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Kirste, S.* ; Kroeze, S.G.C.* ; Henkenberens, C.* ; Schmidt-Hegemann, N.-S.* ; Vogel, M.M. ; Becker, J.* ; Zamboglou, C.* ; Burger, I.* ; Derlin, T.* ; Bartenstein, P.* ; Ruf, J.* ; la Fougère, C.* ; Eiber, M.* ; Christiansen, H.* ; Combs, S.E. ; Mueller, A.* ; Belka, C.* ; Guckenberger, M.* ; Grosu, A.*

Combining 68Ga-PSMA-PET/CT-directed and elective radiation therapy improves outcome in oligorecurrent prostate cancer: A retrospective multicenter study.

Front. Oncol. 11:640467 (2021)
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BackgroundIn case of oligo-recurrent prostate cancer (PC) following prostatectomy, Ga-68-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.MethodsData of 394 patients with oligo-recurrent Ga-68-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.ResultsIn 204 patients (51.8%) RT was directed only to lesions seen on Ga-68-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.ConclusionsIn 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 Ga-68-PSMA-PET/CT-guided focal radiotherapy. These findings need to be evaluated in a randomized controlled trial.
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Publication type Article: Journal article
Document type Scientific Article
Keywords Metastasis-directed Radiotherapy ; Oligorecurrent ; Prostate Cancer ; Elective Prostate Bed Radiotherapy ; Radiotherapy ; Elective Nodal Radiotherapy; Recurrent
ISSN (print) / ISBN 2234-943X
e-ISSN 2234-943X
Quellenangaben Volume: 11, Issue: , Pages: , Article Number: 640467 Supplement: ,
Publisher Frontiers
Publishing Place Avenue Du Tribunal Federal 34, Lausanne, Ch-1015, Switzerland
Reviewing status Peer reviewed