Target definition in salvage postoperative radiotherapy for prostate cancer: 18F-fluorocholine PET/CT assessment of local recurrence

Kabbaj, O. El; Robin, Philippe; Bourhis, David; Dissaux, G.; Rosenfelder, N.; Valéri, Antoine; Fournier, Georges; Salaun, Pierre–Yves; Pradier, Olivier; Malhaire, Jean-Pierre; Abgral, Ronan; Schick, Ulrike

doi:10.1080/0284186x.2017.1385843

Cited by 9 publications

(10 citation statements)

References 23 publications

(29 reference statements)

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“…These standardized volumes do not, however, cover all potential sites of recurrence. In a study assessing the patterns of local relapse in patients with BCR after RP, the anastomosis was the most common site of recurrence (52.8%) identified by 18 F-Choline PET/CT, followed by the retrovesical region (31.7%) and the bladder neck (7%) (42). Eighty-four percent and 83% of local relapses were entirely included in CTV, defined according to RTOG and FROGG guidelines, respectively.…”

Section: Local Relapsementioning

confidence: 99%

PET/CT-Based Salvage Radiotherapy for Recurrent Prostate Cancer After Radical Prostatectomy: Impact on Treatment Management and Future Directions

et al. 2021

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Biochemical recurrence is a clinical situation experienced by 20 to 40% of prostate cancer patients treated with radical prostatectomy (RP). Prostate bed (PB) radiation therapy (RT) remains the mainstay salvage treatment, although it remains non-curative for up to 30% of patients developing further recurrence. Positron emission tomography with computed tomography (PET/CT) using prostate cancer-targeting radiotracers has emerged in the last decade as a new-generation imaging technique characterized by a better restaging accuracy compared to conventional imaging. By adapting targeting of recurrence sites and modulating treatment management, implementation in clinical practice of restaging PET/CT is challenging the established therapeutic standards born from randomized controlled trials. This article reviews the potential impact of restaging PET/CT on changes in the management of recurrent prostate cancer after RP. Based on PET/CT findings, it addresses potential adaptation of RT target volumes and doses, as well as use of androgen-deprivation therapy (ADT). However, the impact of such management changes on the oncological outcomes of PET/CT-based salvage RT strategies is as yet unknown.

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Section: Local Relapsementioning

confidence: 99%

PET/CT-Based Salvage Radiotherapy for Recurrent Prostate Cancer After Radical Prostatectomy: Impact on Treatment Management and Future Directions

et al. 2021

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“…Based on the observation that hypofractionated PORT appears to have a more substantial effect on late grade 3+ GU toxicity compared with GI toxicity as well as higher rates of GU toxicity compared with prior conventionally fractionated treatments, 12 , 25 the risk-benefit ratio of the inclusion of various postprostatectomy anatomic zones in the treatment volume is likely different than in conventionally fractionated radiation therapy. Current CTV recommendations have been reported to inadequately provide coverage of the area posterior to the vesicourethral anastomosis (VUA) 40 and in the posterolateral aspect of the treatment field at the anorectal interface. 41 Based on the possibility that serious late GI toxicity appears less frequent than corresponding rates of serious late GU toxicity when delivering treatment with a hypofractionated compared with a standard dose schedule, expansion of the posterior aspect of the treatment volume to ensure adequate coverage of the VUA and posterolateral anorectal recess may improve oncologic control without substantial cost in terms of GI toxicity.…”

Section: Discussionmentioning

confidence: 99%

A Phase 1 Trial of Highly Conformal, Hypofractionated Postprostatectomy Radiation Therapy

Patel

Rowe

Schott

et al. 2022

Advances in Radiation Oncology

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“…Wang et al found two thirds of the relapses occur in the vicinity of the vesicourethral anastomosis [7]. El Kabbaj et al used 18F -Fluorocholine PET/CT imaging to show that more than half of suspected relapses occurred at the anastomotic site [8].…”

Section: Discussionmentioning

confidence: 99%

MRI validation of Post-Prostatectomy Radiotherapy Contouring

et al. 2019

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Introduction: Level One Evidence has established the indications for, and importance of, adjuvant radiotherapy following radical prostatectomy. Several guidelines have addressed delineation of the prostate bed but with variable specification of the inferior border relative to the penile bulb or to the first CT slice distal to visible urine in the bladder neck. This work determines the correlation between the caudal aspect of the anastomosis shown by the tip of the urethrogram cone and MRI anatomy. Materials and Methods : Sixteen patients receiving adjuvant radiotherapy following prostatectomy underwent diagnostic MRI in addition to planning CT with Urethrogram. The CT Reference Slice, tip of urethrogram cone and superior aspect of penile bulb were delineated. Results: MRI clearly demonstrates the penile bulb but not the anastomosis. In these 16 patients, the tip of the urethrogram cone was a median 3.9 mm cranial to the penile bulb (range 0-10.3 mm). Conclusion: We show marked variability in the distance between penile bulb and the tip of the urethrogram cone. In all sixteen patients, placing the inferior border of the CTV 15mm cranial to the penile bulb would have failed to treat the caudal aspect of the anastomosis, a frequent site of local relapse, that cannot be reliably landmarked by any other anatomic structure. Individualizing the treatment volume to patient anatomy is the only way to ensure consistent coverage without treating a larger than necessary volume in many patients. We recommend the use of planning urethrogram to minimize the potential for geographic miss.

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Target definition in salvage postoperative radiotherapy for prostate cancer: 18F-fluorocholine PET/CT assessment of local recurrence

Abstract: In our study, the CTV and CTV ensured the best coverage of LR seen on 18F-FCH PET/CT. When outlining the prostatic fossa, greater coverage of the posterior vesico-urethral region may allow better coverage of potential microscopic disease.

Cited by 9 publications

References 23 publications

PET/CT-Based Salvage Radiotherapy for Recurrent Prostate Cancer After Radical Prostatectomy: Impact on Treatment Management and Future Directions

PET/CT-Based Salvage Radiotherapy for Recurrent Prostate Cancer After Radical Prostatectomy: Impact on Treatment Management and Future Directions

A Phase 1 Trial of Highly Conformal, Hypofractionated Postprostatectomy Radiation Therapy

MRI validation of Post-Prostatectomy Radiotherapy Contouring

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