Purpose or Objective Aim: In the last years, functional imaging has given a significant contribution to the clinical decision making of biochemical relapsed prostate cancer (PCa), allowing early diagnosis of metastatic disease with a limited tumor burden, the so-called oligometastatic patients, and driving local therapies like stereotactic body radiotherapy (SBRT). Herby, we present a prospective study aiming to validate the role of [18F]Fluoro-Methyl Choline ([18F]FMCH) PET/CT in the selection of PCa patients suitable for SBRT. Material and Methods Materials and Methods: Patients with biochemical recurrence were screened. Eligible patients were imaged with Endo-rectal Magnetic Resonance to exclude local recurrence inside the prostate bed and [18F]FMCH PET/CT to assess tumor burden. Patients with up to three synchronous active lesions identified by [18F]FMCH PET/CT were enrolled in the present study. All patients were treated with SBRT on all active lesions revealed by [18F]FMCH PET/CT. Systemic therapy free-survival since the [18F]FMCH PET/CT was considered as the primary endpoint. Results Results: 50 patients were included in the present study. Forty-five patients with oligometastatic PCa (castration sensitive in 34 patients, castration-resistant in 11) for a total of 66 lesions (lymph node and bone lesions, in 44 and 22 cases, respectively) were considered evaluable for the present analysis. After SBRT, five patients were lost at follow-up since they started ADT for personal reason. Patients’ median age at the time of study entry was 70 years (range 50-81). The median length between PCa diagnosis and study enrollment was 69 months (range, 2-180 months). At the time of study entry, Median PSA value was 2,69 ng/mL (range 0.9-27,40). In-field progression was observed in 3 out of 66 irradiated lesions. After the detection of oligorecurrent disease following SBRT, 6 patients underwent further courses of SBRT on the active lesions revealed by [18F]FMCH-PET/CT (two, three, four, five courses respectively in 3,1,1,1 patients). Toxicity higher than grade 2 was not recorded. After a median follow-up of 22.3 months, systemic therapy was started in 24 patients (53,3%). Median systemic therapy free survival was 39.1 months (95%CI6.5-68.6) whereas systemic free survival ratios at 6, 12 and 24-month were 93.5%, 73.9%, and 63.1 %, respectively. At univariate Cox regression analysis, Delta PSA and Gleason Score (GS) demonstrated an impact on systemic therapy free survival (p=0.03 and p<0.001, respectively), being GS higher than 6 related to longer systemic therapy free survival. The Delta PSA remained statistically significant on multivariate analyses while the Gleason Score shows a trend to a statistically significant association (p<0.001 and p=0.18, respectively). Conclusion Conclusion: Based on our findings, [18F]FMCH PET/CT can identify oligometastatic patients suitable for SBRT, resulting in a systemic therapy free survival of 39.1 months.

EP-1568 Long-term results of [18F] Fluorocholine PET/CT guided SBRT in patients with prostate cancer

Pasqualetti, F.;Panichi, M.;Cocuzza, P.;Gonnelli, A.;Baldaccini, D.;Molinari, A.;Cantarella, M.;Mattioni, R.;Montrone, S.;Cristaudo, A.;Marciano, A.;Erba, P. A.;Paiar, F.
2019-01-01

Abstract

Purpose or Objective Aim: In the last years, functional imaging has given a significant contribution to the clinical decision making of biochemical relapsed prostate cancer (PCa), allowing early diagnosis of metastatic disease with a limited tumor burden, the so-called oligometastatic patients, and driving local therapies like stereotactic body radiotherapy (SBRT). Herby, we present a prospective study aiming to validate the role of [18F]Fluoro-Methyl Choline ([18F]FMCH) PET/CT in the selection of PCa patients suitable for SBRT. Material and Methods Materials and Methods: Patients with biochemical recurrence were screened. Eligible patients were imaged with Endo-rectal Magnetic Resonance to exclude local recurrence inside the prostate bed and [18F]FMCH PET/CT to assess tumor burden. Patients with up to three synchronous active lesions identified by [18F]FMCH PET/CT were enrolled in the present study. All patients were treated with SBRT on all active lesions revealed by [18F]FMCH PET/CT. Systemic therapy free-survival since the [18F]FMCH PET/CT was considered as the primary endpoint. Results Results: 50 patients were included in the present study. Forty-five patients with oligometastatic PCa (castration sensitive in 34 patients, castration-resistant in 11) for a total of 66 lesions (lymph node and bone lesions, in 44 and 22 cases, respectively) were considered evaluable for the present analysis. After SBRT, five patients were lost at follow-up since they started ADT for personal reason. Patients’ median age at the time of study entry was 70 years (range 50-81). The median length between PCa diagnosis and study enrollment was 69 months (range, 2-180 months). At the time of study entry, Median PSA value was 2,69 ng/mL (range 0.9-27,40). In-field progression was observed in 3 out of 66 irradiated lesions. After the detection of oligorecurrent disease following SBRT, 6 patients underwent further courses of SBRT on the active lesions revealed by [18F]FMCH-PET/CT (two, three, four, five courses respectively in 3,1,1,1 patients). Toxicity higher than grade 2 was not recorded. After a median follow-up of 22.3 months, systemic therapy was started in 24 patients (53,3%). Median systemic therapy free survival was 39.1 months (95%CI6.5-68.6) whereas systemic free survival ratios at 6, 12 and 24-month were 93.5%, 73.9%, and 63.1 %, respectively. At univariate Cox regression analysis, Delta PSA and Gleason Score (GS) demonstrated an impact on systemic therapy free survival (p=0.03 and p<0.001, respectively), being GS higher than 6 related to longer systemic therapy free survival. The Delta PSA remained statistically significant on multivariate analyses while the Gleason Score shows a trend to a statistically significant association (p<0.001 and p=0.18, respectively). Conclusion Conclusion: Based on our findings, [18F]FMCH PET/CT can identify oligometastatic patients suitable for SBRT, resulting in a systemic therapy free survival of 39.1 months.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11568/1071391
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