title: PET/CT and MRI directed extended salvage radiotherapy in recurrent prostate cancer with lymph node metastases.
abstract: OBJECTIVE
  PET/CT directed extended salvage radiotherapy (esRT) of involved lymph-node (LN) regions may be a salvage strategy for patients with nodal recurrent prostate cancer (PCa) after primary therapy or after previous prostate fossa salvage RT. The aim of the study was to determine the time until prostate-specific antigen (PSA) progression, pattern of failure and toxicity after esRT.
  
  
  METHODS
  25 patients with nodal or nodal+local recurrent PCa confirmed by Choline-PET/CT and Magnetic Resonance Imaging (MRI) were treated with esRT at the sites of recurrence. Acute and late toxicity was recorded. In case of subsequent PSA progression, imaging was performed to confirm next relapse. Mean follow-up was 2.9 years.
  
  
  RESULTS
  According to Choline-PET/CT and MRI findings, 84% (21/25) of esRT were treatment of pelvic only, 12% (3/25) of retroperitoneal only and 4% (1/25) of both pelvic and retroperitoneal regions. 40% (10/25) received concomitant irradiation of the prostatic fossa (after primary radical prostatectomy). Median time to PSA progression of the whole cohort was 19.6 months. Median time to PSA progression for patients with 1-2 PET-positive LN (n=15) was 34.9 months versus median 12.7 months for patients with PET-positive LN≥3 (n=10), p-value: 0.0476. Acute and late toxicity was mild to moderate, no grade-3 adverse events were observed.
  
  
  CONCLUSIONS
  PET/CT and MRI directed esRT of nodal recurrent PCa with or without local recurrence is feasible with low acute and late toxicity. Patients with only one or two PET-positive LN treated by esRT achieved prolonged complete biochemical remission.
authors.affiliation: Department of Radiation Oncology, Albert-Ludwigs University Hospital of Freiburg, Freiburg, Germany; Department of Nuclear Medicine, Albert-Ludwigs University Hospital of Freiburg, Freiburg, Germany. Electronic address: hans.christian.rischke@uniklinik-freiburg.de.
authors.forename: Hans Christian
authors.initials: HC
authors.lastname: Rischke
authors.affiliation: Department of Radiation Oncology, Albert-Ludwigs University Hospital of Freiburg, Freiburg, Germany.
authors.forename: Ann-Kristin
authors.initials: AK
authors.lastname: Eiberger
authors.affiliation: Department of Radiation Oncology, Albert-Ludwigs University Hospital of Freiburg, Freiburg, Germany.
authors.forename: Natalja
authors.initials: N
authors.lastname: Volegova-Neher
authors.affiliation: Department of Radiation Oncology, Albert-Ludwigs University Hospital of Freiburg, Freiburg, Germany.
authors.forename: Karl
authors.initials: K
authors.lastname: Henne
authors.affiliation: Department of Radiology, Albert-Ludwigs University Hospital of Freiburg, Freiburg, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Krauss
authors.affiliation: Department of Radiation Oncology, Albert-Ludwigs University Hospital of Freiburg, Freiburg, Germany.
authors.forename: Anca-L
authors.initials: AL
authors.lastname: Grosu
authors.affiliation: Department of Urology, Albert-Ludwigs University Hospital of Freiburg, Freiburg, Germany.
authors.forename: Cordula A
authors.initials: CA
authors.lastname: Jilg
mesh_terms: D000368:Aged; D002794:Choline / Q000737:chemistry; D015331:Cohort Studies; D003287:Contrast Media; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D016879:Salvage Therapy; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D017430:Prostate-Specific Antigen; D002794:Choline
keywords: Choline PET; MRI; PET/CT; Prostate cancer recurrence; Salvage radiation therapy