M.Kirienko1; E.Incerti2; A.Fodor3; G.Berardi3; C.Fiorino4; E.Busnardo2; P.Mapelli2; R.Calandrino4; N.Di Muzio3; L.Gianolli2; M.

Transcription

1 Role of 11C-choline PET/CT as guide for hypofractionated helical tomotherapy and in predicting outcome in patients affected by lymph-node prostate cancer relapse M.Kirienko1; E.Incerti2; A.Fodor3; G.Berardi3; C.Fiorino4; E.Busnardo2; P.Mapelli2; R.Calandrino4; N.Di Muzio3; L.Gianolli2; M.Picchio2 1 University Milano-Bicocca, Milan, Italy 2 Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy 3 Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy 4 Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy

2 Disclosure Slide Il sottoscritto Margarita Kirienko DICHIARA X che, nell esercizio delle funzioni di Relatore, NON E in alcun modo portatore di interessi commerciali propri o di terzi; dichiara altresì che gli eventuali rapporti avuti negli ultimi due anni con soggetti portatori di interessi commerciali non sono tali da permettere a tali soggetti di influenzare le proprie funzioni al fine di trarne vantaggio; che negli ultimi due anni HA AVUTO i seguenti rapporti anche di finanziamento con soggetti portatori di interessi commerciali in campo sanitario (aziende farmaceutiche, biomedicali e di diagnostica):

3 Background Ch-PET/CT is considered appropriate for prostate cancer LN relapse The standard treatment of lymph nodal (LN) relapses of prostate cancer patients is hormonal therapy and chemotherapy or a combination of both Radiation treatments have been investigated for salvage treatments, using 11C or 18F-choline guidance Definitive results on Ch-PET/CT-guided intensity modulated radiation therapy (IMRT) for LN recurrences have not yet been reported in a large cohort of patients

4 Aim To evaluate the role of 11C-choline PET/CT as guide for hypofractionated helical tomotherapy in predicting outome in order to identify patients who are more likely to benefit from the treatment

5 Patients 81 patients; median follow-up 21.6 months (range 3-99) Age (years), at diagnosis Median (range) 63 (46-79) PSA at relapse (ng/ml) Median (range) 2.59 ( ) Gleason Median (range) 8 8 N.A. Adjuvant / salvage RT before HTT (pts) No Yes Adjuvant Prostate bed only Prostate bed + pelvic LNs Salvage Prostate bed only Prostate bed + pelvic LNs Systemic therapy before HTT No Yes HT HT + CHT 8 (4-10) 45 % 49 % 6 % % 71 % 87 % 13 %

6 PET/CT imaging All the patients underwent 11C-choline PET/CT prior to treatment Acquisition protocol Pts fasting for 6 hours ~ 370 MBq of 11C-Choline Discovery-STE, Discovery-ST, Discovery LS scanners (General Electric Medical System GEMS Milwaukee-Wisconsin-US) Scans acquired with the patients immobilized in radiotherapy treatment position ldct: automatic modulation of the tube current in a range of ma during shallow breathing, 3.75 mm slice thickness. No oral or intravenous contrast were administered to the

7 Treatment Simultaneous Integrated Boost Intensity-Modulated Radiotherapy (SIB-IMRT) guided by GTV defined on 11C-choline PET/CT images 72/81 pts were treated on pelvic and/or lombo-aortic LN chain, delivering 51.8 Gy/28fr + SIB of Gy/28fr on 11C-choline positive LNs 9/81 pts were treated delivering Gy/25-30fr without SIB 61 pts received concomitant hormonal therapy, in association with chemotherapy in 9/61 pts

8 a b Case Treatment plan c d e f 59-yr-old pt, affected by PCa relapse Gleason score 3+3, stage at prostatectomy pt3bn0r1 PSA at relapse ng/ml The whole LN chain received 51.8 Gy dose. SIB was delivered to the Choline PET/CT positive LNs which received 65.5 Gy.

9 Analysis Biochemical response rate, OS, LRFS, CRFS at 2 years were obtained. Clinical and imaging predictors of patient outcome were assessed with Cox univariate and multivariate analyses.

10 Results PSA reduction 3 months after treatment occurred - In 74/81 pts (91.4%) 80% in 48/81 pts (59.3%) 0.2 ng/ml in 40/81 pts (49.4%) 2-year OS % LRFS % CRFS 50%

11 Results Clinical relapse Univariate Multivariate Previous Radiotherapy 3.96 ( ) ( ) Extra-pelvic Choline positive LN location 4.68 ( ) ( ) PSA Nadir <0.1 ng/ml 0.24 ( ) ( ) 0.025

12 Results Death Univariate Multivariate Extra-pelvic Choline positive LN 13.6 ( ) ( ) location PSA Nadir <0.1 ng/ml 0.17 ( ) ( ) EQD2 69Gy 0.37 ( ) ( ) 0.099

13 Conclusions 11C-Choline PET/CT image guided tomotherapy is a valid treatment in lymph nodal relapses, providing a high rate of biochemical response with good clinical relapse free survival Choline positive LN location has a role in predicting patient outcome