PSMA PET 引导的立体定向体部放疗在根治性一线治疗后局部复发性前列腺癌中的应用。

PSMA PET-based stereotactic body radiotherapy for locally recurrent prostate cancer after definitive first-line therapy.

机构信息

Department for Radiation Oncology, Campus Virchow-Klinik, Charité-Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt-Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany.

Department for Obstetrics and Gynecology, Evangelisches Waldkrankenhaus Spandau Krankenhausbetriebs gGmbH, Berlin, Germany.

出版信息

Prostate. 2023 Sep;83(13):1298-1305. doi: 10.1002/pros.24592. Epub 2023 Jul 2.

DOI:10.1002/pros.24592

PMID:37394721

Abstract

BACKGROUND

Advances in prostate-specific membrane antigen (PSMA) PET-computed tomography (CT) and magnetic resonance imaging (MRI) allow the detection and localization of exclusively local prostate-cancer-recurrences after definitive first-line therapy. PSMA-based early detection of circumscribed local recurrences followed by hypofractionated high-precision stereotactic body radiotherapy (SBRT) might yield long-term disease control at moderate rates of adverse effects.

METHODS

Retrospective analysis of 35 patients treated for locally recurrent prostate cancer between November 2012 and December 2021 with PSMA PET- and MRI-based robotic SBRT.

RESULTS

Thirty-five patients treated with local prostate cancer recurrence post surgery, post surgery, and adjuvant/salvage radiotherapy (RT) and after definitive RT. All but one patients had fractionated SBRT in 3-5 fractions. Median progression-free survival (PFS) was 52.2 months for all patients and 52.2 months in the radical prostatectomy (RPE) group, 31.2 months in the RPE + RT group and not reached in the RT group. The most common event was increased urinary frequency grade 1-2. 54.3% of all patients had no acute and 79.4% no late toxicity during follow-up.

DISCUSSION

Our PFS of 52.2 months (RPE), 31.2 months (RPE + RT) and not reached (RT) compares favorably with published data. This method constitutes a valid alternative to morbidity-prone invasive approaches or palliative systemic therapy.

摘要

背景

前列腺特异性膜抗原 (PSMA) PET-计算机断层扫描 (CT) 和磁共振成像 (MRI) 的进步使得在明确的一线治疗后，能够检测和定位局限性前列腺癌复发。在局限性局部复发后，基于 PSMA 的早期检测，然后进行低分割高精准度立体定向体放射治疗 (SBRT)，可能会以中等不良反应发生率实现长期疾病控制。

方法

回顾性分析 2012 年 11 月至 2021 年 12 月期间，35 例接受局部复发性前列腺癌治疗的患者，这些患者接受了基于 PSMA PET 和 MRI 的机器人 SBRT。

结果

35 例患者接受了局部前列腺癌复发治疗，包括手术后、手术后辅助/挽救放疗 (RT) 以及根治性 RT 后。除 1 例患者外，所有患者均接受了分阶段 SBRT，分 3-5 个阶段进行。所有患者的中位无进展生存期 (PFS) 为 52.2 个月，根治性前列腺切除术 (RPE) 组为 52.2 个月，RPE+RT 组为 31.2 个月，RT 组未达到。最常见的事件是尿频率增加 1-2 级。在随访期间，54.3%的患者无急性毒性，79.4%的患者无晚期毒性。