Cargando…

Changes of Radiation Treatment Concept Based on (68)Ga-PSMA-11-PET/CT in Early PSA-Recurrences After Radical Prostatectomy

BACKGROUND AND PURPOSE: Salvage radiotherapy (SRT) is the main potentially curative treatment option for prostate cancer patients with post-prostatectomy PSA progression. Improved diagnostics by positron emission tomography/computed tomography (PET/CT) can lead to adjustments in treatment procedures...

Descripción completa

Detalles Bibliográficos
Autores principales: Bottke, Dirk, Miksch, Jonathan, Thamm, Reinhard, Krohn, Thomas, Bartkowiak, Detlef, Beer, Meinrad, Bolenz, Christian, Beer, Ambros J., Prasad, Vikas, Wiegel, Thomas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8204009/
https://www.ncbi.nlm.nih.gov/pubmed/34141618
http://dx.doi.org/10.3389/fonc.2021.665304
_version_ 1783708267128553472
author Bottke, Dirk
Miksch, Jonathan
Thamm, Reinhard
Krohn, Thomas
Bartkowiak, Detlef
Beer, Meinrad
Bolenz, Christian
Beer, Ambros J.
Prasad, Vikas
Wiegel, Thomas
author_facet Bottke, Dirk
Miksch, Jonathan
Thamm, Reinhard
Krohn, Thomas
Bartkowiak, Detlef
Beer, Meinrad
Bolenz, Christian
Beer, Ambros J.
Prasad, Vikas
Wiegel, Thomas
author_sort Bottke, Dirk
collection PubMed
description BACKGROUND AND PURPOSE: Salvage radiotherapy (SRT) is the main potentially curative treatment option for prostate cancer patients with post-prostatectomy PSA progression. Improved diagnostics by positron emission tomography/computed tomography (PET/CT) can lead to adjustments in treatment procedures (e.g. target volume of radiotherapy, androgen deprivation therapy). We analyzed the impact of (68)Ga-PSMA-11-PET/CT on the target volume in early biochemical recurrence (PSA up to 0.5 ng/ml). PATIENTS AND METHODS: We retrospectively analyzed 76 patients with biochemical recurrence after radical prostatectomy in whom SRT was planned after (68)Ga-PSMA-11-PET/CT. All patients had a PSA ≤0.5 ng/ml. An experienced radiation oncologist determined the radiotherapy concept, first with consideration of the PET/CT, second hypothetically based on the clinical and pathological features excluding PET/CT results. RESULTS: Without considering the PET/CT, all 76 patients would have been assigned to RT, 60 (79%) to the bed of the prostate and seminal vesicles alone, and 16 (21%) also to the pelvic lymph nodes because of histopathologic risk factors. Uptake indicative for tumor recurrence in (68)Ga-PSMA-11-PET/CT was found in 54% of the patients. The median pre-PET/CT PSA level was 0.245 ng/ml (range 0.07–0.5 ng/ml). The results of the PET/CT led to a change in the radiotherapeutic target volume in 21 patients (28%). There were major changes in the target volume including the additional irradiation of lymph nodes or the additional or exclusive irradiation of bone metastases in 13 patients (17%). Minor changes including the additional irradiation of original seminal vesicle (base) position resulted in eight patients (11%). CONCLUSION: Using (68)Ga-PSMA-11-PET/CT for radiation planning, a change in the treatment concept was indicated in 28% of patients. With PET/CT, the actual extent of the tumor can be precisely determined even with PSA values of ≤0.5 ng/ml. Thus, the treatment concept can be improved and individualized. This may have a positive impact on progression free survival. Our results warrant further prospective studies.
format Online
Article
Text
id pubmed-8204009
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-82040092021-06-16 Changes of Radiation Treatment Concept Based on (68)Ga-PSMA-11-PET/CT in Early PSA-Recurrences After Radical Prostatectomy Bottke, Dirk Miksch, Jonathan Thamm, Reinhard Krohn, Thomas Bartkowiak, Detlef Beer, Meinrad Bolenz, Christian Beer, Ambros J. Prasad, Vikas Wiegel, Thomas Front Oncol Oncology BACKGROUND AND PURPOSE: Salvage radiotherapy (SRT) is the main potentially curative treatment option for prostate cancer patients with post-prostatectomy PSA progression. Improved diagnostics by positron emission tomography/computed tomography (PET/CT) can lead to adjustments in treatment procedures (e.g. target volume of radiotherapy, androgen deprivation therapy). We analyzed the impact of (68)Ga-PSMA-11-PET/CT on the target volume in early biochemical recurrence (PSA up to 0.5 ng/ml). PATIENTS AND METHODS: We retrospectively analyzed 76 patients with biochemical recurrence after radical prostatectomy in whom SRT was planned after (68)Ga-PSMA-11-PET/CT. All patients had a PSA ≤0.5 ng/ml. An experienced radiation oncologist determined the radiotherapy concept, first with consideration of the PET/CT, second hypothetically based on the clinical and pathological features excluding PET/CT results. RESULTS: Without considering the PET/CT, all 76 patients would have been assigned to RT, 60 (79%) to the bed of the prostate and seminal vesicles alone, and 16 (21%) also to the pelvic lymph nodes because of histopathologic risk factors. Uptake indicative for tumor recurrence in (68)Ga-PSMA-11-PET/CT was found in 54% of the patients. The median pre-PET/CT PSA level was 0.245 ng/ml (range 0.07–0.5 ng/ml). The results of the PET/CT led to a change in the radiotherapeutic target volume in 21 patients (28%). There were major changes in the target volume including the additional irradiation of lymph nodes or the additional or exclusive irradiation of bone metastases in 13 patients (17%). Minor changes including the additional irradiation of original seminal vesicle (base) position resulted in eight patients (11%). CONCLUSION: Using (68)Ga-PSMA-11-PET/CT for radiation planning, a change in the treatment concept was indicated in 28% of patients. With PET/CT, the actual extent of the tumor can be precisely determined even with PSA values of ≤0.5 ng/ml. Thus, the treatment concept can be improved and individualized. This may have a positive impact on progression free survival. Our results warrant further prospective studies. Frontiers Media S.A. 2021-06-01 /pmc/articles/PMC8204009/ /pubmed/34141618 http://dx.doi.org/10.3389/fonc.2021.665304 Text en Copyright © 2021 Bottke, Miksch, Thamm, Krohn, Bartkowiak, Beer, Bolenz, Beer, Prasad and Wiegel 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
Bottke, Dirk
Miksch, Jonathan
Thamm, Reinhard
Krohn, Thomas
Bartkowiak, Detlef
Beer, Meinrad
Bolenz, Christian
Beer, Ambros J.
Prasad, Vikas
Wiegel, Thomas
Changes of Radiation Treatment Concept Based on (68)Ga-PSMA-11-PET/CT in Early PSA-Recurrences After Radical Prostatectomy
title Changes of Radiation Treatment Concept Based on (68)Ga-PSMA-11-PET/CT in Early PSA-Recurrences After Radical Prostatectomy
title_full Changes of Radiation Treatment Concept Based on (68)Ga-PSMA-11-PET/CT in Early PSA-Recurrences After Radical Prostatectomy
title_fullStr Changes of Radiation Treatment Concept Based on (68)Ga-PSMA-11-PET/CT in Early PSA-Recurrences After Radical Prostatectomy
title_full_unstemmed Changes of Radiation Treatment Concept Based on (68)Ga-PSMA-11-PET/CT in Early PSA-Recurrences After Radical Prostatectomy
title_short Changes of Radiation Treatment Concept Based on (68)Ga-PSMA-11-PET/CT in Early PSA-Recurrences After Radical Prostatectomy
title_sort changes of radiation treatment concept based on (68)ga-psma-11-pet/ct in early psa-recurrences after radical prostatectomy
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8204009/
https://www.ncbi.nlm.nih.gov/pubmed/34141618
http://dx.doi.org/10.3389/fonc.2021.665304
work_keys_str_mv AT bottkedirk changesofradiationtreatmentconceptbasedon68gapsma11petctinearlypsarecurrencesafterradicalprostatectomy
AT mikschjonathan changesofradiationtreatmentconceptbasedon68gapsma11petctinearlypsarecurrencesafterradicalprostatectomy
AT thammreinhard changesofradiationtreatmentconceptbasedon68gapsma11petctinearlypsarecurrencesafterradicalprostatectomy
AT krohnthomas changesofradiationtreatmentconceptbasedon68gapsma11petctinearlypsarecurrencesafterradicalprostatectomy
AT bartkowiakdetlef changesofradiationtreatmentconceptbasedon68gapsma11petctinearlypsarecurrencesafterradicalprostatectomy
AT beermeinrad changesofradiationtreatmentconceptbasedon68gapsma11petctinearlypsarecurrencesafterradicalprostatectomy
AT bolenzchristian changesofradiationtreatmentconceptbasedon68gapsma11petctinearlypsarecurrencesafterradicalprostatectomy
AT beerambrosj changesofradiationtreatmentconceptbasedon68gapsma11petctinearlypsarecurrencesafterradicalprostatectomy
AT prasadvikas changesofradiationtreatmentconceptbasedon68gapsma11petctinearlypsarecurrencesafterradicalprostatectomy
AT wiegelthomas changesofradiationtreatmentconceptbasedon68gapsma11petctinearlypsarecurrencesafterradicalprostatectomy