68Ga-PSMA ligand PET/CT-based radiotherapy in locally recurrent and recurrent oligometastatic prostate cancer
68Ga-PSMA ligand PET/CT-based radiotherapy in locally recurrent and recurrent oligometastatic prostate cancer
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DOI：
10.1007/s00066-016-0982-z
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发表时间：
2016-07-01
影响因子：
3.1
通讯作者：
Derlin, Thorsten
中科院分区：
文献类型：
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作者：
Henkenberens, Christoph;von Klot, Christoph A.;Derlin, Thorsten
本研究的目的是评估Ga-68-PSMA配体PET/CT成像在局部复发和/或少转移性前列腺癌放射治疗中的早期疗效。共有29例生化复发患者接受Ga-68-PSMA配体PET/CT对疾病进行重新定位，随后对转移灶进行三维适形放疗或前列腺床调强放疗。前列腺特异性抗原（PSA）水平和影像学检查作为评价治疗效果的参考标准。96.6%的患者PET/CT阳性，13.8%的患者局部复发，58.6%的患者有孤立性淋巴结转移，20.7%的患者有孤立性骨转移，3.4%的患者有淋巴结转移和椎体转移。中位随访时间为8.3个月（3.0-17.3个月）。放疗前PSA中位数为1.47 ng/ml（范围0.52 ~ 32.01 ng/ml），降至0.58 ng/ml（范围< 0.07 ~ 6.33 ng/ml, p < 0.001），有统计学意义。2例患者（6.8%）在12.0和12.7个月后在放射场外出现进展性疾病，中位随访时局部控制率为100%。未观察到III级急性毒性或II级晚期毒性。只有2例患者（6.8%）在放疗后3个月根据LENT-SOMA标准报告持续I级腹泻。未观察到尿失禁恶化或大便失禁。本队列的初步结果表明，基于Ga-68-PSMA配体PET/CT的放射治疗在没有临床重要副作用的情况下，就PSA水平而言，可获得有效的局部控制和显着的治疗反应。此外，这种方法推迟了雄激素剥夺治疗或全身治疗的必要性。
The goal of this work was to evaluate the early efficacy of Ga-68-PSMA ligand PET/CT imaging for radiotherapy of locally recurrent and/or oligometastatic prostate cancer.A total of 29 patients with biochemical recurrence received a Ga-68-PSMA ligand PET/CT for restaging of disease, followed by 3D conformal radiotherapy of metastases or intensity-modulated radiation therapy of the prostate bed. Prostate-specific antigen (PSA) levels and imaging procedures served as the reference standard to assess the treatment efficacy.PET/CT was positive in 96.6% of patients and revealed that 13.8% of patients had locally recurrent disease, 58.6% had isolated lymph node metastases, 20.7% had isolated bone metastases, and 3.4% showed lymph node metastases and a vertebral metastasis. The median follow-up was 8.3 months (range 3.0-17.3 months). The median PSA prior to radiotherapy was 1.47 ng/ml (range 0.52-32.01 ng/ml) and showed a statistically significant decrease to 0.58 ng/ml (range < 0.07 to 6.33 ng/ml, p < 0.001). Two patients (6.8%) developed progressive disease outside the radiation field after 12.0 and 12.7 months, yielding a local control rate of 100% at the median follow-up. No grade III acute toxicity or late toxicity grade II was observed. Only 2 patients (6.8%) reported persisting grade I diarrhoea according to the LENT-SOMA criteria 3 months after radiotherapy. Deterioration of the urinary or faecal continence was not observed.Preliminary results in the presented cohort suggest that radiotherapy based on Ga-68-PSMA ligand PET/CT yields effective local control and significant treatment response in terms of PSA levels in the absence of clinically important side effects. Furthermore, this approach delayed the necessity of androgen deprivation therapy or systemic therapy.