title: Intensity-modulated salvage radiotherapy with simultaneous integrated boost for local recurrence of prostate carcinoma: a pilot study on the place of PET-choline for guiding target volume delineation.
abstract: OBJECTIVE
  The aim of this study was to report the first cases of salvage radiotherapy (RT) using the intensity-modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB) targeted on choline positron emission tomography (PET) uptake in a local recurrent prostate cancer, after a radical prostatectomy.
  
  
  METHODS
  Four patients received salvage irradiation for biochemical relapse that occurred after the initial radical prostatectomy. The relapse occurred from 10 months to 6 years with PSA levels ranging from 2.35 to 4.86 ng ml(-1). For each patient, an (18)F-choline PET-CT showed a focal choline uptake in prostatic fossa, with standardized uptake value calculated on the basis of predicted lean body mass (SUL) max of 3.3-6.8. No involved lymph node or distant metastases were diagnosed. IMRT doses were of 62.7 Gy (1.9 Gy/fraction, 33 fractions), with a SIB of 69.3 Gy (2.1 Gy/fraction, 33 fractions) to a PET-guided target volume.
  
  
  RESULTS
  Acute toxicities were limited. We observed no gastrointestinal toxicity ≥grade 2 and only one grade 2 genitourinary toxicity. At 1-month follow-up evaluation, no complication and a decrease in PSA level (6.8-43.8% of the pre-therapeutic level) were reported. After 4 months, a decrease in PSA level was obtained for all the patients, ranging from 30% to 70%. At a median follow-up of 15 months, PSA level was controlled for all the patients, but one of them experienced a distant lymph node recurrence.
  
  
  CONCLUSIONS
  Salvage irradiation to the prostate bed with SIB guided by PET-CT is feasible, with biological efficacy and no major acute toxicity.
  
  
  CONCLUSIONS
  IMRT with PET-oriented SIB for salvage treatment of prostate cancer is possible, without major acute toxicity.
authors.affiliation: 1 Department of Radiotherapy, Institut de cancérologie de la Loire-Lucien Neuwirth, Saint-Priest en Jarez, France.|2 Department of Nuclear Medicine, Hôpital Nord, CHU de Saint Etienne, France.
authors.forename: Aurélien
authors.initials: A
authors.lastname: Wahart
authors.affiliation: 1 Department of Radiotherapy, Institut de cancérologie de la Loire-Lucien Neuwirth, Saint-Priest en Jarez, France.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Guy
authors.affiliation: 1 Department of Radiotherapy, Institut de cancérologie de la Loire-Lucien Neuwirth, Saint-Priest en Jarez, France.
authors.forename: Alexis
authors.initials: A
authors.lastname: Vallard
authors.affiliation: 3 Centre d'Imagerie Nucléaire, Hôpital Privé de la Loire, Saint Etienne, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Geissler
authors.affiliation: 1 Department of Radiotherapy, Institut de cancérologie de la Loire-Lucien Neuwirth, Saint-Priest en Jarez, France.
authors.forename: Majed
authors.initials: M
authors.lastname: Ben Mrad
authors.affiliation: 4 Department of Radiotherapy, Centre Antoine Lacassagne, Nice, France.
authors.forename: Alexander T
authors.initials: AT
authors.lastname: Falk
authors.affiliation: 2 Department of Nuclear Medicine, Hôpital Nord, CHU de Saint Etienne, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Prevot
authors.affiliation: 1 Department of Radiotherapy, Institut de cancérologie de la Loire-Lucien Neuwirth, Saint-Priest en Jarez, France.
authors.forename: Guy
authors.initials: G
authors.lastname: de Laroche
authors.affiliation: 1 Department of Radiotherapy, Institut de cancérologie de la Loire-Lucien Neuwirth, Saint-Priest en Jarez, France.
authors.forename: Chloé
authors.initials: C
authors.lastname: Rancoule
authors.affiliation: 5 Radiation Oncology, Hôpital d'Instruction des Armées du Val-de-Grâce, Paris, France.
authors.forename: Cyrus
authors.initials: C
authors.lastname: Chargari
authors.affiliation: 1 Department of Radiotherapy, Institut de cancérologie de la Loire-Lucien Neuwirth, Saint-Priest en Jarez, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Magné
mesh_terms: D000368:Aged; D002794:Choline; D006801:Humans; D008297:Male; D064847:Multimodal Imaging; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D010865:Pilot Projects; D049268:Positron-Emission Tomography; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy* / Q000601:surgery; D019275:Radiopharmaceuticals; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D016879:Salvage Therapy / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D017430:Prostate-Specific Antigen; D002794:Choline