Toxicity and efficacy of salvage carbon 11-choline positron emission tomography/computed tomography-guided radiation therapy in patients with lymph node recurrence of prostate cancer.
To report the 3-year toxicity and outcomes of carbon 11 (11C)-choline-positron emission tomography (PET)/computed tomography (CT)-guided radiotherapy (RT), delivered via helical tomotherapy (HTT; Tomotherapy®Hi-Art II®Treatment System, Accuray Inc., Sunnyvale, CA, USA) after lymph node (LN) relapses in patients with prostate cancer.



From January 2005 to March 2013, 81 patients with biochemical recurrence after surgery, with or without adjuvant/salvage RT or radical RT, and with evidence of LN 11C-choline-PET/CT pathological uptake, underwent HTT (median [range] prostate-specific antigen level 2.59 [0.61-187] ng/mL). Of the 81 patients, 72 were treated at the pelvic and/or lumbar-aortic LN chain with HTT at 51.8 Gy/28 fr and with simultaneous integrated boost to a median dose of 65.5 Gy on the pathological uptake sites detected by 11C-choline-PET/CT. Nine patients were treated without simultaneous integrated boost (50-65.5 Gy, 25-30 fr).



With a median (range) follow-up of 36 (9-116) months, 91.4% of the patients had a PSA reduction 3 months after HTT. The 3-year overall, local relapse-free and clinical relapse-free survival rates were 80.0, 89.8 and 61.8%, respectively. The 3-year actuarial incidences of ≥grade 2 rectal and ≥grade 2 genitourinary toxicity were 6.6% (±2.9%) and 26.3% (±5.5%), respectively. A PSA nadir of ≥0.26 ng/mL (hazard ratio [HR] 3.6, 95% confidence interval [CI] 1.7-7.7; P = 0.001), extrapelvic 11C-choline-PET/CT-positive LN location (HR 2.4, 95% CI 0.9-6.4; P = 0.07), RT previous to HTT (HR 2.7; 95% CI 1.07-6.9, P = 0.04) and number of positive LNs (HR 1.13, 95% CI 1.04-1.22; P = 0.003) were the main predictors of clinical relapse after HTT.



11C-choline-PET/CT-guided HTT is safe and effective in the treatment of LN relapses of prostate cancer in previously treated patients.
Department of Radiation Oncology, San Raffaele Scientific Institute, Milan, Italy.
Andrei
A
Fodor
Department of Radiation Oncology, San Raffaele Scientific Institute, Milan, Italy.
Genoveffa
G
Berardi
Department of Medical Physics, San Raffaele Scientific Institute, Milan, Italy.
Claudio
C
Fiorino
Department of Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy.
Maria
M
Picchio
Department of Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy.
Elena
E
Busnardo
Nuclear Medicine, University Milano-Bicocca, Milan, Italy.
Margarita
M
Kirienko
Department of Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy.
Elena
E
Incerti
Department of Radiation Oncology, San Raffaele Scientific Institute, Milan, Italy.
Italo
I
Dell'Oca
Department of Radiation Oncology, San Raffaele Scientific Institute, Milan, Italy.
Cesare
C
Cozzarini
Department of Medical Physics, San Raffaele Scientific Institute, Milan, Italy.
Paola
P
Mangili
Department of Radiation Oncology, San Raffaele Scientific Institute, Milan, Italy.
Marcella
M
Pasetti
Department of Medical Physics, San Raffaele Scientific Institute, Milan, Italy.
Riccardo
R
Calandrino
Department of Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy.
Luigi
L
Gianolli
Department of Radiation Oncology, San Raffaele Scientific Institute, Milan, Italy.
Nadia G
NG
Di Muzio
D000368:Aged; D000369:Aged, 80 and over; D002794:Choline / Q000031:analogs & derivatives*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D000072078:Positron Emission Tomography Computed Tomography; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000532:radiotherapy*; D061089:Radiotherapy, Image-Guided; D050397:Radiotherapy, Intensity-Modulated; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods; D016896:Treatment Outcome
C447081:methyl carbon-11 choline; D002794:Choline
11C- Choline PET/CT; lymph node recurrence; prostate cancer; salvage radiation therapy