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Intensity-Modulated Radiotherapy for Prostate Cancer Implementing Molecular Imaging with 18F-Choline PET-CT to Define a Simultaneous Integrated Boost

Intensitätsmodulierte Radiotherapie des Prostatakarzinoms mit simultanem integrierten Boost nach molekularer Bildgebung mit 18F-Cholin-PET-CT

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Abstract

Purpose:

To report the own experience with 66 patients who received 18F-choline PET-CT (positron emission tomography-computed tomography) for treatment planning.

Patients and Methods:

Image acquisition followed 1 h after injection of 178–355 MBq 18F-choline. An intraprostatic lesion (GTVPET [gross tumor volume]) was defined by a tumor-to-background SUV (standard uptake value) ratio > 2. A dose of 76 Gy was prescribed to the prostate in 2-Gy fractions, with a simultaneous integrated boost up to 80 Gy.

Results:

A boost volume could not be defined for a single patient. One, two and three or more lesions were found for 36 (55%), 22 (33%) and seven patients (11%). The lobe(s) with a positive biopsy correlated with a GTVPET in the same lobe in 63 cases (97%). GTVPET was additionally defined in 33 of 41 prostate lobes (80%) with only negative biopsies. GTVPET, SUVmean and SUVmax were found to be dependent on well-known prognostic risk factors, particularly T-stage and Gleason Score. In multivariate analysis, Gleason Score > 7 resulted as an independent factor for GTVPET > 8 cm3 (hazard ratio 5.5; p = 0.02) and SUVmax > 5 (hazard ratio 4.4; p = 0.04). Neoadjuvant hormonal treatment (NHT) did not affect SUV levels. The mean EUDs (equivalent uniform doses) to the rectum and bladder (55.9 Gy and 54.8 Gy) were comparable to patients (n = 18) who were treated in the same period without a boost (54.3 Gy and 55.6 Gy).

Conclusion:

Treatment planning with 18F-choline PET-CT allows the definition of an integrated boost in nearly all prostate cancer patients – including patients after NHT – without considerably affecting EUDs for the organs at risk. GTVPET and SUV levels were found to be dependent on prognostic risk factors, particularly Gleason Score.

Zusammenfassung

Ziel:

Erfahrungsbericht mit 66 Patienten nach 18F-Cholin-PET-CT (Positronenemissionstompgraphie-Computertomographie) zur Bestrahlungsplanung.

Patienten und Methodik:

Die Bildakquisition erfolgte 1 h nach Injektion von 178–355 MBq 18F-Cholin. Ein intraprostatischer Herd (GTVPET [makroskopisches Tumorvolumen]) wurde ab einem Tumor-zu-Hintergrund-SUV-(„standard uptake value“-)Quotienten > 2 definiert. Die Verschreibungsdosis für die Prostata betrug 76 Gy in 2-Gy-Einzeldosen mit simultanem integrierten Boost bis 80 Gy.

Ergebnisse:

Ein Boostvolumen konnte bei einem Patienten nicht definiert werden. Ein, zwei und drei oder mehr Herde wurden bei 36 (55 %), 22 (33 %) und sieben Patienten (11 %) gefunden. Der/die Lappen mit positiver Biopsie korrelierte/n in 63 Fallen (97 %)mit dem GTVPET im gleichen Lappen. Zusätzlich wurde ein GTVPET in 33 von 41 Lappen (80 %) mit nur negativen Biopsien definiert. GTVPET, SUVmean und SUVmax zeigten eine Abhängigkeit von bekannten Risikofaktoren, insbesondere T-Stadium und Gleason-Score. In multivariater Analyse resultierte ein Gleason-Score > 7 als ein unabhängiger Faktor für GTVPET > 8 cm3 (relatives Risiko 5,5; p = 0,02) und SUVmax > 5 (relatives Risiko 4,4; p = 0,04). Eine neoadjuvante Hormontherapie (NHT) war ohne Einfluss auf SUV-Werte. Die mittleren EUDs („equivalent uniform doses“) für Rektum und Blase (55,9 Gy und 54,8 Gy) waren vergleichbar zu Patienten (n = 18), die in der gleichen Periode ohne Boost bestrahlt wurden (54,3 Gy und 55,6 Gy).

Schlussfolgerung:

Die Bestrahlungsplanung nach 18F-Cholin-PET-CT ermöglicht die Definition eines integrierten Boostvolumens bei nahezu allen Patienten mit Prostatakarzinom – einschließlich Patienten nach NHT – ohne einen relevanten Einfluss auf die EUDs für die Risikoorgane. GTVPET- und SUV-Werte zeigten eine Abhängigkeit von prognostischen Risikofaktoren, insbesondere dem Gleason-Score.

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Authors and Affiliations

  1. Department of Radiotherapy, RWTH Aachen, Aachen, Germany

    Michael Pinkawa, Richard Holy, Marc D. Piroth, Jens Klotz, Sandra Nussen & Michael J. Eble

  2. Department of Nuclear Medicine, RWTH Aachen, Aachen, Germany

    Thomas Krohn & Felix M. Mottaghy

  3. Philips Research, Molecular Imaging Systems, Aachen, Germany

    Martin Weibrecht

  4. Klinik für Strahlentherapie, Universitätsklinikum RWTH Aachen, Pauwelsstraße 30, 52057, Aachen, Germany

    Michael Pinkawa

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  1. Michael Pinkawa
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Pinkawa, M., Holy, R., Piroth, M.D. et al. Intensity-Modulated Radiotherapy for Prostate Cancer Implementing Molecular Imaging with 18F-Choline PET-CT to Define a Simultaneous Integrated Boost. Strahlenther Onkol 186, 600–606 (2010). https://doi.org/10.1007/s00066-010-2122-5

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