Patterns of relapse as determined by 68Ga-PSMA ligand PET/CT after radical prostatectomy Importance for tailoring and individualizing treatment
Patterns of relapse as determined by 68Ga-PSMA ligand PET/CT after radical prostatectomy Importance for tailoring and individualizing treatment
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根治性前列腺切除术后通过 68Ga-PSMA 配体 PET/CT 确定的复发模式 对定制和个性化治疗的重要性
DOI：
10.1007/s00066-017-1231-9
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发表时间：
2018-04-01
影响因子：
3.1
通讯作者：
von Klot, Christoph A.
中科院分区：
文献类型：
--
作者：
Henkenberens, Christoph;Derlin, Thorsten;von Klot, Christoph A.
旨在评估根治性前列腺切除术（RP）后挽救性放射治疗（sRT）前生化复发患者使用Ga-68前列腺特异性膜抗原（PSMA）配体正电子发射断层扫描/计算机断层扫描（PET/CT）成像对疾病重新分期时的复发模式及其对预期治疗的影响。总共有39名RP后生化复发患者，由于不存在生物学上不利的疾病，因此没有辅助RT的主要指征（例如，囊外扩展、精囊侵犯、切缘阳性或淋巴结受累）接受 Ga-68-PSMA 配体 PET/CT 来计划 sRT。84.6% (33/39) 的患者中 PET/CT 呈阳性。这些患者总共观察到 61 个病变（平均每个患者 1.8 个病变）； 30.3%（10/33）的患者前列腺床局部复发疾病。 69.7% (23/33) 的 PET 患者的临床 TNM 分期（TNM：肿瘤-淋巴结-转移-分类）发生改变，从而产生个体化治疗概念。前列腺特异性抗原 (PSA) > 1.0 ng/mL 与盆腔外转移性疾病风险增加显着相关 (p = 0.048)。 PSMA 配体 PET/CT 时的 PSA 水平与标准化摄取峰值值 (SUVpeak; p = 0.002) 相关。根据当前的临床指南，其余 15.4% (6/39) PET 上没有疾病证据的患者接受了剂量为 66.0 Gy 的 sRT。我们的结果表明，对于未接受早期 sRT 的生化复发患者，用于疾病重新分期的 Ga-68-PSMA 配体 PET/CT 可以实现量身定制和个体化的治疗。特别是对于 PSA 水平高于 1.0 ng/mL 的患者，应进行 Ga-68-PSMA 配体 PET/CT 来制定治疗计划，因为患者的转移常常不局限于骨盆。
To evaluate the patterns of relapse and impact on the intended treatment when using Ga-68-prostate-specific membrane antigen (PSMA) ligand positron emission tomography/computed tomography (PET/CT) imaging for restaging of disease in patients with biochemical relapse after radical prostatectomy (RP) before salvage radiotherapy (sRT).In all, 39 patients with biochemical recurrence after RP who had no primary indication for adjuvant RT due to the absence of biologically unfavorable disease (e.g., extracapsular extension, seminal vesicle invasion, positive margins, or lymph node involvement) underwent a Ga-68-PSMA ligand PET/CT for planning of sRT.PET/CT was positive in 84.6% (33/39) of patients. A total of 61 lesions were observed in these patients (on average 1.8 lesions per patient); 30.3% (10/33) of patients had locally recurrent disease in the prostatic bed. The clinical TNM stage (TNM: tumour-lymph nodes-metastasis-classification) was altered in 69.7% (23/33) of patients following PET, resulting in individualized treatment concepts. A prostate-specific antigen (PSA) > 1.0 ng/mL was significantly associated with an increased risk of extrapelvic metastatic disease (p = 0.048). The PSA level at the time of PSMA ligand PET/CT correlated with the peak standardized uptake value (SUVpeak; p = 0.002). According to current clinical guidelines, the remaining 15.4% (6/39) of patients without evidence of disease on PET received sRT with a dose of 66.0 Gy.Our results suggest that in patients with biochemical recurrence who did not receive early sRT, a Ga-68-PSMA ligand PET/CT for restaging of disease allows for tailoring and individualizing treatment. Particularly in patients with PSA levels above 1.0 ng/mL, a Ga-68-PSMA ligand PET/CT should be performed for therapy planning, since patients often have metastases not confined to the pelvis.