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Schiller, K.* ; Sauter, K.* ; Dewes, S.* ; Eiber, M.* ; Maurer, T.* ; Gschwend, J.E.* ; Combs, S.E. ; Habl, G.

Patterns of failure after radical prostatectomy in prostate cancer – implications for radiation therapy planning after 68Ga-PSMA-PET imaging.

Eur. J. Nucl. Med. Mol. Imaging 44, 1656–1662 (2017)
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Background: Salvage radiotherapy (SRT) after radical prostatectomy (RPE) and lymphadenectomy (LAE) is the appropriate radiotherapy option for patients with persistent/ recurrent prostate cancer (PC). 68Ga-PSMA-PET imaging has been shown to accurately detect PC lesions in a primary setting as well as for local recurrence or for lymph node (LN) metastases. Objective: In this study we evaluated the patterns of recurrence after RPE in patients with PC, putting a highlight on the differentiation between sites that would have been covered by a standard radiation therapy (RT) field in consensus after the RTOG consensus and others that would have not. Methods and materials: Thirty-one out of 83 patients (37%) with high-risk PC were the subject of our study. Information from 68Ga-PSMA-PET imaging was used to individualize treatment plans to include suspicious lesions as well as possibly boost sites with tracer uptake in LN or the prostate bed. For evaluation, 68Ga-PSMA-PET-positive LN were contoured in a patient dataset with a standard lymph drainage (RTOG consensus on CTV definition of pelvic lymph nodes) radiation field depicting color-coded nodes that would have been infield or outfield of that standard lymph drainage field and thereby visualizing typical patterns of failure of a “blind” radiation therapy after RPE and LAE. Results: Compared to negative conventional imaging (CT/MRI), lesions suspicious for PC were detected in 27/31 cases (87.1%) by 68Ga-PSMA-PET imaging, which resulted in changes to the radiation concept. There were 16/31 patients (51.6%) that received a simultaneous integrated boost (SIB) to a subarea of the prostate bed (in only three cases this dose escalation would have been planned without the additional knowledge of 68Ga-PSMA-PET imaging) and 18/31 (58.1%) to uncommon (namely presacral, paravesical, pararectal, preacetabular and obturatoric) LN sites. Furthermore, 14 patients (45.2%) had a changed TNM staging result by means of 68Ga-PSMA-PET imaging. Conclusion: Compared to conventional CT or MRI staging, 68Ga-PSMA-PET imaging detects more PC lesions and, thus, significantly influences radiation planning in recurrent prostate cancer patients enabling individually tailored treatment.
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Publication type Article: Journal article
Document type Scientific Article
Keywords 68ga-psma-pet Imaging ; Lymphadenectomy ; Prostate Cancer ; Radical Prostatectomy ; Salvage Radiotherapy ; Tailored Treatment; Androgen Suppression; Biochemical Recurrence; Diagnostic-value; Hbed-cc; Radiotherapy; Pet/ct; Deprivation; Irradiation; Monotherapy; Castration
ISSN (print) / ISBN 1619-7070
e-ISSN 1432-105X
Quellenangaben Volume: 44, Issue: 10, Pages: 1656–1662 Article Number: , Supplement: ,
Publisher Springer
Publishing Place New York
Reviewing status Peer reviewed