Intensity-Modulated Radiotherapy for Prostate Cancer Implementing Molecular Imaging with 18F-Choline PET-CT to Define a Simultaneous Integrated Boost

Abstract

Treatment planning with (18)F-choline PET-CT allows the definition of an integrated boost in nearly all prostate cancer patients - including patients after NHT - without considerably affecting EUDs for the organs at risk. GTV(PET) and SUV levels were found to be dependent on prognostic risk factors, particularly Gleason Score.

18F-fluorocholine for prostate cancer imaging: a systematic review of the literature

“…39,48 Seven studies evaluated 18 F-FCH for defining intra-prostatic lesions or limited lymph node recurrence for dose-escalated radiotherapy. 47,[49][50][51][52][53][54] Two clinical studies evaluated the physiological distribution and false-positive 18 F-FCH uptakes. 55,56 The literature data on 18 F-FCH prostate cancer imaging are summarized in Table 1.…”

“…20,21,24,34,35,37,38,42,57 Early time points for imaging (0-15 min post-intravenous injection) and/or delayed imaging time points (30,40,45,60, 90-120 and 65-200 min post-intravenous injection) have been also described in the published literature. 22,23,[27][28][29][30][31][32][33]36,39,40,41,[43][44][45][46][47][48][49][50][51][52][54][55][56] 34 16…”

“…An earlier study of a smaller number of PCa patients (n ¼ 12) using the same 18 F-FCH PET/CT SUVmax criteria to define DILs modeled the ability to escalate dose to the DILs to 80-83 Gy with a whole prostate dose of 76 Gy, whereas maintaining dose to the bladder and rectum within acceptable limits. 50 In comparison, Niayazi et al 53 modeled the potential benefit of 18 F-FCH defined lesions. The benefit of a DIL boosting strategy was modest at best, and was dependent on the assumed sensitivity of the 18 F-FCH PET study.…”

“…17 Focal salvage RT PET/CT Pinkawa et al 50 12 Focal salvage RT PET/CT Pinkawa et al 49 66 Focal salvage RT PET/CT 2. Utility of 18 F-FCH PET and PET/CT for definition of intra-prostatic foci or limited nodal recurrence.…”

Is there any impact of PET/CT on radiotherapy planning in rectalcancer patients undergoing preoperative IMRT?

“…Therefore, intensity-modulated radiation therapy (IMRT) might be effective in minimizing this problem. IMRT also allows better dose conformity and improved possibility of closely tailoring the dose distribution around the target compared to 3-dimensional conformal radiotherapy (CRT) techniques (11,12). Moreover, using PET/CT in conjunction with IMRT may have additional advantages in rectal cancer radiation therapy.…”