Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Australia.
Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Australia; University of Sydney, Australia; Genesis Cancer Care, Australia.
Radiother Oncol. 2018 Feb;126(2):244-248. doi: 10.1016/j.radonc.2017.10.022. Epub 2017 Nov 10.
To identify sites of failure with Ga-PSMA-PET (PSMA-PET) imaging in patients who have Biochemical Failure (BF) following post-prostatectomy radiotherapy.
Between June 2006 and January 2016, 409 men received post prostatectomy intensity modulated radiation treatment (IMRT) with protocolised planning. 310 patients received radiation treatment (RT) to the Prostate Fossa (PF) alone and 99 patients received RT to PF and pelvic lymphatics (PF + LN) usually in combination with androgen deprivation (AD) therapy. Any failure not detected on conventional imaging was delineated with PSMA-PET scanning. Sites of failure were characterised as in-field (PF ± LN), or out of field (nodal alone, distant metastatic alone (visceral or bone) or multi-site failure). Nodal failure was further divided into pelvic failure and/or distant failure.
119 men developed BF, defined as a PSA rise of >0.2 or greater, above post-RT nadir. Freedom from BF was 71% in the PF group and 70% in the PF + LN group, with median follow up of 52 and 44 months respectively. AD was used concomitantly in 13% of the PF group and 92% of the PF + LN group. 81 patients with BF (68%) had PSMA-PET imaging performed as per study intent, 67 (80%) of whom had PSMA avid disease identified. PSMA-PET delineated in-field failure occurred in 2/50 (4%) of the PF group and 1/17 (6%) in the PF + LN group. Nodal failure alone was 33/50 (66%) for the PF group vs 7/17 (41%) for the PF + LN group. For the nodal only failure patients, 18/33 (55%) had pelvic-only nodal failure in the PF group compared to 1/7 (14%) in the PF + LN group (p = 0.03). 16 (32%) of the PSMA avid failures in the PF group would have been encompassed by standard pelvic lymphatic radiotherapy volumes.
Post-prostatectomy radiation treatment resulted in excellent in-field control rates. Isolated pelvic nodal failure was rare in those receiving radiotherapy to the prostatic fossa and pelvic nodes but accounted for one third of failures in those receiving PF alone treatment.
在前列腺癌根治术后接受放疗后出现生化失败（BF）的患者中，通过 Ga-PSMA-PET（PSMA-PET）成像识别失败部位。
2006 年 6 月至 2016 年 1 月期间，409 名男性接受了前列腺癌根治术后强度调制放射治疗（IMRT），并采用了规范化的计划。310 名患者仅接受了前列腺窝（PF）的放射治疗（RT），99 名患者接受了 PF 和盆腔淋巴结（PF+LN）的 RT，通常与雄激素剥夺（AD）治疗联合使用。任何未在常规影像检查中检测到的失败均通过 PSMA-PET 扫描进行描绘。失败部位的特征为场内（PF±LN）或场外（仅淋巴结、仅远处转移（内脏或骨骼）或多部位失败）。淋巴结失败进一步分为盆腔失败和/或远处失败。
119 名男性出现 BF，定义为 PSA 升高>0.2 或高于 RT 后最低点。PF 组的 BF 无复发生存率为 71%，PF+LN 组为 70%，中位随访时间分别为 52 和 44 个月。PF 组中有 13%的患者同时使用 AD，PF+LN 组中有 92%的患者同时使用 AD。81 名 BF 患者（68%）按照研究意向进行了 PSMA-PET 成像，其中 67 名（80%）患者发现了 PSMA 活性疾病。PSMA-PET 描绘了场内失败，PF 组中有 2/50（4%），PF+LN 组中有 1/17（6%）。PF 组的淋巴结单独失败为 33/50（66%），PF+LN 组为 7/17（41%）。对于仅淋巴结失败的患者，PF 组中有 18/33（55%）为盆腔仅淋巴结失败，而 PF+LN 组中仅 1/7（14%）为盆腔仅淋巴结失败（p=0.03）。PF 组中 16 名（32%）PSMA 活性失败患者的标准盆腔淋巴结放疗体积可以包含。
前列腺癌根治术后放射治疗的场内控制率非常高。在接受前列腺窝和盆腔淋巴结放疗的患者中，孤立性盆腔淋巴结失败很少见，但在仅接受 PF 治疗的患者中，三分之一的患者出现失败。
