Parker William P, Evans Jaden D, Stish Bradley J, Park Sean S, Olivier Kenneth, Choo Richard, Nathan Mark A, Welch Brian T, Karnes R Jeffrey, Mynderse Lance A, Pisansky Thomas M, Kwon Eugene D, Lowe Val J, Davis Brian J
Department of Urology, Mayo Clinic, Rochester, Minnesota.
Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
Int J Radiat Oncol Biol Phys. 2017 Mar 1;97(3):526-535. doi: 10.1016/j.ijrobp.2016.11.014. Epub 2016 Nov 17.
To evaluate C-11 choline positron emission tomography/computed tomography (CholPET) in staging and determining patterns of recurrence in prostate cancer patients with rising prostate-specific antigen levels after prostatectomy radiation therapy (RT).
The study includes patients with biochemical failure after postprostatectomy RT who underwent CholPET between 2008 and 2015. Patient and disease characteristics were examined in relation to sites of recurrence. All RT dosimetry records were reviewed, and recurrences were mapped on a representative computed tomography dataset with their relationship relative to the irradiated fossa field as out of field (OOF), edge of field (EOF; recurrence within <45-Gy isodose lines), or in field (IF; recurrence within ≥45-Gy isodose lines).
Forty-one patients were identified with 121 sites of recurrence (median 2 sites; interquartile range [IQR], 1-4). The median prostate-specific antigen level at CholPET was 3.1 (IQR, 1.9-5.6) ng/mL. Median interval from RT to biochemical failure was 24 (IQR, 10-46) months, with recurrence identified on CholPET at a median of 15 (IQR, 7-28) months from biochemical failure. Histologic confirmation of recurrence was obtained in 20 patients (49%), with the remainder confirmed by treatment response. Five patients (12%) had IF recurrences, 10 patients (24%) had EOF recurrences (median dose 10 Gy; IQR, 5-30 Gy), and 36 patients (88%) had OOF recurrences. Ten patients had combination failures: 6 (15%) EOF/OOF and 4 (10%) IF/OOF. Fifty-seven recurrences (47%) were pelvic nodal sites inferior to the L5-S1 interspace, of which 52 (43%) were within a pelvic RT field. Eighty-one recurrences (67%) were nodal and inferior to the aortic bifurcation.
Using CholPET, we found that the majority of patients evaluated for biochemical failure recurred outside of the postprostatectomy RT field. Furthermore, most recurrence sites were nodal and inferior to the aortic bifurcation. These results provide data that may be useful for examining strategies that include elective lymph node irradiation in postprostatectomy patients.
评估¹¹C-胆碱正电子发射断层扫描/计算机断层扫描（CholPET）在前列腺癌患者前列腺切除术后放疗（RT）后前列腺特异性抗原水平升高时进行分期及确定复发模式的应用。
本研究纳入2008年至2015年间接受CholPET检查的前列腺切除术后放疗出现生化失败的患者。研究患者和疾病特征与复发部位的关系。回顾所有放疗剂量记录，并将复发部位标注在代表性的计算机断层扫描数据集上，根据其与照射野的关系分为野外（OOF）、野边缘（EOF；复发位于<45 Gy等剂量线内）或野内（IF；复发位于≥45 Gy等剂量线内）。
41例患者共发现121个复发部位（中位数2个部位；四分位间距[IQR]，1 - 4）。CholPET检查时前列腺特异性抗原水平中位数为3.1（IQR，1.9 - 5.6）ng/mL。从放疗至生化失败的中位间隔时间为24（IQR，10 - 46）个月，CholPET检查发现复发的时间中位数为生化失败后15（IQR，7 - 28）个月。20例患者（49%）获得复发的组织学确诊，其余通过治疗反应确诊。5例患者（12%）为野内复发，10例患者（24%）为野边缘复发（中位剂量10 Gy；IQR，5 - 30 Gy），36例患者（88%）为野外复发。10例患者为联合失败：6例（15%）为野边缘/野外复发，4例（10%）为野内/野外复发。57个复发部位（47%）位于L5 - S1间隙以下的盆腔淋巴结，其中52个（43%）位于盆腔放疗野内。81个复发部位（67%）为淋巴结且位于主动脉分叉以下。
使用CholPET，我们发现大多数接受生化失败评估的患者在前列腺切除术后放疗野外复发。此外，大多数复发部位为淋巴结且位于主动脉分叉以下。这些结果为研究包括前列腺切除术后患者选择性淋巴结照射的策略提供了可能有用的数据。
