Department of Radiation Oncology, Klinik für Radioonkologie und Strahlentherapie, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
Department of Nuclear Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.
Radiat Oncol. 2017 Aug 23;12(1):140. doi: 10.1186/s13014-017-0877-x.
By the use of PSMA positron emission tomography (PET) detection of prostate cancer lesions with a high sensitivity and specificity combined with a favorable lesion to background contrast is feasible. Therefore, PSMA-PET is increasingly used for planning of radiotherapy treatment; however, any data on intermediate-term outcome is missing so far.
Patients with high-risk or very high risk prostate cancer, referred for salvage radiotherapy (SRT, n = 22) between 2013 and 2015, underwent PSMA-PET prior to therapy. Irradiation was planned on PET data with boost to macroscopic tumors/metastases. Treatment related toxicity was measured using Common Terminology Criteria for Adverse Events (CTCAE, v4.0).
Findings in PSMA-PET led to treatment modifications in 77% of SRT patients compared to available CT information. One patient did not receive irradiation due to disseminated disease, the other patients received increased boost doses to macroscopic disease and/or inclusion of additional target volumes. Toxicity was low as only 2 patients reported toxicities > grade 1. With a Median follow-up time of 29 in patients that were not lost to follow-up, prolonged PSA responses below baseline were observed in the majority of patients (14 of 20). In hormone-naïve SRT patients (n = 11), radiotherapy led to prolonged PSA decrease in 8/11 patients, however with 3 of these 8 patients receiving repeated PSMA based irradiation of novel lesions during follow-up.
PSMA-PET guided planning of radiotherapy led to change of treatment in the majority of patients. Treatment related toxicity was well tolerated and promising results regarding intermediate-term PSA decrease were observed.
No trial registration was performed due to retrospective evaluation.
利用 PSMA 正电子发射断层扫描（PET）检测前列腺癌病变具有较高的灵敏度和特异性，并具有良好的病变与背景对比，这是可行的。因此，PSMA-PET 越来越多地用于放射治疗计划；然而，目前还缺乏任何关于中期结果的数据。
2013 年至 2015 年间，因挽救性放疗（SRT）而转诊的高危或极高危前列腺癌患者在治疗前进行 PSMA-PET 检查。根据 PET 数据对肿瘤/转移灶进行放疗，并对其进行强化照射。使用常见不良事件术语标准（CTCAE，v4.0）来测量治疗相关毒性。
与现有 CT 信息相比，PSMA-PET 的检查结果导致 77%的 SRT 患者的治疗方式发生了改变。由于疾病扩散，有 1 名患者未接受放疗，而其他患者则接受了更大剂量的强化照射，或纳入了更多的靶区。毒性较低，只有 2 名患者报告的毒性>1 级。在未失访的 20 名患者中，中位随访时间为 29 个月，大多数患者（14 例中有 14 例）的 PSA 反应持续低于基线。在未接受激素治疗的 SRT 患者（n=11）中，放疗使 8/11 例患者的 PSA 下降持续时间延长，但在这 8 例患者中有 3 例在随访期间接受了基于 PSMA 的新病变的重复照射。
PSMA-PET 指导放疗计划的制定使大多数患者的治疗方式发生了改变。治疗相关毒性可耐受，PSA 降低的中期结果有较好的前景。
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