11C-Choline PET Guided Salvage Radiation Therapy for Isolated Pelvic and Paraortic Nodal Recurrence of Prostate Cancer After Radical Prostatectomy: Rationale and Early Genitourinary or Gastrointestinal Toxicities

Krishan R. Jethwa, Christopher D. Hellekson, Jaden D. Evans, William S. Harmsen, Tyler J. Wilhite, Thomas J. Whitaker, Sean S. Park, C. Richard Choo, Bradley J. Stish, Kenneth R. Olivier, Rimki Haloi, Val J. Lowe, Brian T. Welch, J. Fernando Quevedo, Lance A. Mynderse, R. Jeffrey Karnes, Eugene D. Kwon, Brian J. Davis

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalAdvances in Radiation Oncology
DOIs
StateAccepted/In press - Jan 1 2019

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Salvage Therapy
Prostatectomy
Choline
Prostatic Neoplasms
Radiotherapy
Positron-Emission Tomography
Recurrence
Lymph Nodes
Pelvis
Prostate-Specific Antigen
Terminology
Androgens
Counseling

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

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11C-Choline PET Guided Salvage Radiation Therapy for Isolated Pelvic and Paraortic Nodal Recurrence of Prostate Cancer After Radical Prostatectomy : Rationale and Early Genitourinary or Gastrointestinal Toxicities. / Jethwa, Krishan R.; Hellekson, Christopher D.; Evans, Jaden D.; Harmsen, William S.; Wilhite, Tyler J.; Whitaker, Thomas J.; Park, Sean S.; Choo, C. Richard; Stish, Bradley J.; Olivier, Kenneth R.; Haloi, Rimki; Lowe, Val J.; Welch, Brian T.; Quevedo, J. Fernando; Mynderse, Lance A.; Karnes, R. Jeffrey; Kwon, Eugene D.; Davis, Brian J.

In: Advances in Radiation Oncology, 01.01.2019.

Research output: Contribution to journalArticle

Jethwa, Krishan R. ; Hellekson, Christopher D. ; Evans, Jaden D. ; Harmsen, William S. ; Wilhite, Tyler J. ; Whitaker, Thomas J. ; Park, Sean S. ; Choo, C. Richard ; Stish, Bradley J. ; Olivier, Kenneth R. ; Haloi, Rimki ; Lowe, Val J. ; Welch, Brian T. ; Quevedo, J. Fernando ; Mynderse, Lance A. ; Karnes, R. Jeffrey ; Kwon, Eugene D. ; Davis, Brian J. / 11C-Choline PET Guided Salvage Radiation Therapy for Isolated Pelvic and Paraortic Nodal Recurrence of Prostate Cancer After Radical Prostatectomy : Rationale and Early Genitourinary or Gastrointestinal Toxicities. In: Advances in Radiation Oncology. 2019.
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title = "11C-Choline PET Guided Salvage Radiation Therapy for Isolated Pelvic and Paraortic Nodal Recurrence of Prostate Cancer After Radical Prostatectomy: Rationale and Early Genitourinary or Gastrointestinal Toxicities",
abstract = "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-na{\"i}ve 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.",
author = "Jethwa, {Krishan R.} and Hellekson, {Christopher D.} and Evans, {Jaden D.} and Harmsen, {William S.} and Wilhite, {Tyler J.} and Whitaker, {Thomas J.} and Park, {Sean S.} and Choo, {C. Richard} and Stish, {Bradley J.} and Olivier, {Kenneth R.} and Rimki Haloi and Lowe, {Val J.} and Welch, {Brian T.} and Quevedo, {J. Fernando} and Mynderse, {Lance A.} and Karnes, {R. Jeffrey} and Kwon, {Eugene D.} and Davis, {Brian J.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.adro.2019.06.006",
language = "English (US)",
journal = "Advances in Radiation Oncology",
issn = "2452-1094",
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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.

PY - 2019/1/1

Y1 - 2019/1/1

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

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JF - Advances in Radiation Oncology

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