223Ra治疗的最终结果及18F-氟化物PET在转移性去势抵抗性前列腺癌疗效评估中的作用——单机构经验

Final Outcome of 223Ra-therapy and the Role of 18F-fluoride-PET in Response Evaluation in Metastatic Castration-resistant Prostate Cancer-A Single Institution Experience.

作者信息

Kairemo Kalevi, Milton Denai R, Etchebehere Elba, Rohren Eric M, Macapinlac Homer A

机构信息

Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, United States.

Department of Molecular Radiotherapy and Nuclear Medicine, Docrates Cancer Center, Helsinki, Finland.

出版信息

Curr Radiopharm. 2018;11(2):147-152. doi: 10.2174/1874471011666180629145030.

DOI:10.2174/1874471011666180629145030

PMID:29956640

Abstract

BACKGROUND

223Ra was the first therapeutic alpha-emitting radionuclide registered for clinical practice. This radionuclide is targeting actively bone-forming cells, and it is approved for treating metastatic skeletal disease in prostate cancer. 18F-PET is used to detect skeletal metastatic disease based on osteoblastic activity. The aim of this study was to analyze, if 18F-PET can be used assessing the results of 223Ra therapy, and to report final median overall survival in a total of 773 therapy cycles.

METHODS

A 161 men with castration-resistant prostate cancer were included in a single institution study (Protocol#: PA14-0848) and they received a total of 773 223Ra therapy cycles.

RESULTS

The median overall survival (95% CI) was 12.4 (9.1, 16.1) months in patient population. Interim Na18F-PET imaging was applied in 14 patients at baseline, after 3 cycles and after 6 cycles. TLF10 (skeletal disease burden at SUV-values >10 on Na18F -PET) were calculated in all these PET studies, and there was no significant association between change in TLF10 after 3 cycles and TLF10 after 6 cycles (p=0.20).

CONCLUSION

From these results, we conclude that interim imaging does not help in assessing the final outcome of 223Ra therapy. The survival benefit of 223Ra therapy alone is more than a year in a high-risk group of advanced prostate cancer.

摘要

背景

镭-223是首个获批用于临床实践的发射α粒子的治疗性放射性核素。这种放射性核素靶向活跃的骨形成细胞，已被批准用于治疗前列腺癌的骨转移疾病。18F-PET基于成骨细胞活性用于检测骨转移疾病。本研究的目的是分析18F-PET是否可用于评估镭-223治疗的结果，并报告总共773个治疗周期的最终中位总生存期。

方法

161名去势抵抗性前列腺癌男性患者纳入一项单中心研究（方案编号：PA14-0848），他们共接受了773个镭-223治疗周期。

结果

患者群体的中位总生存期（95%CI）为12.4（9.1，16.1）个月。14名患者在基线、3个周期后和6个周期后进行了中期18F-NaPET成像。在所有这些PET研究中计算了TLF10（18F-NaPET上SUV值>10时的骨疾病负担），3个周期后TLF10的变化与6个周期后TLF10之间无显著相关性（p=0.20）。