Zang Anna-Lena, Maier Timo, Freitag-Wolf Sandra, Fabian Alexander, Rodler Severin, Dunst Jürgen, Krug David, Lützen Ulf, Wittenstein Olaf
Department of Radiotherapy, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany.
Department of Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany.
Clin Transl Radiat Oncol. 2025 Jul 23;54:101021. doi: 10.1016/j.ctro.2025.101021. eCollection 2025 Sep.
PURPOSE: PSMA-PET/CT is frequently used for staging patients with de-novo or recurrent prostate cancer (PCa). In patients with oligometastatic PCa PSMA-PET/CT guided stereotactic ablative body radiotherapy (SABR) is a common treatment option. Follow-up is regularly performed via measurement of prostate-specific-antigen (PSA) level. Response assessment based on follow-up PSMA-PET/CTs is poorly studied. Therefore, we report on long-term local tumor response using repeated PSMA-PET/CTs of patients with oligometastatic PCa after PSMA-PET/CT guided SABR. METHODS/PATIENTS: Patients with de-novo oligometastatic or oligoprogressive PCa who received PSMA-PET/CT-directed SABR with 5 × 7 Gy of at least one bone or lymph node lesion between 2015 and 2019 and had one or more follow-up PSMA-PET/CT were included in this retrospective single center analysis. PSMA response was evaluated by visual and quantitative assessment of local PSMA uptake pre- and post-SABR. RESULTS: Overall, 48 patients with 97 irradiated lesions and a total of 145 PSMA-PET/CT-scans were analyzed. 26 patients received androgen-deprivation-therapy (ADT) at any time. Median SUV per lesion was 10.88 (range 1.59-122.11) before SABR with a median CTV of 4.75 cm (Range 0.68-60.4 cm). In the first follow-up PET/CT after a median of 13 months (range 3-42) after SABR, median SUV per lesion declined to 2.2 (range 0.13-26.09). Complete remission (CR) was observed in 49 lesions, partial remission in 32 and stable disease in 12 lesions. Four lesions were non-responders. Over the course of up to five follow-up PSMA-PET/CTs a maximum of 90 % of the lesions showed CR. Median time to SUV was 19 months (range 3-50). 5-year local control was 86 %. No short-term or long-term toxicities were reported. CONCLUSION: PSMA-PET/CT directed SABR provides excellent long-term local tumor control of 90% in bone and lymph node metastasis of oligometastatic PCa and is well tolerated. PSMA activity may further decrease after initial re-imaging with PSMA-PET/CT.
目的：PSMA-PET/CT常用于初发或复发性前列腺癌（PCa）患者的分期。在寡转移PCa患者中，PSMA-PET/CT引导下的立体定向消融体部放疗（SABR）是一种常见的治疗选择。通常通过测量前列腺特异性抗原（PSA）水平进行随访。基于随访PSMA-PET/CT的疗效评估研究较少。因此，我们报告寡转移PCa患者在PSMA-PET/CT引导下SABR后，通过重复PSMA-PET/CT评估的长期局部肿瘤反应。 方法/患者：本回顾性单中心分析纳入了2015年至2019年间接受PSMA-PET/CT引导下SABR治疗、至少一个骨或淋巴结病灶接受5×7 Gy照射的初发寡转移或寡进展性PCa患者，且这些患者进行了一次或多次随访PSMA-PET/CT。通过对SABR前后局部PSMA摄取的视觉和定量评估来评价PSMA反应。 结果：共分析了48例患者的97个照射病灶以及总共145次PSMA-PET/CT扫描。26例患者在任何时间接受了雄激素剥夺治疗（ADT）。SABR前每个病灶的SUV中位数为10.88（范围1.59 - 122.11），CTV中位数为4.75 cm（范围0.68 - 60.4 cm）。SABR后中位13个月（范围3 - 42个月）的首次随访PET/CT中，每个病灶的SUV中位数降至2.2（范围0.13 - 26.09）。49个病灶观察到完全缓解（CR），32个病灶部分缓解，12个病灶病情稳定。4个病灶无反应。在多达5次随访PSMA-PET/CT过程中，最多90%的病灶显示CR。达到SUV的中位时间为19个月（范围3 - 50个月）。5年局部控制率为86%。未报告短期或长期毒性反应。 结论：PSMA-PET/CT引导下的SABR对寡转移PCa的骨和淋巴结转移提供了90%的出色长期局部肿瘤控制，且耐受性良好。初次PSMA-PET/CT重新成像后，PSMA活性可能会进一步降低。
Strahlenther Onkol. 2025-2-28
Clin Transl Oncol. 2023-4
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