Natalja, Henne Karl, Krauss Tobias, Grosu Anca-L, Jilg Cordula A
Department of Radiation Oncology, Albert-Ludwigs University Hospital of Freiburg, Freiburg, Germany; Department of Nuclear Medicine, Albert-Ludwigs University Hospital of Freiburg, Freiburg, Germany.
Department of Radiation Oncology, Albert-Ludwigs University Hospital of Freiburg, Freiburg, Germany.
Adv Med Sci. 2016 Sep;61(2):212-218. doi: 10.1016/j.advms.2016.01.003. Epub 2016 Feb 3.
PET/CT directed extended salvage radiotherapy (esRT) of involved lymph-node (LN) regions may be a salvage strategy for patients with nodal recurrent prostate cancer (PCa) after primary therapy or after previous prostate fossa salvage RT. The aim of the study was to determine the time until prostate-specific antigen (PSA) progression, pattern of failure and toxicity after esRT.
25 patients with nodal or nodal+local recurrent PCa confirmed by Choline-PET/CT and Magnetic Resonance Imaging (MRI) were treated with esRT at the sites of recurrence. Acute and late toxicity was recorded. In case of subsequent PSA progression, imaging was performed to confirm next relapse. Mean follow-up was 2.9 years.
According to Choline-PET/CT and MRI findings, 84% (21/25) of esRT were treatment of pelvic only, 12% (3/25) of retroperitoneal only and 4% (1/25) of both pelvic and retroperitoneal regions. 40% (10/25) received concomitant irradiation of the prostatic fossa (after primary radical prostatectomy). Median time to PSA progression of the whole cohort was 19.6 months. Median time to PSA progression for patients with 1-2 PET-positive LN (n=15) was 34.9 months versus median 12.7 months for patients with PET-positive LN≥3 (n=10), p-value: 0.0476. Acute and late toxicity was mild to moderate, no grade-3 adverse events were observed.
PET/CT and MRI directed esRT of nodal recurrent PCa with or without local recurrence is feasible with low acute and late toxicity. Patients with only one or two PET-positive LN treated by esRT achieved prolonged complete biochemical remission.
对受累淋巴结（LN）区域进行PET/CT引导下的扩大挽救性放疗（esRT）可能是原发性治疗后或先前前列腺窝挽救性放疗后发生淋巴结复发前列腺癌（PCa）患者的一种挽救策略。本研究的目的是确定esRT后前列腺特异性抗原（PSA）进展的时间、失败模式和毒性。
25例经胆碱PET/CT和磁共振成像（MRI）确诊为淋巴结或淋巴结+局部复发PCa的患者在复发部位接受esRT治疗。记录急性和晚期毒性。如果随后出现PSA进展，则进行成像以确认下一次复发。平均随访时间为2.9年。
根据胆碱PET/CT和MRI结果，84%（21/25）的esRT仅治疗盆腔，12%（3/25）仅治疗腹膜后，4%（1/25）治疗盆腔和腹膜后区域。40%（10/25）的患者同时接受前列腺窝照射（在原发性根治性前列腺切除术后）。整个队列的PSA进展中位时间为19.6个月。1-2个PET阳性LN患者（n=15）的PSA进展中位时间为34.9个月，而PET阳性LN≥3个患者（n=10）的中位时间为12.7个月，p值：0.0476。急性和晚期毒性为轻度至中度，未观察到3级不良事件。
PET/CT和MRI引导下对有或无局部复发的淋巴结复发PCa进行esRT是可行的，急性和晚期毒性较低。接受esRT治疗的仅有一两个PET阳性LN的患者实现了延长的完全生化缓解。
