Toxicity and efficacy of salvage 11C-Choline PET/CT-guided radiation therapy in patients with prostate cancer lymph nodal recurrence

A Fodor, Genoveffa Berardi, C Fiorino, M Picchio, E Busnardo, M Kirienko, E Incerti, I Dell'Oca, C Cozzarini, P Mangili, M Pasetti, R Calandrino, L Gianolli, NG Di Muzio

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Abstract

OBJECTIVE: To report the 3-year toxicity and outcome results of 11C-Choline positron emission tomography/computed tomography (11C-Ch-PET/CT)-guided radiotherapy, delivered with helical tomotherapy (Tomotherapy® Hi-Art II® Treatment System, Accuray Incorporated, USA) (HTT) of lymph-nodal (LN) relapses in prostate cancer patients. PATIENTS AND METHODS: From 01/2005 to 03/2013, 81 patients with biochemical recurrence - after surgery±adjuvant/salvage radiotherapy (RT) or radical RT and with evidence of LN 11C-Ch-PET/CT pathological uptake underwent HTT (median PSA: 2.59(0.61-187) ng/ml). 72/81 patients were treated on pelvic and/or lumbar-aortic LN chain with HTT at 51.8 Gy/28 fr and with simultaneous integrated boost (SIB) to a median dose of 65.5 Gy on the pathological uptake sites detected by 11C-Ch-PET/CT. Nine patients were treated without SIB(50-65.5 Gy, 25-30 fr). RESULTS: With a median follow-up of 36 (9-116) months, 91.4% of the patients presented a PSA reduction 3 months after HTT. The 3 year overall, local-relapse-free and clinical-relapse-free survival were 80.0%, 89.8% and 61.8%, respectively. The 3-year actuarial incidences of ≥G2 rectal and ≥G2 GU toxicity were 6.6% (± 2.9%) and 26.3% (±5.5%) respectively. A PSA nadir ≥0.26 ng/ml (HR:3.6; 95%CI 1.7-7.7, p=0.001), extra-pelvic 11C-Ch-PET/CT positive LN location (HR:2.4; 95%CI 0.9-6.4, p=0.07), RT previous to HTT (HR:2.7; 95% CI 1.07-6.9, p=0.04) and number of positive LN (HR:1.13; 95%CI 1.04-1.22, p=0.003) were the main predictors of clinical relapse after HTT . CONCLUSIONS: 11C-Ch-PET/CT-guided HTT is safe and effective in the treatment of LN relapses of previously treated prostate cancer patients. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Original languageEnglish
Pages (from-to)406-413
Number of pages8
JournalBJU International
Volume119
Issue number3
DOIs
Publication statusPublished - 2017

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Lymph
Choline
Prostatic Neoplasms
Radiotherapy
Recurrence
Intensity-Modulated Radiotherapy
Art
Survival
Incidence
Therapeutics

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Toxicity and efficacy of salvage 11C-Choline PET/CT-guided radiation therapy in patients with prostate cancer lymph nodal recurrence. / Fodor, A; Berardi, Genoveffa; Fiorino, C; Picchio, M; Busnardo, E; Kirienko, M; Incerti, E; Dell'Oca, I; Cozzarini, C; Mangili, P; Pasetti, M; Calandrino, R; Gianolli, L; Di Muzio, NG.

In: BJU International, Vol. 119, No. 3, 2017, p. 406-413.

Research output: Contribution to journalArticle

Fodor, A ; Berardi, Genoveffa ; Fiorino, C ; Picchio, M ; Busnardo, E ; Kirienko, M ; Incerti, E ; Dell'Oca, I ; Cozzarini, C ; Mangili, P ; Pasetti, M ; Calandrino, R ; Gianolli, L ; Di Muzio, NG. / Toxicity and efficacy of salvage 11C-Choline PET/CT-guided radiation therapy in patients with prostate cancer lymph nodal recurrence. In: BJU International. 2017 ; Vol. 119, No. 3. pp. 406-413.
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title = "Toxicity and efficacy of salvage 11C-Choline PET/CT-guided radiation therapy in patients with prostate cancer lymph nodal recurrence",
abstract = "OBJECTIVE: To report the 3-year toxicity and outcome results of 11C-Choline positron emission tomography/computed tomography (11C-Ch-PET/CT)-guided radiotherapy, delivered with helical tomotherapy (Tomotherapy{\circledR} Hi-Art II{\circledR} Treatment System, Accuray Incorporated, USA) (HTT) of lymph-nodal (LN) relapses in prostate cancer patients. PATIENTS AND METHODS: From 01/2005 to 03/2013, 81 patients with biochemical recurrence - after surgery±adjuvant/salvage radiotherapy (RT) or radical RT and with evidence of LN 11C-Ch-PET/CT pathological uptake underwent HTT (median PSA: 2.59(0.61-187) ng/ml). 72/81 patients were treated on pelvic and/or lumbar-aortic LN chain with HTT at 51.8 Gy/28 fr and with simultaneous integrated boost (SIB) to a median dose of 65.5 Gy on the pathological uptake sites detected by 11C-Ch-PET/CT. Nine patients were treated without SIB(50-65.5 Gy, 25-30 fr). RESULTS: With a median follow-up of 36 (9-116) months, 91.4{\%} of the patients presented a PSA reduction 3 months after HTT. The 3 year overall, local-relapse-free and clinical-relapse-free survival were 80.0{\%}, 89.8{\%} and 61.8{\%}, respectively. The 3-year actuarial incidences of ≥G2 rectal and ≥G2 GU toxicity were 6.6{\%} (± 2.9{\%}) and 26.3{\%} (±5.5{\%}) respectively. A PSA nadir ≥0.26 ng/ml (HR:3.6; 95{\%}CI 1.7-7.7, p=0.001), extra-pelvic 11C-Ch-PET/CT positive LN location (HR:2.4; 95{\%}CI 0.9-6.4, p=0.07), RT previous to HTT (HR:2.7; 95{\%} CI 1.07-6.9, p=0.04) and number of positive LN (HR:1.13; 95{\%}CI 1.04-1.22, p=0.003) were the main predictors of clinical relapse after HTT . CONCLUSIONS: 11C-Ch-PET/CT-guided HTT is safe and effective in the treatment of LN relapses of previously treated prostate cancer patients. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.",
author = "A Fodor and Genoveffa Berardi and C Fiorino and M Picchio and E Busnardo and M Kirienko and E Incerti and I Dell'Oca and C Cozzarini and P Mangili and M Pasetti and R Calandrino and L Gianolli and {Di Muzio}, NG",
year = "2017",
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language = "English",
volume = "119",
pages = "406--413",
journal = "BJU International",
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publisher = "Wiley-Blackwell Publishing Ltd",
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TY - JOUR

T1 - Toxicity and efficacy of salvage 11C-Choline PET/CT-guided radiation therapy in patients with prostate cancer lymph nodal recurrence

AU - Fodor, A

AU - Berardi, Genoveffa

AU - Fiorino, C

AU - Picchio, M

AU - Busnardo, E

AU - Kirienko, M

AU - Incerti, E

AU - Dell'Oca, I

AU - Cozzarini, C

AU - Mangili, P

AU - Pasetti, M

AU - Calandrino, R

AU - Gianolli, L

AU - Di Muzio, NG

PY - 2017

Y1 - 2017

N2 - OBJECTIVE: To report the 3-year toxicity and outcome results of 11C-Choline positron emission tomography/computed tomography (11C-Ch-PET/CT)-guided radiotherapy, delivered with helical tomotherapy (Tomotherapy® Hi-Art II® Treatment System, Accuray Incorporated, USA) (HTT) of lymph-nodal (LN) relapses in prostate cancer patients. PATIENTS AND METHODS: From 01/2005 to 03/2013, 81 patients with biochemical recurrence - after surgery±adjuvant/salvage radiotherapy (RT) or radical RT and with evidence of LN 11C-Ch-PET/CT pathological uptake underwent HTT (median PSA: 2.59(0.61-187) ng/ml). 72/81 patients were treated on pelvic and/or lumbar-aortic LN chain with HTT at 51.8 Gy/28 fr and with simultaneous integrated boost (SIB) to a median dose of 65.5 Gy on the pathological uptake sites detected by 11C-Ch-PET/CT. Nine patients were treated without SIB(50-65.5 Gy, 25-30 fr). RESULTS: With a median follow-up of 36 (9-116) months, 91.4% of the patients presented a PSA reduction 3 months after HTT. The 3 year overall, local-relapse-free and clinical-relapse-free survival were 80.0%, 89.8% and 61.8%, respectively. The 3-year actuarial incidences of ≥G2 rectal and ≥G2 GU toxicity were 6.6% (± 2.9%) and 26.3% (±5.5%) respectively. A PSA nadir ≥0.26 ng/ml (HR:3.6; 95%CI 1.7-7.7, p=0.001), extra-pelvic 11C-Ch-PET/CT positive LN location (HR:2.4; 95%CI 0.9-6.4, p=0.07), RT previous to HTT (HR:2.7; 95% CI 1.07-6.9, p=0.04) and number of positive LN (HR:1.13; 95%CI 1.04-1.22, p=0.003) were the main predictors of clinical relapse after HTT . CONCLUSIONS: 11C-Ch-PET/CT-guided HTT is safe and effective in the treatment of LN relapses of previously treated prostate cancer patients. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

AB - OBJECTIVE: To report the 3-year toxicity and outcome results of 11C-Choline positron emission tomography/computed tomography (11C-Ch-PET/CT)-guided radiotherapy, delivered with helical tomotherapy (Tomotherapy® Hi-Art II® Treatment System, Accuray Incorporated, USA) (HTT) of lymph-nodal (LN) relapses in prostate cancer patients. PATIENTS AND METHODS: From 01/2005 to 03/2013, 81 patients with biochemical recurrence - after surgery±adjuvant/salvage radiotherapy (RT) or radical RT and with evidence of LN 11C-Ch-PET/CT pathological uptake underwent HTT (median PSA: 2.59(0.61-187) ng/ml). 72/81 patients were treated on pelvic and/or lumbar-aortic LN chain with HTT at 51.8 Gy/28 fr and with simultaneous integrated boost (SIB) to a median dose of 65.5 Gy on the pathological uptake sites detected by 11C-Ch-PET/CT. Nine patients were treated without SIB(50-65.5 Gy, 25-30 fr). RESULTS: With a median follow-up of 36 (9-116) months, 91.4% of the patients presented a PSA reduction 3 months after HTT. The 3 year overall, local-relapse-free and clinical-relapse-free survival were 80.0%, 89.8% and 61.8%, respectively. The 3-year actuarial incidences of ≥G2 rectal and ≥G2 GU toxicity were 6.6% (± 2.9%) and 26.3% (±5.5%) respectively. A PSA nadir ≥0.26 ng/ml (HR:3.6; 95%CI 1.7-7.7, p=0.001), extra-pelvic 11C-Ch-PET/CT positive LN location (HR:2.4; 95%CI 0.9-6.4, p=0.07), RT previous to HTT (HR:2.7; 95% CI 1.07-6.9, p=0.04) and number of positive LN (HR:1.13; 95%CI 1.04-1.22, p=0.003) were the main predictors of clinical relapse after HTT . CONCLUSIONS: 11C-Ch-PET/CT-guided HTT is safe and effective in the treatment of LN relapses of previously treated prostate cancer patients. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

U2 - 10.1111/bju.13510

DO - 10.1111/bju.13510

M3 - Article

VL - 119

SP - 406

EP - 413

JO - BJU International

JF - BJU International

SN - 1464-4096

IS - 3

ER -