Radiation treatment of lymph node recurrence from prostate cancer: Is 11C-choline PET/CT predictive of survival outcomes?

Elena Incerti, Andrei Fodor, Paola Mapelli, Claudio Fiorino, Pierpaolo Alongi, Margarita Kirienko, Giampiero Giovacchini, Elena Busnardo, Luigi Gianolli, Nadia Di Muzio, Maria Picchio

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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 languageEnglish
Pages (from-to)1836-1842
Number of pages7
JournalJournal of Nuclear Medicine
Volume56
Issue number12
DOIs
Publication statusPublished - Dec 1 2015

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Choline
Prostatic Neoplasms
Lymph Nodes
Radiation
Recurrence
Survival
Therapeutics
Intensity-Modulated Radiotherapy
Tumor Burden
ROC Curve
Prostate-Specific Antigen

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 journalArticle

Incerti, Elena ; Fodor, Andrei ; Mapelli, Paola ; Fiorino, Claudio ; Alongi, Pierpaolo ; Kirienko, Margarita ; Giovacchini, Giampiero ; Busnardo, Elena ; Gianolli, Luigi ; Di Muzio, Nadia ; Picchio, Maria. / Radiation treatment of lymph node recurrence from prostate cancer : Is 11C-choline PET/CT predictive of survival outcomes?. In: Journal of Nuclear Medicine. 2015 ; Vol. 56, No. 12. pp. 1836-1842.
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title = "Radiation treatment of lymph node recurrence from prostate cancer: Is 11C-choline PET/CT predictive of survival outcomes?",
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.",
keywords = "C-choline PET/CT, Imaging parameters, Lymph node recurrence, Prostate cancer, Survival outcomes",
author = "Elena Incerti and Andrei Fodor and Paola Mapelli and Claudio Fiorino and Pierpaolo Alongi and Margarita Kirienko and Giampiero Giovacchini and Elena Busnardo and Luigi Gianolli and {Di Muzio}, Nadia and Maria Picchio",
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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

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