Sepulcri Matteo, Fusella Marco, Cuppari Lea, Zorz Alessandra, Paiusco Marta, Evangelista Laura
Department of Radiation Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy.
Department of Medical Physics, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy.
Clin Transl Radiat Oncol. 2021 Jul 27;30:71-77. doi: 10.1016/j.ctro.2021.07.002. eCollection 2021 Sep.
This study aims to establish whether metabolic parameters obtainable from FCH PET/CT can predict long-term response to radical radiotherapy (rRT) in patients with localized prostate cancer (PCa).
Drawing on a single-center database, we retrospectively reviewed the pre-treatment FCH PET/CT scans of 50 patients who underwent rRT between 2012 and 2017. Patients were enrolled if they had a follow-up of at least 3 years after rRT. Various metabolic parameters were considered for each PET/CT, including FCH multifocality. rRT was administered to all patients for a total equivalent dose of 76-80 Gy, using a standard or hypofractionated schedule. Patients were classified as disease-free (DF) if their PSA levels after rRT rose by <2 ng/mL vis-à-vis their PSA nadir, or as not disease free (NDF) if their PSA levels rose by more than 2 ng/ml.
A multifocal FCH uptake in the prostate gland was identified in 27 patients (54%). At 3-year follow-up, 37 patients (74%) were judged DF, and 13 (26%) were NDF. The SUVmax and SUVmean, and the sum of the two values in all FCH foci in the prostate gland were significantly higher for NDF patients than for DF patients (all p < 0.005). The sum of the TLCKA levels in all FCH foci was likewise significantly higher in patients who were NDF than in those found DF (median 54.5 vs. 29.4; p < 0.05). At univariate analysis, the most of PET-metrics and Gleason Score were predictors of biochemical relapse after 3-year follow-up (all p < 0.05).
Higher SUVs seems predict a worse outcome for patients with multifocal intraprostatic lesions who are candidates for rRT.
本研究旨在确定通过氟胆碱（FCH）正电子发射断层扫描/计算机断层扫描（PET/CT）获得的代谢参数是否能够预测局限性前列腺癌（PCa）患者接受根治性放疗（rRT）后的长期反应。
利用单中心数据库，我们回顾性分析了2012年至2017年间接受rRT的50例患者的治疗前FCH PET/CT扫描。如果患者在rRT后至少有3年的随访，则纳入研究。对每个PET/CT考虑了各种代谢参数，包括FCH多灶性。所有患者均接受rRT，总等效剂量为76 - 80 Gy，采用标准或大分割方案。如果rRT后患者的前列腺特异性抗原（PSA）水平相对于其PSA最低点升高<2 ng/mL，则分类为无疾病（DF）；如果PSA水平升高超过2 ng/ml，则分类为非无疾病（NDF）。
27例患者（54%）在前列腺中发现多灶性FCH摄取。在3年随访时，37例患者（74%）被判定为DF，13例（26%）为NDF。NDF患者的最大标准摄取值（SUVmax）和平均标准摄取值（SUVmean）以及前列腺中所有FCH病灶这两个值的总和均显著高于DF患者（所有p < 0.005）。NDF患者中所有FCH病灶的总病变糖酵解活性（TLCKA）水平总和同样显著高于DF患者（中位数54.5对29.4；p < 0.05）。在单因素分析中，大多数PET指标和 Gleason评分是3年随访后生化复发的预测因素（所有p < 0.05）。
较高的SUV值似乎预示着接受rRT的前列腺内多灶性病变患者预后较差。
