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Extended nodal radiotherapy for prostate cancer relapse guided with [11C]-choline PET/CT: ten-year results in patients enrolled in a prospective trial

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Aims

To report long-term outcomes of relapsed prostate cancer (PC) patients treated in a prospective single-arm study with extended–nodal radiotherapy (ENRT) and [11C]-choline positron emission tomography (PET)/computed tomography (CT)-guided simultaneous integrated boost (SIB) to positive lymph nodes (LNs).

Methods

From 12/2009 to 04/2015, 60 PC patients with biochemical relapse and positive LNs only were treated in this study. ENRT at a median total dose (TD) = 51.8 Gy/28 fr and PET/CT-guided SIB to positive LNs at a median TD = 65.5 Gy was prescribed. Median PSA at relapse was 2.3 (interquartile range, IQR:1.3–4.0) ng/ml. Median number of positive LNs: 2 (range: 1–18). Androgen deprivation therapy (ADT) was prescribed for 48 patients for a median of 30.7 (IQR: 18.5–43.1) months.

Results

Median follow-up from the end of salvage treatment was 121.8 (IQR: 116.1, 130.9) months; 3-, 5-, and 10-year BRFS were 45.0%, 36.0%, and 24.0%, respectively; DMFS: 67.9%, 57.2%, and 45.2%; CRFS: 62.9%, 53.9%, and 42.0%; and OS: 88.2%, 76.3%, and 47.9%, respectively. Castration resistance (p < 0.0001) and ≥ 6 positive LN (p = 0.0024) significantly influenced OS at multivariate analysis. Castration resistance (p < 0.0001 for both) influenced DMFS and CRFS in multivariate analysis.

Conclusions

In PC relapsed patients treated with ENRT and [11C]-choline-PET/CT-guided SIB for positive LNs, with 10-year follow-up, a median Kaplan–Meier estimate CRFS of 67 months and OS of 110 months were obtained. These highly favorable results should be confirmed in a prospective, randomized trial.

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Data availability

The data that support the findings of this study (anonymized individual participant data) are available on request from the corresponding author to researchers who provide a methodologically sound proposal. Requests made to the corresponding author (AF) will be evaluated by the IRCCS San Raffaele Scientific Institute Ethics Committee.

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Author information

Authors and Affiliations

  1. Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy

    A. Fodor, C. L. Deantoni, L. Giannini, F. Ferrario, S. L. Villa, C. Cozzarini & N. G. Di Muzio

  2. University Center for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy

    C. Brombin, P. M. V. Rancoita & M. C. S. Di Serio

  3. Vita-Salute San Raffaele University, Milan, Italy

    C. Brombin, P. M. V. Rancoita, M. Picchio, M. C. S. Di Serio, A. Chiti & N. G. Di Muzio

  4. Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy

    P. Mangili, A. Del Vecchio & C. Fiorino

  5. Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy

    M. Picchio & A. Chiti

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  1. A. Fodor
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  2. C. Brombin
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  15. N. G. Di Muzio
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Contributions

Prof. Nadia Di Muzio and Prof. Maria Picchio contributed to the study’s conception and design. Material preparation, data collection, and analysis were performed by Andrei Fodor, Prof. Chiara Brombin, Chiara Lucrezia Deantoni, Laura Giannini, Federica Ferrario, Stefano Lorenzo Villa, and Paola Maria Vittoria Rancoita. The first draft of the manuscript was written by Andrei Fodor, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to A. Fodor.

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Fodor, A., Brombin, C., Deantoni, C.L. et al. Extended nodal radiotherapy for prostate cancer relapse guided with [11C]-choline PET/CT: ten-year results in patients enrolled in a prospective trial. Eur J Nucl Med Mol Imaging 51, 590–603 (2024). https://doi.org/10.1007/s00259-023-06445-4

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