Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Germany.
Division of Medical Physics, Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Germany.
Radiother Oncol. 2017 Jun;123(3):472-477. doi: 10.1016/j.radonc.2017.04.021. Epub 2017 May 9.
To demonstrate the feasibility and to evaluate the tumour control probability (TCP) and normal tissue complication probability (NTCP) of IMRT dose painting using Ga-HBED-CC PSMA PET/CT for target delineation in prostate cancer (PCa).
10 patients had PSMA PET/CT scans prior to prostatectomy. GTV-PET was generated on the basis of an intraprostatic SUVmax of 30%. Two IMRT plans were generated for each patient: Plan which consisted of whole-prostate IMRT to 77Gy, and Plan which consisted of whole-prostate IMRT to 77Gy and a simultaneous integrated boost to the GTV-PET up to 95Gy (35 fractions). The feasibility of these plans was judged by their ability to adhere to the FLAME trial protocol. TCP-histo/-PET were calculated on co-registered histology (GTV-histo) and GTV-PET, respectively. NTCPs for rectum and bladder were calculated.
All plans reached prescription doses whilst adhering to dose constraints. In Plan and Plan mean doses in GTV-histo were 75.8±0.3Gy and 96.9±1Gy, respectively. Average TCP-histo values for Plan and Plan were 70% (range: 15-97%), and 96% (range: 78-100%, p<0.0001). Average TCP-PET values for Plan and Plan were 55% (range: 27-82%), and 100% (range: 99-100%, p<0.0001). There was no significant difference between TCP-PET and TCP-histo in Plan (p=0.25). There were no significant differences in rectal (p=0.563) and bladder (p=0.3) NTCPs.
IMRT dose painting using PSMA PET/CT was technically feasible and resulted in significantly higher TCPs without higher NTCPs.
展示使用 Ga-HBED-CC PSMA PET/CT 进行靶区勾画的调强放疗剂量绘画的可行性，并评估前列腺癌（PCa）的肿瘤控制概率（TCP）和正常组织并发症概率（NTCP）。
10 例患者在前列腺切除术前行 PSMA PET/CT 扫描。GTV-PET 是根据前列腺内 SUVmax 为 30%生成的。为每位患者生成了两种 IMRT 计划：一种是 77Gy 的全前列腺 IMRT 计划，另一种是 77Gy 的全前列腺 IMRT 计划和 GTV-PET 的同步整合提升至 95Gy（35 个分次）。通过它们遵守 FLAME 试验方案的能力来判断这些计划的可行性。在配准的组织学（GTV-histo）和 GTV-PET 上分别计算 TCP-histo/-PET。计算直肠和膀胱的 NTCP。
所有计划都达到了处方剂量，同时遵守了剂量限制。在 Plan 和 Plan 中，GTV-histo 的平均剂量分别为 75.8±0.3Gy 和 96.9±1Gy。Plan 和 Plan 的平均 TCP-histo 值分别为 70%（范围：15-97%）和 96%（范围：78-100%，p<0.0001）。Plan 和 Plan 的平均 TCP-PET 值分别为 55%（范围：27-82%）和 100%（范围：99-100%，p<0.0001）。Plan 中 TCP-PET 与 TCP-histo 之间无显著差异（p=0.25）。直肠（p=0.563）和膀胱（p=0.3）NTCP 无显著差异。
使用 PSMA PET/CT 进行调强放疗剂量绘画在技术上是可行的，并且在不增加更高 NTCP 的情况下显著提高了 TCP。
