Details

Autor(en) / Beteiligte

• Parker, William P., MD
• Evans, Jaden D., MD
• Stish, Bradley J., MD
• Park, Sean S., MD, PhD
• Olivier, Kenneth, MD
• Choo, Richard, MD
• Nathan, Mark A., MD
• Welch, Brian T., MD
• Karnes, R. Jeffrey, MD
• Mynderse, Lance A., MD
• Pisansky, Thomas M., MD
• Kwon, Eugene D., MD
• Lowe, Val J., MD
• Davis, Brian J., MD, PhD

Titel

Patterns of Recurrence Following Post-Prostatectomy Fossa Radiotherapy Identified by C-11 Choline PET/CT

Ist Teil von

• International journal of radiation oncology, biology, physics, 2016-11, Vol.97 (3), p.526-535

Erscheinungsjahr

2016

Quelle

Elsevier ScienceDirect Journals

Beschreibungen/Notizen

• Abstract Purpose To evaluate C-11 choline PET/CT (CholPET) in staging and determining patterns of recurrence in prostate cancer patients with rising PSA post prostatectomy radiotherapy (RT). Materials and Methods The study includes patients with biochemical failure following post-prostatectomy RT who underwent CholPET between 2008 and 2015. Patient and disease characteristics were examined in relation to sites of recurrence. All RT dosimetry records were reviewed, and recurrences were mapped on a representative CT dataset with their relationship relative to the irradiated fossa field as out-of-field (OOF), edge-of-field (EOF; recurrence within <45Gy isodose lines), or in-field (IF; recurrence within ≥45 Gy isodose lines). Results Forty-one patients were identified with 121 sites of recurrence (median 2 sites; IQR 1-4). The median PSA at CholPET was 3.1 (IQR 1.9-5.6) ng/mL. Median interval from RT to biochemical failure was 24 (IQR: 10-46) months, with recurrence identified on CholPET at a median of 15 (IQR 7-28) months from biochemical failure. Histologic confirmation of recurrence was obtained in 20 (49%) patients; with the remainder confirmed by treatment response. Five patients (12%) had IF recurrences, 10 patients (24%) had EOF recurrences (median dose 10 Gy; IQR 5-30 Gy), and 36 patients (88%) had OOF recurrences. Ten patients had combination failures: 6 (15%) EOF/OOF and 4 (10%) IF/OOF. Fifty-seven (47%) of recurrences were pelvic nodal sites inferior to the L5-S1 interspace of which 52 (43%) are within a pelvic RT field. Eighty-one (67%) of recurrences were nodal and inferior to the aortic bifurcation. Conclusions Using CholPET, we found that the majority of patients evaluated for biochemical failure recurred outside of the post-prostatectomy RT field. Furthermore, most recurrence sites were nodal and inferior to the aortic bifurcation. These results provide data which may be useful for examining strategies that include elective lymph node irradiation in post-prostatectomy patients.