Akin-Akintayo Oladunni O, Jani Ashesh B, Odewole Oluwaseun, Tade Funmilayo I, Nieh Peter T, Master Viraj A, Bellamy Leah M, Halkar Raghuveer K, Zhang Chao, Chen Zhengjia, Goodman Mark M, Schuster David M
From the *Department of Radiology and Imaging Sciences, Emory University, Atlanta; †Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta; ‡Department of Family Medicine, Morehouse School of Medicine, Atlanta; §Department of Urology, Emory University, Atlanta; and ∥Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA.
Clin Nucl Med. 2017 Jan;42(1):e22-e28. doi: 10.1097/RLU.0000000000001379.
We explored the influence of FACBC (fluciclovine) PET/CT on the decision to offer radiotherapy and radiotherapy treatment field recommendations in postprostatectomy patients with recurrent prostate cancer.
After obtaining institutional review board approval and informed consent, 87 patients with detectable prostate-specific antigen (PSA) levels were recruited into a prospective clinical trial. After an initial provider-determined radiotherapy plan based on conventional imaging, 44 of 87 patients were randomized to additionally undergo fluciclovine PET/CT. Pre- and post-fluciclovine radiotherapy decisions were compared and changes were noted. Statistical significance of these decision changes was determined.
Two of 44 patients in the experimental arm dropped out before fluciclovine scanning. Thirty-four (81.0%) of 42 had positive results on fluciclovine. Overall radiotherapy decision was changed in 17 (40.5%) of 42. Mean PSA, original Gleason score, and prostatectomy-PET interval did not differ significantly between patients with and without radiotherapy decision changes. Two (4.8%) of 42 had the decision for radiotherapy withdrawn due to positive extrapelvic findings. Radiotherapy field decision was changed in 15 (35.7%) of 42. Eleven (73.3%) of 15 had fields changed from prostate bed only to both prostate bed and pelvis, while 4 (26.7%) of 15 had fields changed from both prostate bed and pelvis to prostate bed only. Changes in overall radiotherapy decision and field were statistically significant (P < 0.0001). However, the change in the decision to offer radiotherapy or not was not statistically significant (P = 0.15).
Fluciclovine PET/CT significantly changed radiotherapy management decisions in postprostatectomy patients with recurrent prostate cancer. Further work in determining differences in PSA-free survival is ongoing.
我们探讨了氟代脱氧胸苷（fluciclovine）PET/CT对前列腺癌根治术后复发患者放疗决策及放疗野推荐的影响。
获得机构审查委员会批准并取得知情同意后，87例前列腺特异性抗原（PSA）水平可检测的患者被纳入一项前瞻性临床试验。在最初由医生根据传统影像确定放疗计划后，87例患者中的44例被随机分组，额外接受氟代脱氧胸苷PET/CT检查。比较氟代脱氧胸苷检查前后的放疗决策，并记录变化情况。确定这些决策变化的统计学意义。
试验组44例患者中有2例在氟代脱氧胸苷扫描前退出。42例患者中有34例（81.0%）氟代脱氧胸苷检查结果为阳性。42例患者中有17例（40.5%）的总体放疗决策发生了改变。放疗决策有变化和无变化的患者之间，平均PSA、原始Gleason评分以及前列腺切除术后与PET检查的间隔时间差异均无统计学意义。42例患者中有2例（4.8%）因盆腔外阳性结果而撤销了放疗决定。42例患者中有15例（35.7%）的放疗野决策发生了改变。15例中有11例（73.3%）的放疗野从仅前列腺床改为前列腺床和盆腔，而15例中有4例（26.7%）的放疗野从前列腺床和盆腔改为仅前列腺床。总体放疗决策和放疗野的变化具有统计学意义（P < 0.0001）。然而，是否进行放疗的决策变化无统计学意义（P = 0.15）。
氟代脱氧胸苷PET/CT显著改变了前列腺癌根治术后复发患者的放疗管理决策。关于确定无PSA生存期差异的进一步研究正在进行中。
