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Belliveau C, Benhacene-Boudam MK, Juneau D, Olivié D, Barkati M, Delouya G, Taussky D, Lambert C, Beauchemin MC, Menard C. F18-DCFPyL PSMA-PET/CT vs. mpMRI for Localizing the Gross Target Volume for Radiotherapy in Prostate Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e368. [PMID: 37785257 DOI: 10.1016/j.ijrobp.2023.06.2464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Local recurrences in prostate cancer (Pca) after radiotherapy generally occur in the site of dominant tumor burden, and recent evidence based on multi parametric (mpMRI) supports tumor-targeted escalation of dose to improve biochemical disease-free survival outcomes. With the recent emergence of prostate cancer targeted radiotracers, we hypothesize that PSMA-PET and mpMRI may not equally depict the pathological gross target volume (pGTV) at risk of recurrence after radiotherapy. MATERIALS/METHODS Subjects who underwent both mpMRI and 18F DCFPyl PSMA-PET/CT prior to radiotherapy were identified from a prospective REB-approved registry. Patients who were naive to radiotherapy and patients with local recurrences were evaluated. Each patient underwent standard of care systematic biopsies prior to imaging and treatment. Sextants from prostate biopsy were analyzed on an independent basis. Per previous published work, pGTV at risk of recurrence was defined as the pathological dominant lesions with peak PCL (percentage core length) involvement and any sextants with ≽ 40% PCL involvement. Each imaging method was analyzed independently to determine spatial correspondence of the visible tumor to pGTV at risk of recurrence. Lesions scored 4-5 (PIRADSv2.1) were identified on mpMRI. For PSMA-PET, regions with uptake higher than the adjacent background with scaling SUVmin-max 0-10 were identified. RESULTS Forty-seven patients with histopathological proven intermediate to high-risk Pca represented the study cohort. Of the 320 sextants, 135 were involved with PCa. Thirty-six percent (17∕47) of patients had a history of prior radiotherapy. PSMA-PET identified the pGTV in 89% (42∕47) of patients, while mpMRI yielded a higher detection rate at 98% (46∕47) (89% vs 98% p = 0.038). The only pGTV not detected on mpMRI was also missed by PSMA-PET, and had received EBRT in 2011. Of the four other pGTVs at risk of recurrence missed by PSMA-PET, three had no history of prior radiotherapy and one was treated with brachytherapy in 2005. Overall, we found no differences in imaging detection rates between previously treated and untreated patients. More detailed volumetric analyses are ongoing and will be presented. CONCLUSION mpMRI may provide superior detection of the pGTV at risk of recurrence in comparison to PSMA-PET. Until further research is completed, clinicians should exercise caution in omitting mpMRI and utilizing PSMA-PET as the sole imaging method for GTV targeting.
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Affiliation(s)
- C Belliveau
- Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | | | - D Juneau
- Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - D Olivié
- Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - M Barkati
- Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - G Delouya
- Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - D Taussky
- Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - C Lambert
- Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - M C Beauchemin
- Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - C Menard
- Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
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Pra AD, Lyness J, Pollack A, Tran PT, Koontz BF, Abramowitz MC, Mahal BA, Martin AG, Michalski JM, Balogh A, Lukka H, Faria SL, Rodrigues G, Beauchemin MC, Lee RJ, Seaward SA, Coen SD, Allen AM, Pugh S, Feng FY. Impact of Testosterone Recovery on Clinical Outcomes of Patients Treated with Salvage Radiotherapy and Androgen Suppression: A Secondary Analysis of the NRG/RTOG 0534 Sport Phase 3 Trial. Int J Radiat Oncol Biol Phys 2023; 117:S82-S83. [PMID: 37784585 DOI: 10.1016/j.ijrobp.2023.06.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Testosterone (T) kinetics and its relationship with clinical outcomes has not been studied in trials using salvage radiotherapy and androgen deprivation therapy (ADT). We performed a secondary analysis of the NRG Oncology/RTOG 0534 SPPORT trial, which compared prostate bed radiotherapy (PBRT) (arm 1), PBRT + short-term androgen deprivation therapy (ADT) (arm 2), or PBRT + pelvic lymph node radiotherapy (PLNRT) + short-term ADT (arm 3). We assessed longitudinal serum T levels and the impact of testosterone recovery (TR) on clinical outcomes. MATERIALS/METHODS ADT was given for 4-6 months in arms 2 and 3, starting 2 months prior to radiotherapy. The trial excluded patients with baseline T < 40% of the lower limit of normal. TR was defined in 3 ways: 1) return to non-castrate level (>50 ng/dL), 2) return to normal level (>300 ng/dL), and 3) return to baseline level. Time to TR was estimated using cumulative incidence and death without an event considered a competing risk. Unadjusted and adjusted hazard ratios and 95% confidence intervals (CIs) were calculated using Cox proportional hazards model. Freedom from progression (FFP) was defined as biochemical failure according to the Phoenix definition (PSA ≥2 ng/mL over the nadir PSA), clinical failure (local, regional, or distant), or death from any cause. RESULTS A total of 1699 patients with T at baseline and at least 1 follow-up assessment were included. The median age was 64 years (IQR 59 - 69), 12.8% were black, 14.9% had diabetes, and 54.1% were former or current smokers. Median baseline T in arms 1, 2 and 3 was 320 ng/dL (IQR 239 - 424), 319 ng/dL (IQR 237 - 438) and 330 ng/dL (IQR 252 - 446), respectively. At 6 months, median T in arms 1, 2 and 3 was 290 ng/dL (IQR 210 - 390), 190.4 ng/dL (IQR 66 - 296) and 191 ng/dL (IQR 40.5 - 313). At 2 years, in arms 2 and 3, TR to non-castrate, normal and baseline levels were 95%, 55% and 23%, respectively. At 5 years, in arms 2 and 3, TR to non-castrate, normal and baseline levels were 98%, 73% and 42%, respectively. FFP was superior in arms 2 and 3 vs. arm 1 in patients with TR by all three definitions. In patients with recovered T to normal levels by 2 years (n = 904), the 5-year FFP rates were 71.8% (95% CI 66.9-76.6) in arm 1, 77.2% (72.1-82.2) in arm 2, and 86.3% (82.3-90.3) in arm 3 (arm 2 vs arm 1: HR 0.74, 95% CI 0.56-0.98, p = 0.034; arm 3 vs arm 1: HR 0.54, 95% CI 0.40-0.72, p<.0001). CONCLUSION This work represents the largest study of T kinetics in patients treated with salvage radiation and ADT. Approximately half of patients did not normalize their T levels by 2 years. Our data validate an incremental and meaningful FFP benefit of adding short-term ADT and PLNRT to PBRT independent of T recovery.
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Affiliation(s)
- A Dal Pra
- Department of Radiation Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL
| | - J Lyness
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
| | - A Pollack
- Department of Radiation Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL
| | - P T Tran
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | | | - M C Abramowitz
- Department of Radiation Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL
| | - B A Mahal
- Department of Radiation Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL
| | - A G Martin
- Department of Radiation Oncology CHU de Québec-Université Laval, Québec, QC, Canada
| | - J M Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - A Balogh
- Tom Baker Cancer Centre, Calgary, AB, Canada
| | - H Lukka
- Juravinski Cancer Centre, Hamilton, ON, Canada
| | - S L Faria
- McGill University Health Centre, Montreal, QC, Canada
| | - G Rodrigues
- London Health Sciences Centre, London, ON, Canada
| | - M C Beauchemin
- Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - R J Lee
- Intermountain Medical Center, Murray, UT
| | | | - S D Coen
- Southeast Clinical Oncology Research Consortium, Winston Salem, NC
| | - A M Allen
- Rabin Medical Center - Beilinson Hospital, Petah Tickva, Israel
| | - S Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
| | - F Y Feng
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
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Belliveau C, Barkati M, Delouya G, Taussky D, Beauchemin MC, Lambert C, Beaulieu L, Beliveau-Nadeau D, Nicolas B, Carrier JF, Vigneault E, Ménard C. Focal HDR brachytherapy boost to stereotactic radiotherapy (fBTsRT) for prostate cancer: a phase II randomized controlled trial. Radiat Oncol 2022; 17:203. [PMID: 36494834 PMCID: PMC9733116 DOI: 10.1186/s13014-022-02173-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND For patients with a higher burden of localized prostate cancer, radiation dose escalation with brachytherapy boosts have improved cancer control outcomes at the cost of urinary toxicity. We hypothesize that a focal approach to brachytherapy boosts targeting only grossly visualized tumor volumes (GTV) combined with stereotactic radiotherapy will improve quality of life (QoL) outcomes without compromising cancer control. METHODS 150 patients with intermediate or high-risk prostate cancer will be enrolled and randomized 1:1 in a cohort multiple randomized clinical trial phase 2 design. Patients are eligible if planned for standard-of-care (SOC) high dose rate (HDR) brachytherapy boost to radiotherapy (RT) with GTVs encompassing < 50% of the prostate gland. Those randomly selected will be offered the experimental treatment, consisting of focal HDR brachytherapy boost (fBT) of 13-15 Gy in 1 fraction followed by stereotactic radiotherapy (sRT) 36.25-40 Gy in 5 fractions to the prostate (+/- 25 Gy to the elective pelvis) delivered every other day. The primary endpoint is to determine if fBTsRT is superior to SOC by having fewer patients experience a minimally important decline (MID) in urinary function as measured by EPIC-26 at 1 and 2 years. Secondary endpoints include rates of toxicity measured by Common Terminology Criteria for Adverse Events (CTCAE), and failure-free survival outcomes. DISCUSSION This study will determine whether a novel approach for the treatment of localized prostate cancer, fBTsRT, improves QoL and merits further evaluation. Trial registration This trial was prospectively registered in ClinicalTrials.gov as NCT04100174 as a companion to registry NCT03378856 on September 24, 2019.
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Affiliation(s)
- C. Belliveau
- grid.410559.c0000 0001 0743 2111Radiation Oncology, CHUM - Centre Hospitalier de l’Université de Montréal, 900 Saint Denis St, Montreal, QC H2X 0A9 Canada
| | - M. Barkati
- grid.410559.c0000 0001 0743 2111Radiation Oncology, CHUM - Centre Hospitalier de l’Université de Montréal, 900 Saint Denis St, Montreal, QC H2X 0A9 Canada
| | - G. Delouya
- grid.410559.c0000 0001 0743 2111Radiation Oncology, CHUM - Centre Hospitalier de l’Université de Montréal, 900 Saint Denis St, Montreal, QC H2X 0A9 Canada
| | - D. Taussky
- grid.410559.c0000 0001 0743 2111Radiation Oncology, CHUM - Centre Hospitalier de l’Université de Montréal, 900 Saint Denis St, Montreal, QC H2X 0A9 Canada
| | - M. C. Beauchemin
- grid.410559.c0000 0001 0743 2111Radiation Oncology, CHUM - Centre Hospitalier de l’Université de Montréal, 900 Saint Denis St, Montreal, QC H2X 0A9 Canada
| | - C. Lambert
- grid.410559.c0000 0001 0743 2111Radiation Oncology, CHUM - Centre Hospitalier de l’Université de Montréal, 900 Saint Denis St, Montreal, QC H2X 0A9 Canada
| | - L. Beaulieu
- grid.23856.3a0000 0004 1936 8390Radiation Oncology, Centre universitaire de Québec, Université Laval, 2705 Laurier Boulevard, Quebec City, QC G1V 4G2 Canada
| | - D. Beliveau-Nadeau
- grid.410559.c0000 0001 0743 2111Radiation Oncology, CHUM - Centre Hospitalier de l’Université de Montréal, 900 Saint Denis St, Montreal, QC H2X 0A9 Canada
| | - B. Nicolas
- grid.410559.c0000 0001 0743 2111Radiation Oncology, CHUM - Centre Hospitalier de l’Université de Montréal, 900 Saint Denis St, Montreal, QC H2X 0A9 Canada
| | - J. F. Carrier
- grid.410559.c0000 0001 0743 2111Radiation Oncology, CHUM - Centre Hospitalier de l’Université de Montréal, 900 Saint Denis St, Montreal, QC H2X 0A9 Canada
| | - E. Vigneault
- grid.23856.3a0000 0004 1936 8390Radiation Oncology, Centre universitaire de Québec, Université Laval, 2705 Laurier Boulevard, Quebec City, QC G1V 4G2 Canada
| | - C. Ménard
- grid.410559.c0000 0001 0743 2111Radiation Oncology, CHUM - Centre Hospitalier de l’Université de Montréal, 900 Saint Denis St, Montreal, QC H2X 0A9 Canada
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