Abstract
PET/CT is a valuable tool to detect lymph node (LN) metastases in patients with biochemical failure after primary treatment for prostate cancer (PCa). The aim was to assess the predictive role of imaging parameters derived by 11C-choline PET/CT on survival outcomes-overall survival, locoregional relapse-free survival, clinical relapsefree survival (cRFS), and biochemical relapse-free survival (bRFS)-in patients treated with helical tomotherapy (HTT) for LN recurrence. Methods: This retrospective study included 68 patients affected by PCa (mean age, 68 y; age range, 51-81 y) with biochemical recurrence after primary treatment (median prostate-specific antigen values obtained at the time of PET/CT scan, 2.42 ng/mL; range, 0.61-27.56 ng/mL) who underwent 11C-choline PET/CT from January 2005 to January 2013 and were treated with HTT in correspondence of the pathologic choline LN uptake. PET-derived parameters, including maximum/mean standardized uptake value (SUVmax and SUVmean, respectively) and metabolic tumor volume (MTV) with a threshold of 40%, 50%, and 60% were calculated. The best cutoff values of PET-derived parameters discriminating between patients with and without relapse, after treatment guided by PET, were assessed by receiver-operating-characteristic (ROC) curve analysis. Univariate and multivariate Cox regression analysis including the most predictive PET-derived parameters and survival outcomes were performed. Results: The median follow-up was 20 mo (mean, 26 mo; range, 3-97 mo). 11C-choline PET/CT showed pathologic LN uptake in 4 patients at the pelvic level, in 5 at the abdominal level, in 13 at both the pelvic and the abdominal level, and in 46 at the abdominal or pelvic or other sites. The 2-y overall survival, locoregional relapse-free survival, cRFS, and bRFS were 87%, 91%, 51%, and 40%, respectively. On the basis of ROC curves, the most discriminative cutoff value for MTV values was an MTV threshold of 60% (MTV60) of greater than 0.64 cm3. No significant cutoff values were found for SUVmax or SUVmean at univariate analysis, whereas MTV60 was confirmed as an independent predictor in multivariate analysis and significantly correlated with bRFS and cRFS. MTV60 and extrapelvic disease well predict the risk of cRFS. Conclusion: 11C-choline PET/CT performed as a guide for HTT on LN recurrence is predictive of survival. In particular, MTV60 and extrapelvic disease were the best predictors of tumor response for bRFS and cRFS in PCa patients with LN recurrence after primary treatment. This information may be useful in emerging treatment strategies.
| Original language | English |
|---|---|
| Pages (from-to) | 1836-1842 |
| Number of pages | 7 |
| Journal | Journal of Nuclear Medicine |
| Volume | 56 |
| Issue number | 12 |
| DOIs | |
| Publication status | Published - Dec 1 2015 |
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Keywords
- C-choline PET/CT
- Imaging parameters
- Lymph node recurrence
- Prostate cancer
- Survival outcomes
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging
Cite this
Radiation treatment of lymph node recurrence from prostate cancer : Is 11C-choline PET/CT predictive of survival outcomes? / Incerti, Elena; Fodor, Andrei; Mapelli, Paola; Fiorino, Claudio; Alongi, Pierpaolo; Kirienko, Margarita; Giovacchini, Giampiero; Busnardo, Elena; Gianolli, Luigi; Di Muzio, Nadia; Picchio, Maria.
In: Journal of Nuclear Medicine, Vol. 56, No. 12, 01.12.2015, p. 1836-1842.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Radiation treatment of lymph node recurrence from prostate cancer
T2 - Is 11C-choline PET/CT predictive of survival outcomes?
AU - Incerti, Elena
AU - Fodor, Andrei
AU - Mapelli, Paola
AU - Fiorino, Claudio
AU - Alongi, Pierpaolo
AU - Kirienko, Margarita
AU - Giovacchini, Giampiero
AU - Busnardo, Elena
AU - Gianolli, Luigi
AU - Di Muzio, Nadia
AU - Picchio, Maria
PY - 2015/12/1
Y1 - 2015/12/1
N2 - PET/CT is a valuable tool to detect lymph node (LN) metastases in patients with biochemical failure after primary treatment for prostate cancer (PCa). The aim was to assess the predictive role of imaging parameters derived by 11C-choline PET/CT on survival outcomes-overall survival, locoregional relapse-free survival, clinical relapsefree survival (cRFS), and biochemical relapse-free survival (bRFS)-in patients treated with helical tomotherapy (HTT) for LN recurrence. Methods: This retrospective study included 68 patients affected by PCa (mean age, 68 y; age range, 51-81 y) with biochemical recurrence after primary treatment (median prostate-specific antigen values obtained at the time of PET/CT scan, 2.42 ng/mL; range, 0.61-27.56 ng/mL) who underwent 11C-choline PET/CT from January 2005 to January 2013 and were treated with HTT in correspondence of the pathologic choline LN uptake. PET-derived parameters, including maximum/mean standardized uptake value (SUVmax and SUVmean, respectively) and metabolic tumor volume (MTV) with a threshold of 40%, 50%, and 60% were calculated. The best cutoff values of PET-derived parameters discriminating between patients with and without relapse, after treatment guided by PET, were assessed by receiver-operating-characteristic (ROC) curve analysis. Univariate and multivariate Cox regression analysis including the most predictive PET-derived parameters and survival outcomes were performed. Results: The median follow-up was 20 mo (mean, 26 mo; range, 3-97 mo). 11C-choline PET/CT showed pathologic LN uptake in 4 patients at the pelvic level, in 5 at the abdominal level, in 13 at both the pelvic and the abdominal level, and in 46 at the abdominal or pelvic or other sites. The 2-y overall survival, locoregional relapse-free survival, cRFS, and bRFS were 87%, 91%, 51%, and 40%, respectively. On the basis of ROC curves, the most discriminative cutoff value for MTV values was an MTV threshold of 60% (MTV60) of greater than 0.64 cm3. No significant cutoff values were found for SUVmax or SUVmean at univariate analysis, whereas MTV60 was confirmed as an independent predictor in multivariate analysis and significantly correlated with bRFS and cRFS. MTV60 and extrapelvic disease well predict the risk of cRFS. Conclusion: 11C-choline PET/CT performed as a guide for HTT on LN recurrence is predictive of survival. In particular, MTV60 and extrapelvic disease were the best predictors of tumor response for bRFS and cRFS in PCa patients with LN recurrence after primary treatment. This information may be useful in emerging treatment strategies.
AB - PET/CT is a valuable tool to detect lymph node (LN) metastases in patients with biochemical failure after primary treatment for prostate cancer (PCa). The aim was to assess the predictive role of imaging parameters derived by 11C-choline PET/CT on survival outcomes-overall survival, locoregional relapse-free survival, clinical relapsefree survival (cRFS), and biochemical relapse-free survival (bRFS)-in patients treated with helical tomotherapy (HTT) for LN recurrence. Methods: This retrospective study included 68 patients affected by PCa (mean age, 68 y; age range, 51-81 y) with biochemical recurrence after primary treatment (median prostate-specific antigen values obtained at the time of PET/CT scan, 2.42 ng/mL; range, 0.61-27.56 ng/mL) who underwent 11C-choline PET/CT from January 2005 to January 2013 and were treated with HTT in correspondence of the pathologic choline LN uptake. PET-derived parameters, including maximum/mean standardized uptake value (SUVmax and SUVmean, respectively) and metabolic tumor volume (MTV) with a threshold of 40%, 50%, and 60% were calculated. The best cutoff values of PET-derived parameters discriminating between patients with and without relapse, after treatment guided by PET, were assessed by receiver-operating-characteristic (ROC) curve analysis. Univariate and multivariate Cox regression analysis including the most predictive PET-derived parameters and survival outcomes were performed. Results: The median follow-up was 20 mo (mean, 26 mo; range, 3-97 mo). 11C-choline PET/CT showed pathologic LN uptake in 4 patients at the pelvic level, in 5 at the abdominal level, in 13 at both the pelvic and the abdominal level, and in 46 at the abdominal or pelvic or other sites. The 2-y overall survival, locoregional relapse-free survival, cRFS, and bRFS were 87%, 91%, 51%, and 40%, respectively. On the basis of ROC curves, the most discriminative cutoff value for MTV values was an MTV threshold of 60% (MTV60) of greater than 0.64 cm3. No significant cutoff values were found for SUVmax or SUVmean at univariate analysis, whereas MTV60 was confirmed as an independent predictor in multivariate analysis and significantly correlated with bRFS and cRFS. MTV60 and extrapelvic disease well predict the risk of cRFS. Conclusion: 11C-choline PET/CT performed as a guide for HTT on LN recurrence is predictive of survival. In particular, MTV60 and extrapelvic disease were the best predictors of tumor response for bRFS and cRFS in PCa patients with LN recurrence after primary treatment. This information may be useful in emerging treatment strategies.
KW - C-choline PET/CT
KW - Imaging parameters
KW - Lymph node recurrence
KW - Prostate cancer
KW - Survival outcomes
UR - http://www.scopus.com/inward/record.url?scp=84958249632&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84958249632&partnerID=8YFLogxK
U2 - 10.2967/jnumed.115.163741
DO - 10.2967/jnumed.115.163741
M3 - Article
C2 - 26405166
AN - SCOPUS:84958249632
VL - 56
SP - 1836
EP - 1842
JO - Journal of Nuclear Medicine
JF - Journal of Nuclear Medicine
SN - 0161-5505
IS - 12
ER -