68Ga-PSMA PET/CT 对前列腺癌患者放射治疗计划的影响。

Impact of 68Ga-PSMA PET/CT on radiation treatment planning of prostate cancer patients.

机构信息

Department of Radiotherapy and Radiation Oncology, Rostock University Medical Center, Rostock, Germany.

Department of Nuclear Medicine, Rostock University Medical Center, Rostock, Germany.

出版信息

Nuklearmedizin. 2024 Jun;63(3):199-206. doi: 10.1055/a-2284-0593. Epub 2024 Apr 5.

DOI:10.1055/a-2284-0593

PMID:38580313

Abstract

AIM

This study aimed to assess the impact of Ga-PSMA PET/CT on radiation treatment (RT) planning in prostate cancer patients with salvage (sRT) or definitive (dRT) radiotherapy.

METHODS

38 patients (27 sRT, median PSA 0.79 ng/ml (range 0.06-12.1); 11 dRT, median PSA 4.35 ng/ml (range 1.55-55.5) underwent Ga-PSMA PET/CT before RT. Influence of Ga-PSMA PET/CT on the extent of planning target volume (PTV) and addition of PET-based boosts were assessed. Median follow up was 12 months (range 3-24).

RESULTS

Ga-PSMA PET/CT showed positive findings in 23/38 patients (8/23: local recurrence (LR), 11/23: nodal metastasis, 1/23: LR and nodal, 2/23: solitary bone metastasis, 1/23: oligometastatic nodal/ bone metastases). In sRT primary PTV was changed in 16/27 patients extending the PTV to the lymphatic drainage (10/16), PSMA-positive LR (3/16), bone metastases (2/16) and both nodal/bone metastases (1/16). PET-based increase of primary PTV was 116%. PET-based boosts were administered in 19/27 patients (8/19: local, 10/19: nodal, 1/19: both), median boost volume was 31.3 cm (range 17.2-80.2) (local) and 19.7 cm (range 3.0-109.3) (nodal). PTV was changed in 1/11 (9%) of dRT patients (extension of primary PTV to the lymphatic drainage (RT volume of 644.5 cm), additional nodal boost (volume of 2.7 cm, 23.1 Gy)). All patients showed biochemical response (mean PSA decrease 88.8 +/- 14.0%). Nadir PSA was reached 10 months (range 1-17) after end of RT (median 0.07 ng/ml, range 0.002-3.96). Within a median 12 months follow-up (range 3-22/8-24 in sRT/dRT), median PSA was 0.05 ng/ml (range 0.002-8.5) (sRT) and 0.26 ng/ml (range 0.02-2.68) (dRT).

CONCLUSIONS

Ga-PSMA PET/CT influenced sRT planning in almost 63% and dRT in 9% of patients by change of PTV and additional boosts.

摘要

目的

本研究旨在评估 Ga-PSMA PET/CT 对接受挽救性（sRT）或根治性（dRT）放疗的前列腺癌患者放射治疗（RT）计划的影响。

方法

38 例患者（27 例 sRT，中位 PSA 0.79ng/ml（范围 0.06-12.1）；11 例 dRT，中位 PSA 4.35ng/ml（范围 1.55-55.5））在 RT 前接受 Ga-PSMA PET/CT 检查。评估 Ga-PSMA PET/CT 对计划靶区（PTV）范围和基于 PET 的加量的影响。中位随访时间为 12 个月（范围 3-24）。

结果

Ga-PSMA PET/CT 在 23/38 例患者（8/23：局部复发（LR），11/23：淋巴结转移，1/23：LR 和淋巴结，2/23：单发骨转移，1/23：寡转移淋巴结/骨转移）中显示阳性发现。在 sRT 中，27 例患者中有 16 例原发 PTV 发生变化，将 PTV 扩展至淋巴引流区（10/16）、PSMA 阳性 LR（3/16）、骨转移（2/16）和淋巴结/骨转移（1/16）。基于 PET 的原发 PTV 增加了 116%。在 27 例患者中有 19 例（8/19：局部，10/19：淋巴结，1/19：两者）接受了基于 PET 的加量。中位加量体积为 31.3cm³（范围 17.2-80.2）（局部）和 19.7cm³（范围 3.0-109.3）（淋巴结）。11 例 dRT 患者中有 1 例（将原发 PTV 扩展至淋巴引流区（RT 体积为 644.5cm³），额外的淋巴结加量（体积为 2.7cm³，23.1Gy））发生 PTV 变化。所有患者均表现出生化缓解（平均 PSA 下降 88.8%±14.0%）。PSA 最低值在 RT 结束后 10 个月（范围 1-17）达到（中位值 0.07ng/ml，范围 0.002-3.96）。中位随访 12 个月（范围 3-22/8-24 sRT/dRT）时，sRT 组中位 PSA 为 0.05ng/ml（范围 0.002-8.5），dRT 组为 0.26ng/ml（范围 0.02-2.68）。