Frontiers in Oncology (May 2021)

Combining 68Ga-PSMA-PET/CT-Directed and Elective Radiation Therapy Improves Outcome in Oligorecurrent Prostate Cancer: A Retrospective Multicenter Study

  • Simon Kirste,
  • Simon Kirste,
  • Stephanie G. C. Kroeze,
  • Christoph Henkenberens,
  • Nina-Sophie Schmidt-Hegemann,
  • Nina-Sophie Schmidt-Hegemann,
  • Marco M. E. Vogel,
  • Marco M. E. Vogel,
  • Jessica Becker,
  • Constantinos Zamboglou,
  • Constantinos Zamboglou,
  • Irene Burger,
  • Thorsten Derlin,
  • Peter Bartenstein,
  • Juri Ruf,
  • Christian la Fougère,
  • Christian la Fougère,
  • Matthias Eiber,
  • Hans Christiansen,
  • Stephanie E. Combs,
  • Stephanie E. Combs,
  • Arndt-Christian Müller,
  • Arndt-Christian Müller,
  • Claus Belka,
  • Claus Belka,
  • Matthias Guckenberger,
  • Anca-Ligia Grosu,
  • Anca-Ligia Grosu

DOI
https://doi.org/10.3389/fonc.2021.640467
Journal volume & issue
Vol. 11

Abstract

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BackgroundIn case of oligo-recurrent prostate cancer (PC) following prostatectomy, 68Ga-PSMA-PET/CT can be used to detect a specific site of recurrence and to initiate metastasis-directed radiation therapy (MDT). However, large heterogeneities exist concerning doses, treatment fields and radiation techniques, with some studies reporting focal radiotherapy (RT) to PSMA-PET/CT positive lesions only and other studies using elective RT strategies. We aimed to compare oncological outcomes and toxicity between PET/CT-directed RT (PDRT) and PDRT plus elective RT (eRT; i.e. prostate bed, pelvic or paraaortal nodes) in a large retrospective multicenter study.MethodsData of 394 patients with oligo-recurrent 68Ga-PSMA-PET/CT-positive PC treated between 04/2013 and 01/2018 in six different academic institutions were evaluated. Primary endpoint was biochemical-recurrence-free survival (bRFS). bRFS was analyzed using Kaplan–Meier survival curves and log rank testing. Uni- and multivariate analyses were performed to determine influence of treatment parameters.ResultsIn 204 patients (51.8%) RT was directed only to lesions seen on 68Ga-PSMA-PET/CT (PDRT), 190 patients (48.2%) received PDRT plus eRT. PDRT plus eRT was associated with a significantly improved 3-year bRFS compared to PDRT alone (53 vs. 37%; p = 0.001) and remained an independent factor in multivariate analysis (p = 0.006, HR 0.29, 95% CI 0.12–0.68). This effect was more pronounced in the subgroup of patients who were treated with PDRT and elective prostate bed radiotherapy (ePBRT) with a 3-year bRFS of 61% versus 22% (p <0.001). Acute and late toxicity grade ≥3 was 0.8% and 3% after PDRT plus eRT versus no toxicity grade ≥3 after PDRT alone.ConclusionsIn this large cohort of patients with oligo-recurrent prostate cancer, elective irradiation of the pelvic lymphatics and the prostatic bed significantly improved bRFS when added to 68Ga-PSMA-PET/CT-guided focal radiotherapy. These findings need to be evaluated in a randomized controlled trial.

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