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Combining (68)Ga-PSMA-PET/CT-Directed and Elective Radiation Therapy Improves Outcome in Oligorecurrent Prostate Cancer: A Retrospective Multicenter Study

BACKGROUND: In case of oligo-recurrent prostate cancer (PC) following prostatectomy, (68)Ga-PSMA-PET/CT can be used to detect a specific site of recurrence and to initiate metastasis-directed radiation therapy (MDT). However, large heterogeneities exist concerning doses, treatment fields and radiati...

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Autores principales: Kirste, Simon, Kroeze, Stephanie G. C., Henkenberens, Christoph, Schmidt-Hegemann, Nina-Sophie, Vogel, Marco M. E., Becker, Jessica, Zamboglou, Constantinos, Burger, Irene, Derlin, Thorsten, Bartenstein, Peter, Ruf, Juri, la Fougère, Christian, Eiber, Matthias, Christiansen, Hans, Combs, Stephanie E., Müller, Arndt-Christian, Belka, Claus, Guckenberger, Matthias, Grosu, Anca-Ligia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8141738/
https://www.ncbi.nlm.nih.gov/pubmed/34041020
http://dx.doi.org/10.3389/fonc.2021.640467
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author Kirste, Simon
Kroeze, Stephanie G. C.
Henkenberens, Christoph
Schmidt-Hegemann, Nina-Sophie
Vogel, Marco M. E.
Becker, Jessica
Zamboglou, Constantinos
Burger, Irene
Derlin, Thorsten
Bartenstein, Peter
Ruf, Juri
la Fougère, Christian
Eiber, Matthias
Christiansen, Hans
Combs, Stephanie E.
Müller, Arndt-Christian
Belka, Claus
Guckenberger, Matthias
Grosu, Anca-Ligia
author_facet Kirste, Simon
Kroeze, Stephanie G. C.
Henkenberens, Christoph
Schmidt-Hegemann, Nina-Sophie
Vogel, Marco M. E.
Becker, Jessica
Zamboglou, Constantinos
Burger, Irene
Derlin, Thorsten
Bartenstein, Peter
Ruf, Juri
la Fougère, Christian
Eiber, Matthias
Christiansen, Hans
Combs, Stephanie E.
Müller, Arndt-Christian
Belka, Claus
Guckenberger, Matthias
Grosu, Anca-Ligia
author_sort Kirste, Simon
collection PubMed
description BACKGROUND: In case of oligo-recurrent prostate cancer (PC) following prostatectomy, (68)Ga-PSMA-PET/CT can be used to detect a specific site of recurrence and to initiate metastasis-directed radiation therapy (MDT). However, large heterogeneities exist concerning doses, treatment fields and radiation techniques, with some studies reporting focal radiotherapy (RT) to PSMA-PET/CT positive lesions only and other studies using elective RT strategies. We aimed to compare oncological outcomes and toxicity between PET/CT-directed RT (PDRT) and PDRT plus elective RT (eRT; i.e. prostate bed, pelvic or paraaortal nodes) in a large retrospective multicenter study. METHODS: Data of 394 patients with oligo-recurrent (68)Ga-PSMA-PET/CT-positive PC treated between 04/2013 and 01/2018 in six different academic institutions were evaluated. Primary endpoint was biochemical-recurrence-free survival (bRFS). bRFS was analyzed using Kaplan–Meier survival curves and log rank testing. Uni- and multivariate analyses were performed to determine influence of treatment parameters. RESULTS: In 204 patients (51.8%) RT was directed only to lesions seen on (68)Ga-PSMA-PET/CT (PDRT), 190 patients (48.2%) received PDRT plus eRT. PDRT plus eRT was associated with a significantly improved 3-year bRFS compared to PDRT alone (53 vs. 37%; p = 0.001) and remained an independent factor in multivariate analysis (p = 0.006, HR 0.29, 95% CI 0.12–0.68). This effect was more pronounced in the subgroup of patients who were treated with PDRT and elective prostate bed radiotherapy (ePBRT) with a 3-year bRFS of 61% versus 22% (p <0.001). Acute and late toxicity grade ≥3 was 0.8% and 3% after PDRT plus eRT versus no toxicity grade ≥3 after PDRT alone. CONCLUSIONS: In this large cohort of patients with oligo-recurrent prostate cancer, elective irradiation of the pelvic lymphatics and the prostatic bed significantly improved bRFS when added to (68)Ga-PSMA-PET/CT-guided focal radiotherapy. These findings need to be evaluated in a randomized controlled trial.
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spelling pubmed-81417382021-05-25 Combining (68)Ga-PSMA-PET/CT-Directed and Elective Radiation Therapy Improves Outcome in Oligorecurrent Prostate Cancer: A Retrospective Multicenter Study Kirste, Simon Kroeze, Stephanie G. C. Henkenberens, Christoph Schmidt-Hegemann, Nina-Sophie Vogel, Marco M. E. Becker, Jessica Zamboglou, Constantinos Burger, Irene Derlin, Thorsten Bartenstein, Peter Ruf, Juri la Fougère, Christian Eiber, Matthias Christiansen, Hans Combs, Stephanie E. Müller, Arndt-Christian Belka, Claus Guckenberger, Matthias Grosu, Anca-Ligia Front Oncol Oncology BACKGROUND: In case of oligo-recurrent prostate cancer (PC) following prostatectomy, (68)Ga-PSMA-PET/CT can be used to detect a specific site of recurrence and to initiate metastasis-directed radiation therapy (MDT). However, large heterogeneities exist concerning doses, treatment fields and radiation techniques, with some studies reporting focal radiotherapy (RT) to PSMA-PET/CT positive lesions only and other studies using elective RT strategies. We aimed to compare oncological outcomes and toxicity between PET/CT-directed RT (PDRT) and PDRT plus elective RT (eRT; i.e. prostate bed, pelvic or paraaortal nodes) in a large retrospective multicenter study. METHODS: Data of 394 patients with oligo-recurrent (68)Ga-PSMA-PET/CT-positive PC treated between 04/2013 and 01/2018 in six different academic institutions were evaluated. Primary endpoint was biochemical-recurrence-free survival (bRFS). bRFS was analyzed using Kaplan–Meier survival curves and log rank testing. Uni- and multivariate analyses were performed to determine influence of treatment parameters. RESULTS: In 204 patients (51.8%) RT was directed only to lesions seen on (68)Ga-PSMA-PET/CT (PDRT), 190 patients (48.2%) received PDRT plus eRT. PDRT plus eRT was associated with a significantly improved 3-year bRFS compared to PDRT alone (53 vs. 37%; p = 0.001) and remained an independent factor in multivariate analysis (p = 0.006, HR 0.29, 95% CI 0.12–0.68). This effect was more pronounced in the subgroup of patients who were treated with PDRT and elective prostate bed radiotherapy (ePBRT) with a 3-year bRFS of 61% versus 22% (p <0.001). Acute and late toxicity grade ≥3 was 0.8% and 3% after PDRT plus eRT versus no toxicity grade ≥3 after PDRT alone. CONCLUSIONS: In this large cohort of patients with oligo-recurrent prostate cancer, elective irradiation of the pelvic lymphatics and the prostatic bed significantly improved bRFS when added to (68)Ga-PSMA-PET/CT-guided focal radiotherapy. These findings need to be evaluated in a randomized controlled trial. Frontiers Media S.A. 2021-05-10 /pmc/articles/PMC8141738/ /pubmed/34041020 http://dx.doi.org/10.3389/fonc.2021.640467 Text en Copyright © 2021 Kirste, Kroeze, Henkenberens, Schmidt-Hegemann, Vogel, Becker, Zamboglou, Burger, Derlin, Bartenstein, Ruf, la Fougère, Eiber, Christiansen, Combs, Müller, Belka, Guckenberger and Grosu https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Kirste, Simon
Kroeze, Stephanie G. C.
Henkenberens, Christoph
Schmidt-Hegemann, Nina-Sophie
Vogel, Marco M. E.
Becker, Jessica
Zamboglou, Constantinos
Burger, Irene
Derlin, Thorsten
Bartenstein, Peter
Ruf, Juri
la Fougère, Christian
Eiber, Matthias
Christiansen, Hans
Combs, Stephanie E.
Müller, Arndt-Christian
Belka, Claus
Guckenberger, Matthias
Grosu, Anca-Ligia
Combining (68)Ga-PSMA-PET/CT-Directed and Elective Radiation Therapy Improves Outcome in Oligorecurrent Prostate Cancer: A Retrospective Multicenter Study
title Combining (68)Ga-PSMA-PET/CT-Directed and Elective Radiation Therapy Improves Outcome in Oligorecurrent Prostate Cancer: A Retrospective Multicenter Study
title_full Combining (68)Ga-PSMA-PET/CT-Directed and Elective Radiation Therapy Improves Outcome in Oligorecurrent Prostate Cancer: A Retrospective Multicenter Study
title_fullStr Combining (68)Ga-PSMA-PET/CT-Directed and Elective Radiation Therapy Improves Outcome in Oligorecurrent Prostate Cancer: A Retrospective Multicenter Study
title_full_unstemmed Combining (68)Ga-PSMA-PET/CT-Directed and Elective Radiation Therapy Improves Outcome in Oligorecurrent Prostate Cancer: A Retrospective Multicenter Study
title_short Combining (68)Ga-PSMA-PET/CT-Directed and Elective Radiation Therapy Improves Outcome in Oligorecurrent Prostate Cancer: A Retrospective Multicenter Study
title_sort combining (68)ga-psma-pet/ct-directed and elective radiation therapy improves outcome in oligorecurrent prostate cancer: a retrospective multicenter study
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8141738/
https://www.ncbi.nlm.nih.gov/pubmed/34041020
http://dx.doi.org/10.3389/fonc.2021.640467
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