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Fodor A, Brombin C, Deantoni CL, Giannini L, Ferrario F, Villa SL, Mangili P, Rancoita PMV, Cozzarini C, Picchio M, Del Vecchio A, Fiorino C, Di Serio MCS, Chiti A, Di Muzio NG. 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 2024; 51:590-603. [PMID: 37747578 DOI: 10.1007/s00259-023-06445-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 09/15/2023] [Indexed: 09/26/2023]
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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Affiliation(s)
- A Fodor
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - C Brombin
- University Center for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - C L Deantoni
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - L Giannini
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - F Ferrario
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - S L Villa
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - P Mangili
- Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - P M V Rancoita
- University Center for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - C Cozzarini
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - M Picchio
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - A Del Vecchio
- Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - C Fiorino
- Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - M C S Di Serio
- University Center for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - A Chiti
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - N G Di Muzio
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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Seyedin SN, Bassalow R, Mawlawi OR, Turner LM, Patel RR, Mazin SR, Oderinde OM, Voronenko Y, Wages CA, Olcott PD, Chang JY, Balter PA, Welsh JW. The potential of biology-guided radiation therapy in thoracic cancer: A preliminary treatment planning study. Front Oncol 2022; 12:921473. [PMID: 36313653 PMCID: PMC9613936 DOI: 10.3389/fonc.2022.921473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 09/23/2022] [Indexed: 01/12/2023] Open
Abstract
Purpose We investigated the feasibility of biology-guided radiotherapy (BgRT), a technique that utilizes real-time positron emission imaging to minimize tumor motion uncertainties, to spare nearby organs at risk. Methods Volumetric modulated arc therapy (VMAT), intensity-modulated proton (IMPT) therapy, and BgRT plans were created for a paratracheal node recurrence (case 1; 60 Gy in 10 fractions) and a primary peripheral left upper lobe adenocarcinoma (case 2; 50 Gy in four fractions). Results For case 1, BgRT produced lower bronchus V40 values compared to VMAT and IMPT. For case 2, total lung V20 was lower in the BgRT case compared to VMAT and IMPT. Conclusions BgRT has the potential to reduce the radiation dose to proximal critical structures but requires further detailed investigation.
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Affiliation(s)
- Steven N. Seyedin
- Department of Radiation Oncology, University of California, Irvine-Chao Family Comprehensive Cancer Center, Orange, CA, United States,*Correspondence: Steven N. Seyedin,
| | - Rostem Bassalow
- Northwest Medical Physics Center, Lynnwood, WA, United States
| | - Osama R. Mawlawi
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Lehendrick M. Turner
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Roshal R. Patel
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | | | | | | | - Cody A. Wages
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | | | - Joe Y. Chang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Peter A. Balter
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - James W. Welsh
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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