DOI: 10.1007/s00259-018-4159-0Pages: 1-9

Salvage extended field or involved field nodal irradiation in 18F-fluorocholine PET/CT oligorecurrent nodal failures from prostate cancer

1. University Hospital Jean Minjoz, Department of Radiation Oncology

2. Unicancer-Georges François Leclerc Cancer Center, Department of Nuclear Medicine

3. Unicancer-Georges François Leclerc Cancer Center, Department of Radiation Oncology

4. Unicancer-Georges François Leclerc Cancer Center, Department of Biostatistics

5. Unicancer-Georges François Leclerc Cancer Center, Department of Medical Physics and Radiation Oncology

6. IMAC CNRS FRE2005, University of Burgundy, Medical Imaging Group

Correspondence to:
Gilles Créhange
Tel: +33-380-737-517
Email: gcrehange@cgfl.fr

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Abstract

Purpose

The concept of metastasis-directed therapy for nodal oligorecurrences with stereotactic body radiotherapy is increasingly accepted. Hence, the comparison between salvage extended field radiotherapy (s-EFRT) and salvage involved field radiotherapy (s-IFRT) in patients with 18F-fluorocholine (FCH) PET/CT+ nodal oligorecurrences from prostate cancer is worthy of investigation.

Methods

Patients with oligorecurrent nodes on FCH PET/CT treated with salvage radiotherapy between 2009 and 2017 in a single tertiary cancer centre were selected for this study. Patients treated with s-IFRT were compared with those treated with s-EFRT. Toxicities and times to failure (TTF) were compared between the two groups.

Results

The study included 62 patients with positive lymph nodes only who underwent FCH PET/CT for a rising PSA level after radical prostatectomy or radiotherapy. Of these patients, 35 had s-IFRT and 27 had s-EFRT. After a median follow-up of 41.8 months (range 5.9–108.1 months), no differences were observed in acute or late gastrointestinal and genitourinary toxicities of grade 2 or more between the two groups. The 3-year failure rates were 55.3% (95% CI 37.0–70.3%) in the s-IFRT group and 88.3% (95% CI 66.9–96.1%) in the s-EFRT group (p = 0.0094). In multivariate analysis of TTF, an interval of >5 years was significantly correlated with better outcomes (HR = 0.33, 95% CI 0.13–0.86, p = 0.023). There was a strong trend toward better outcomes with s-EFRT even after adjusting for concomitant androgen-deprivation therapy (HR = 0.38, 95% CI 0.12–1.27, p = 0.116).

Conclusion

FCH PET-positive node-targeted s-EFRT is feasible with low rates of toxicity and longer TTF, suggesting that oligorecurrent nodal disease diagnosed on FCH PET is unlikely.

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  • Accepted: Sep 5, 2018
  • Online: Sep 28, 2018

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