Clinically Significant Prostate Cancer Local Recurrence After Radiation Therapy Occurs at the Site of Primary Tumor: Magnetic Resonance Imaging and Step-Section Pathology Evidence

Pucar, Darko; Hricak, Hedvig; Shukla–Dave, Amita; Kuroiwa, Kentaro; Drobnjak, Marija; Eastham, James A.; Scardino, Peter T.; Zeléfsky, Michael J.

doi:10.1016/j.ijrobp.2007.03.065

Cited by 273 publications

(157 citation statements)

References 47 publications

Supporting

Mentioning

151

Contrasting

Unclassified

Order By: Relevance

“…Firstly, these treatments may not be necessary in lower risk patients, and may result in unnecessary treatment-related morbidities (2). Secondly, whole gland treatments may not treat IPLs aggressively enough in higher risk patients, resulting in a high likelihood of local recurrences (3)(4)(5). Focal treatments using modalities such as intensity-modulated radiotherapy, focal brachytherapy, focused ultrasound and cryotherapy have been proposed as ways of overcoming these problems (2,(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Comparison of [11C]choline Positron Emission Tomography With T2- and Diffusion-Weighted Magnetic Resonance Imaging for Delineating Malignant Intraprostatic Lesions

Chang

Joon

Davis

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

View full text Add to dashboard Cite

Purpose: To compare the accuracy of 11 C-choline (CHOL) positron emission tomography (PET) with the combination of T2-weighted (T2W) and diffusion-weighted (DW) magnetic resonance imaging (MRI) for delineating malignant intraprostatic lesions (IPLs) for guiding focal therapies and to investigate factors predicting the accuracy of CHOL-PET.Methods and Materials: This study included 21 patients who underwent CHOL-PET and T2W-/DW-MRI prior to radical prostatectomy. Two observers manually delineated IPL contours for each scan, and automatic IPL contours were generated on CHOL-PET based on varying proportions of the maximum standardized uptake value (SUV). IPLs identified on prostatectomy specimens defined the reference standard contours. The imaging-based contours were compared with the reference standard contours using Dice similarity coefficient (DSC), sensitivity and specificity. Factors that could potentially predict the DSC of the best contouring method were analyzed using linear models.Results: The best automatic contouring method, SUV60, had similar correlations (DSC 0.59) with the manual PET contours (DSC 0.52, P=0.127) and significantly better correlations than the manual MRI contours (DSC 0.37, P<0.001). The sensitivity and specificity values were 72% and 71% for SUV60; 53% and 86% for PET manual contouring; and 28% and 92% for MRI manual contouring. The tumor volume and transition zone pattern could independently predict the accuracy of CHOL-PET.Conclusions: CHOL-PET is superior to the combination of T2W-and DW-MRI for delineating IPLs. The accuracy of CHOL-PET is insufficient for gland-sparing focal therapies, 3 however may be accurate enough for focal boost therapies. The transition zone pattern is a new classification that may predict for how well CHOL-PET delineates IPLs.

show abstract

Section: Introductionmentioning

confidence: 99%

Comparison of [11C]choline Positron Emission Tomography With T2- and Diffusion-Weighted Magnetic Resonance Imaging for Delineating Malignant Intraprostatic Lesions

Chang

Joon

Davis

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

View full text Add to dashboard Cite

show abstract

“…10,11 Approximately 66% of men who have localized failure after EBRT can develop recurrent unifocal or unilateral cancer, and the main site of recurrence is usually the site of the index lesion before EBRT. [12][13][14][15][16] By targeting this lesion with a margin of normal tissue, side effects may be reduced by minimizing collateral tissue damage with acceptable cancer control. [17][18][19] To test this hypothesis, we evaluated the safety, feasibility, side-effect profile, and early cancer control rates of focal salvage therapy using HIFU.…”

Section: Introductionmentioning

confidence: 99%

Focal salvage therapy for localized prostate cancer recurrence after external beam radiotherapy

Ahmed

Cathcart

McCartan

et al. 2012

Cancer

View full text Add to dashboard Cite

BACKGROUND:The objective of this study was to evaluate the safety, feasibility, side-effect profile, and proof of concept for focal salvage therapy using high-intensity focused ultrasound (HIFU). METHODS: A registry-based analysis was conducted between 2004 and 2009 of 430 patients who underwent HIFU. Thirty-nine patients received focal salvage therapy for localized recurrence after external beam radiotherapy. Multiparametric magnetic resonance imaging studies combined with transperineal template prostate mapping biopsies or transrectal biopsies were used to localize disease. Validated questionnaires were used to assess functional outcomes. Biochemical failure was defined by using both Phoenix criteria (prostate-specific antigen [PSA] nadir plus 2 ng/mL) and Stuttgart criteria (PSA nadir plus 1.2 ng/mL). RESULTS: The mean pre-HIFU PSA level was 4.6 ng/mL. The median follow-up was 17 months (interquartile range, 10-29 months). International Index of Erectile Function-5 scores decreased from a median AE standard deviation (SD) of 18 AE 16 to 13 AE 21 at 6 months, demonstrating worsening function. Scores on the University of California Los Angeles-Expanded Prostate Cancer Index Composite Urinary domain indicate that pad-free, leak-free continence status was 64%, and the pad-free rate was 87.2% at last follow-up. One rectourethral fistula occurred and spontaneously resolved with urinary and bowel diversion. The actuarial progression-free survival rate (including PSA nonresponders) was 69% at 1 year and 49% at 2 years according to Phoenix criteria. Excluding PSA nonresponders, these rates were 74% and 58%, respectively (Phoenix criteria). CONCLUSIONS: The results from this study indicated that focal salvage therapy is a potential strategy for localized recurrence after radiotherapy that may reduce the harms resulting from whole-gland salvage therapies. Cancer 2012;118:4148-55. V C 2012 American Cancer Society.KEYWORDS: focal, salvage, high-intensity focused ultrasound, prostate cancer, external beam radiotherapy. INTRODUCTIONBiochemical failure in men who have undergone external beam radiation therapy (EBRT) for localized prostate cancer can occur in approximately 10% to 30%. 1-3 The biochemical control rates observed are significantly better with high-dose radiation compared with conventional doses. However, most men who fail EBRT receive androgen-deprivation therapy, which can have an impact on quality of life and cardiac, metabolic, and bone health. 4,5 However, many patients have localized disease that may be suitable for local salvage therapy using surgery, brachytherapy, cryotherapy, or high-intensity focused ultrasound (HIFU). Those who undergo whole-gland salvage therapy have a significant risk of genitourinary and bowel complications, because the viability of surrounding tissues may have been compromised by previous radiation. The biochemical cancer control rates that result from these salvage therapies are on the order of 40% to 60% over 2 to 5 years follow-up. [6][7][8] We previously reported our early res...

show abstract

“…This is the concept of using functional imaging to identify regions within the conventional target volumes that may have different biology and thus may require escalated doses of radiation to achieve tumor control Previous studies of local recurrence patterns support the use of dose painting in prostate cancer (5,6). These studies show that dominant intraprostatic lesions (DILs) identified on pre-treatment imaging are the main sites of local recurrence following radiotherapy.…”

Section: Introductionmentioning

confidence: 99%

Histopathological correlation of 11C-choline PET scans for target volume definition in radical prostate radiotherapy

Chang

Joon

Lee

et al. 2011

Radiotherapy and Oncology

View full text Add to dashboard Cite

Clinically Significant Prostate Cancer Local Recurrence After Radiation Therapy Occurs at the Site of Primary Tumor: Magnetic Resonance Imaging and Step-Section Pathology Evidence

Cited by 273 publications

References 47 publications

Comparison of [11C]choline Positron Emission Tomography With T2- and Diffusion-Weighted Magnetic Resonance Imaging for Delineating Malignant Intraprostatic Lesions

Comparison of [11C]choline Positron Emission Tomography With T2- and Diffusion-Weighted Magnetic Resonance Imaging for Delineating Malignant Intraprostatic Lesions

Focal salvage therapy for localized prostate cancer recurrence after external beam radiotherapy

Histopathological correlation of 11C-choline PET scans for target volume definition in radical prostate radiotherapy

Contact Info

Product

Resources

About