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Ferumoxtran-10 MR Lymphography for Target Definition and Follow-up in a Patient Undergoing Image-Guided, Dose-Escalated Radiotherapy of Lymph Nodes upon PSA Relapse

Ferumoxtran-10-MR-Lymphographie zur Zieldefinition und Therapiekontrolle bei einem Patienten mit bildgeführter dosiseskalierter Strahlentherapie der Lymphknoten bei PSA-Rezidiv

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Abstract

Purpose:

Evaluation of the lymph node situation in patients with prostate cancer is essential for effective radiotherapy. Using magnet resonance imaging (MRI) of the lymph nodes with ferumoxtran-10 (MR lymphography), it is possible to detect lymph node metastasis. We present our initial experience with ferumoxtran-10 MR lymphography as the basis for image-guided, doseescalated lymph node radiotherapy and for early follow-up after radiotherapy.

Patients and Methods:

A patient with suspicion for lymph node metastasis after radical prostatectomy was examined with MR lymphography with the lymph node-specific contrast media ferumoxtran-10. Radiotherapy was performed as intensity-modulated radiotherapy with a total dose of 44 Gy to the whole lymphatic drainage, 60 Gy to the area of affected lymph nodes, 71 Gy to the prostate bed, and 75 Gy to the anastomosis region. 8 weeks after completion of radiotherapy, a follow-up MR lymphography with ferumoxtran-10 was performed.

Results:

In the first MRI with ferumoxtran-10, 5 metastatic lymph nodes were found in the iliac region. The scan 8 weeks postradiotherapy no longer showed lymph nodes suspicious for metastases. PSA (prostate-specific antigen) decreased from 2.06 ng/ml pretherapeutically to 0.02 ng/ml at 2 weeks after treatment and was no longer detectable at 8 months after treatment.

Conclusions:

Lymph node staging with ferumoxtran-10 and subsequent dose escalation with intensity-modulated radiotherapy led to the elimination of positive lymph nodes and a decrease in the PSA value.

Zusammenfassung

Ziel:

Die Evaluation des Lymphknotenstatus bei Patienten mit Prostatakarzinom ist für eine erfolgreiche Strahlentherapie notwendig. Eine Möglichkeit zur Erkennung von Lymphknotenmetastasen stellt die Magnetresonanztomographie der Lymphknoten mittels Ferumoxtran-10 dar. Wir stellen erste Erfahrungen mit Ferumoxtran-10 als Grundlage für eine bildgeführte Strahlentherapie der Lymphabflusswege vor.

Patienten und Methodik:

Ein Patient mit Verdacht auf Lymphknotenmetastasen nach radikaler Prostatektomie wurde mittels Magnetresonanztomographie der Lymphknoten mit dem lymphknotenspezifischen Kontrastmittel Ferumoxtran-10 untersucht (Tabelle 1). Eine Intensitäts-modulierte Strahlentherapie wurde mit folgender Gesamtdosis durchgeführt: 44 Gy gesamte Lymphabflusswege, 60 Gy metastatische Lymphknoten, 71 Gy Prostataloge und 75 Gy Anastomosenregion (Abbildung 2). 8 Wochen nach Beendigung der Strahlentherapie wurde eine erneute Magnetresonanztomographie der Lymphknoten zur Kontrolle durchgeführt.

Ergebnisse:

In der ersten Magnetresonanztomographie der Lymphkntoten zeigten sich 5 metastatische Lymphknoten iliakal (Abbildung 1a und 1b). In der Kontrolluntersuchung 8 Wochen nach Therapie konnten keine verdächtigen Lymphknoten mehr nachgewiesen werden (Abbildung 3a und 3b, Tabelle 2). Der PSA-Wert (prostataspezifisches Antigen) sank von 2,06 ng/ml vor Therapie auf 0,02 ng/ml 2 Wochen nach Therapie und war 8 Monate nach Therapie nicht mehr messbar.

Schlussfolgerung:

Die Intensitätsmodulierte Strahlentherapie mit gesteigerter Dosis auf Grundlage des Lymphknotenstaging mittels Ferumoxtran-10 führte zu einer Eliminierung metastatischer Lymphknoten und einem Absinken des PSA-Wertes.

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Authors and Affiliations

  1. Department of Clinical Radiology and Nuclear Medicine, University Medical Center, Mannheim, Germany

    Anja M. Weidner, Dietmar J. Dinter & Stefan O. Schoenberg

  2. Department of Radiation Oncology, University Medical Center, Nijmegen, The Netherlands

    Emile N. J. Th. van Lin & Tom Rozema

  3. Department of Radiation Oncology, University Medical Center, Mannheim, Germany

    Frederik Wenz & Frank Lohr

  4. Department of Radiology, University Medical Center, Nijmegen, The Netherlands

    Jelle O. Barentsz

  5. Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1–3, 68167, Mannheim, Germany

    Anja M. Weidner

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  1. Anja M. Weidner
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Correspondence to Anja M. Weidner.

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Weidner, A.M., van Lin, E.N.J.T., Dinter, D.J. et al. Ferumoxtran-10 MR Lymphography for Target Definition and Follow-up in a Patient Undergoing Image-Guided, Dose-Escalated Radiotherapy of Lymph Nodes upon PSA Relapse. Strahlenther Onkol 187, 206–212 (2011). https://doi.org/10.1007/s00066-010-2195-1

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  • DOI: https://doi.org/10.1007/s00066-010-2195-1

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