Nodal recurrence patterns on PET/CT after RTOG-based nodal radiotherapy for prostate cancer
Purpose: Biochemical failure after external beam radiotherapy (RT) for node-positive prostate cancer (PCN+) frequently involves nodal recurrences, in most cases out of field. This raises the question if current RTOG-based elective nodal fields can still be considered optimal. Modern diagnostic tools...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2020-05-01
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| Series: | Clinical and Translational Radiation Oncology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405630820300124 |
| _version_ | 1818827442523996160 |
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| author | C.P. Liskamp M.L. Donswijk H.G. van der Poel E.E. Schaake W.V. Vogel |
| author_facet | C.P. Liskamp M.L. Donswijk H.G. van der Poel E.E. Schaake W.V. Vogel |
| author_sort | C.P. Liskamp |
| collection | DOAJ |
| description | Purpose: Biochemical failure after external beam radiotherapy (RT) for node-positive prostate cancer (PCN+) frequently involves nodal recurrences, in most cases out of field. This raises the question if current RTOG-based elective nodal fields can still be considered optimal. Modern diagnostic tools like PSMA PET/CT and choline PET/CT can visualize nodal recurrences with unprecedented accuracy. We evaluated recurrence patterns on PET/CT after RT for PCN+, with the aim to explore options for improved nodal target definition. Methods and materials: Data of all patients treated with curative intent EBRT for PCN+ in NKI-AVL from 2008 to 2018 were retrospectively reviewed. EBRT comprised 70 Gy to the prostate or 66–70 Gy to the prostate bed, 60 Gy to involved nodes, and 52,5–56 Gy (46 Gy EQD2) to RTOG-based elective nodal fields, in 35 fractions. Locations of recurrences on PET/CT were noted, and nodal locations were correlated with the applied EBRT fields. Results: 42 patients received PSMA (28) or choline (14) PET/CT at biochemical recurrence. 35 patients (83%) had a positive scan. At their first positive scan 17 patients had nodal metastasis, in some cases together with a local recurrence or distant disease. In-field nodal recurrences were uncommon (n = 3). Out-field nodal recurrences occurred more frequently (n = 14), with the majority (n = 12) just above the elective nodal field. These nodes were the single area of detectable failure in 6 patients (14%). Conclusions: Current RT with RTOG-based nodal fields for PCN+ provides good in-field tumour control, but frequent out-field nodal recurrences suggest missed microscopic locations. Expanding elective fields to include the aorta bifurcation may prolong recurrence-free survival. Future research must address whether the potential benefits of this strategy outbalance additional toxicity. Keywords: Prostate cancer, Radiotherapy, PSMA PET/CT, Choline PET/CT, Recurrence patterns, Target definition |
| first_indexed | 2024-12-19T00:43:37Z |
| format | Article |
| id | doaj.art-8b6115b394634666b86bcb3309cc18c2 |
| institution | Directory Open Access Journal |
| issn | 2405-6308 |
| language | English |
| last_indexed | 2024-12-19T00:43:37Z |
| publishDate | 2020-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Clinical and Translational Radiation Oncology |
| spelling | doaj.art-8b6115b394634666b86bcb3309cc18c22022-12-21T20:44:24ZengElsevierClinical and Translational Radiation Oncology2405-63082020-05-0122914Nodal recurrence patterns on PET/CT after RTOG-based nodal radiotherapy for prostate cancerC.P. Liskamp0M.L. Donswijk1H.G. van der Poel2E.E. Schaake3W.V. Vogel4Department of Radiation Oncology, NKI-AVL, Amsterdam, The NetherlandsDepartment of Nuclear Medicine, NKI-AVL, Amsterdam, The NetherlandsDepartment of Urology, NKI-AVL, Amsterdam, The NetherlandsDepartment of Radiation Oncology, NKI-AVL, Amsterdam, The NetherlandsDepartment of Radiation Oncology, NKI-AVL, Amsterdam, The Netherlands; Department of Nuclear Medicine, NKI-AVL, Amsterdam, The Netherlands; Corresponding author at: Department of Nuclear Medicine, The Netherlands Cancer Institute – Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.Purpose: Biochemical failure after external beam radiotherapy (RT) for node-positive prostate cancer (PCN+) frequently involves nodal recurrences, in most cases out of field. This raises the question if current RTOG-based elective nodal fields can still be considered optimal. Modern diagnostic tools like PSMA PET/CT and choline PET/CT can visualize nodal recurrences with unprecedented accuracy. We evaluated recurrence patterns on PET/CT after RT for PCN+, with the aim to explore options for improved nodal target definition. Methods and materials: Data of all patients treated with curative intent EBRT for PCN+ in NKI-AVL from 2008 to 2018 were retrospectively reviewed. EBRT comprised 70 Gy to the prostate or 66–70 Gy to the prostate bed, 60 Gy to involved nodes, and 52,5–56 Gy (46 Gy EQD2) to RTOG-based elective nodal fields, in 35 fractions. Locations of recurrences on PET/CT were noted, and nodal locations were correlated with the applied EBRT fields. Results: 42 patients received PSMA (28) or choline (14) PET/CT at biochemical recurrence. 35 patients (83%) had a positive scan. At their first positive scan 17 patients had nodal metastasis, in some cases together with a local recurrence or distant disease. In-field nodal recurrences were uncommon (n = 3). Out-field nodal recurrences occurred more frequently (n = 14), with the majority (n = 12) just above the elective nodal field. These nodes were the single area of detectable failure in 6 patients (14%). Conclusions: Current RT with RTOG-based nodal fields for PCN+ provides good in-field tumour control, but frequent out-field nodal recurrences suggest missed microscopic locations. Expanding elective fields to include the aorta bifurcation may prolong recurrence-free survival. Future research must address whether the potential benefits of this strategy outbalance additional toxicity. Keywords: Prostate cancer, Radiotherapy, PSMA PET/CT, Choline PET/CT, Recurrence patterns, Target definitionhttp://www.sciencedirect.com/science/article/pii/S2405630820300124 |
| spellingShingle | C.P. Liskamp M.L. Donswijk H.G. van der Poel E.E. Schaake W.V. Vogel Nodal recurrence patterns on PET/CT after RTOG-based nodal radiotherapy for prostate cancer Clinical and Translational Radiation Oncology |
| title | Nodal recurrence patterns on PET/CT after RTOG-based nodal radiotherapy for prostate cancer |
| title_full | Nodal recurrence patterns on PET/CT after RTOG-based nodal radiotherapy for prostate cancer |
| title_fullStr | Nodal recurrence patterns on PET/CT after RTOG-based nodal radiotherapy for prostate cancer |
| title_full_unstemmed | Nodal recurrence patterns on PET/CT after RTOG-based nodal radiotherapy for prostate cancer |
| title_short | Nodal recurrence patterns on PET/CT after RTOG-based nodal radiotherapy for prostate cancer |
| title_sort | nodal recurrence patterns on pet ct after rtog based nodal radiotherapy for prostate cancer |
| url | http://www.sciencedirect.com/science/article/pii/S2405630820300124 |
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