Combining 68Ga-PSMA-PET/CT-Directed and Elective Radiation Therapy Improves Outcome in Oligorecurrent Prostate Cancer: A Retrospective Multicenter Study
Kirste S, Kroeze SGC, Henkenberens C, Schmidt-Hegemann NS, Vogel MME, Becker J, Zamboglou C, Burger I, Derlin T, Bartenstein P, Ruf J, La Fougere C, Eiber M, Christiansen H, Combs SE, Mueller AC, Belka C, Guckenberger M, Grosu AL (2021)
Publication Type: Journal article
Publication year: 2021
Journal
Book Volume: 11
Article Number: 640467
Abstract
Background: In case of oligo-recurrent prostate cancer (PC) following prostatectomy, 68Ga-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. Methods: Data of 394 patients with oligo-recurrent 68Ga-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. Results: In 204 patients (51.8%) RT was directed only to lesions seen on 68Ga-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. Conclusions: In 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 68Ga-PSMA-PET/CT-guided focal radiotherapy. These findings need to be evaluated in a randomized controlled trial.
Involved external institutions
Albert-Ludwigs-Universität Freiburg
Germany (DE)
University of Zurich / Universität Zürich (UZH)
Switzerland (CH)
Medizinische Hochschule Hannover (MHH) / Hannover Medical School
Germany (DE)
Universitätsklinikum der Ludwig-Maximilians-Universität München
Germany (DE)
Universitätsklinikum Tübingen
Germany (DE)
Technische Universität München (TUM)
Germany (DE)
Germany (DE)
University of Zurich / Universität Zürich (UZH)
Switzerland (CH)
Medizinische Hochschule Hannover (MHH) / Hannover Medical School
Germany (DE)
Universitätsklinikum der Ludwig-Maximilians-Universität München
Germany (DE)
Universitätsklinikum Tübingen
Germany (DE)
Technische Universität München (TUM)
Germany (DE)
How to cite
APA:
Kirste, S., Kroeze, S.G.C., Henkenberens, C., Schmidt-Hegemann, N.-S., Vogel, M.M.E., Becker, J.,... Grosu, A.-L. (2021). Combining 68Ga-PSMA-PET/CT-Directed and Elective Radiation Therapy Improves Outcome in Oligorecurrent Prostate Cancer: A Retrospective Multicenter Study. Frontiers in Oncology, 11. https://doi.org/10.3389/fonc.2021.640467
MLA:
Kirste, Simon, et al. "Combining 68Ga-PSMA-PET/CT-Directed and Elective Radiation Therapy Improves Outcome in Oligorecurrent Prostate Cancer: A Retrospective Multicenter Study." Frontiers in Oncology 11 (2021).
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