TY - JOUR
T1 - 11C-Choline PET Guided Salvage Radiation Therapy for Isolated Pelvic and Paraortic Nodal Recurrence of Prostate Cancer After Radical Prostatectomy
T2 - Rationale and Early Genitourinary or Gastrointestinal Toxicities
AU - Jethwa, Krishan R.
AU - Hellekson, Christopher D.
AU - Evans, Jaden D.
AU - Harmsen, William S.
AU - Wilhite, Tyler J.
AU - Whitaker, Thomas J.
AU - Park, Sean S.
AU - Choo, C. Richard
AU - Stish, Bradley J.
AU - Olivier, Kenneth R.
AU - Haloi, Rimki
AU - Lowe, Val J.
AU - Welch, Brian T.
AU - Quevedo, J. Fernando
AU - Mynderse, Lance A.
AU - Karnes, R. Jeffrey
AU - Kwon, Eugene D.
AU - Davis, Brian J.
N1 - Funding Information:
Sources of support: This work was made possible in part through a grant from the National Institutes of Health (NCI R01 CA200551).
Publisher Copyright:
© 2019 The Authors
PY - 2019/10/1
Y1 - 2019/10/1
N2 - Purpose: To assess gastrointestinal (GI) and genitourinary (GU) adverse events (AEs) of 11C-choline-positron emission tomography (CholPET) guided lymph node (LN) radiation therapy (RT) in patients who experience biochemical failure after radical prostatectomy. Methods and Materials: From 2013 to 2016, 107 patients experienced biochemical failure of prostate cancer, had CholPET-detected pelvic and/or paraortic LN recurrence, and were referred for RT. Patients received androgen suppression and CholPET guided LN RT (median dose, 45 Gy) with a simultaneous integrated boost to CholPET-avid sites (median dose, 56.25 Gy), all in 25 fractions. RT-naïve patients had the prostatic fossa included in the initial treatment volumes followed by a sequential boost (median dose, 68 Gy). GI and GU AEs were reported per Common Terminology Criteria for Adverse Events (version 4.0) with data gathered retrospectively. Differences in maximum GI and GU AEs at baseline, immediately post-RT, and at early (median, 4 months) and late (median, 14 months) follow-up were assessed. Results: Median follow-up was 16 months (interquartile range [IQR], 11-25). Median prostate-specific antigen at time of positive CholPET was 2.3 ng/mL (IQR, 1.3-4.8), with a median of 2 (IQR, 1-4) choline-avid LNs per patient. Most recurrences were within the pelvis (53%) or pelvis + paraortic (40%). Baseline rates of grade 1 to 2 GI AEs were 8.4% compared with 51.9% (4.7% grade 2) of patients post-RT (P <. 01). These differences resolved by 4-month (12.2%, P =. 65) and 14-month AE assessments (9.1%, P =. 87). There was no significant change in grade 1 to 2 GU AEs post-RT (64.1%) relative to baseline (56.0%, P =. 21), although differences did arise at 4-month (72.2%, P =. 01) and 14-month (74.3%, P =. 01) AE assessments. Conclusions: Salvage CholPET guided nodal RT has acceptably low rates of acute GI and GU AEs and no significant detriment in 14-month GI AEs. These data are of value in counseling patients and designing prospective trials evaluating the oncologic efficacy of this treatment strategy.
AB - Purpose: To assess gastrointestinal (GI) and genitourinary (GU) adverse events (AEs) of 11C-choline-positron emission tomography (CholPET) guided lymph node (LN) radiation therapy (RT) in patients who experience biochemical failure after radical prostatectomy. Methods and Materials: From 2013 to 2016, 107 patients experienced biochemical failure of prostate cancer, had CholPET-detected pelvic and/or paraortic LN recurrence, and were referred for RT. Patients received androgen suppression and CholPET guided LN RT (median dose, 45 Gy) with a simultaneous integrated boost to CholPET-avid sites (median dose, 56.25 Gy), all in 25 fractions. RT-naïve patients had the prostatic fossa included in the initial treatment volumes followed by a sequential boost (median dose, 68 Gy). GI and GU AEs were reported per Common Terminology Criteria for Adverse Events (version 4.0) with data gathered retrospectively. Differences in maximum GI and GU AEs at baseline, immediately post-RT, and at early (median, 4 months) and late (median, 14 months) follow-up were assessed. Results: Median follow-up was 16 months (interquartile range [IQR], 11-25). Median prostate-specific antigen at time of positive CholPET was 2.3 ng/mL (IQR, 1.3-4.8), with a median of 2 (IQR, 1-4) choline-avid LNs per patient. Most recurrences were within the pelvis (53%) or pelvis + paraortic (40%). Baseline rates of grade 1 to 2 GI AEs were 8.4% compared with 51.9% (4.7% grade 2) of patients post-RT (P <. 01). These differences resolved by 4-month (12.2%, P =. 65) and 14-month AE assessments (9.1%, P =. 87). There was no significant change in grade 1 to 2 GU AEs post-RT (64.1%) relative to baseline (56.0%, P =. 21), although differences did arise at 4-month (72.2%, P =. 01) and 14-month (74.3%, P =. 01) AE assessments. Conclusions: Salvage CholPET guided nodal RT has acceptably low rates of acute GI and GU AEs and no significant detriment in 14-month GI AEs. These data are of value in counseling patients and designing prospective trials evaluating the oncologic efficacy of this treatment strategy.
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U2 - 10.1016/j.adro.2019.06.006
DO - 10.1016/j.adro.2019.06.006
M3 - Article
AN - SCOPUS:85070549436
SN - 2452-1094
VL - 4
SP - 659
EP - 667
JO - Advances in Radiation Oncology
JF - Advances in Radiation Oncology
IS - 4
ER -