Top

European Journal of Nuclear Medicine and Molecular Imaging

Published in:

Open Access 01-01-2020 | Prostate Cancer | Original Article

[¹⁸F]Fluorocholine PET/CT-guided stereotactic body radiotherapy in patients with recurrent oligometastatic prostate cancer

Authors: Francesco Pasqualetti, Marco Panichi, Martina Sollini, Aldo Sainato, Luca Galli, Riccardo Morganti, Serena Chiacchio, Andrea Marciano, Roberta Zanca, Lorenzo Mannelli, Gabriele Coraggio, Andrea Sbrana, Paola Cocuzza, Sabrina Montrone, Davide Baldaccini, Alessandra Gonnelli, Alessandro Molinari, Martina Cantarella, Valentina Mazzotti, Sergio Ricci, Fabiola Paiar, Paola Anna Erba

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 1/2020

Abstract

Background

In the last years, functional imaging has given a significant contribution to the clinical decision-making of biochemically relapsed prostate cancer (PCa). Hereby, we present a prospective study aiming to validate the role of [¹⁸F]Fluoro-Methyl Choline ([¹⁸F]FMCH) PET/CT in the selection of PCa patients suitable for stereotactic body radiotherapy (SBRT).

Methods

Patients with biochemical recurrence limited up to three lesions revealed by [¹⁸F]FMCH PET/CT were enrolled in the present study and treated with SBRT on all active lesions. Systemic therapy-free survival since the [¹⁸F]FMCH PET/CT was considered as the primary endpoint.

Results

Forty-six patients were evaluated, and a total of 67 lesions were treated. After a median follow-up of 28.9 months, systemic therapy was started in 30 patients (65.2%) and median systemic therapy-free survival was 39.1 months (95% CI 6.5–68.6); 6, 12, and 24-month ratios were 93.5%, 73.9%, and 63.1%, respectively. At univariate Cox regression analysis, Delta PSA demonstrated an impact on systemic therapy-free survival (p < 0.001).

Conclusions

Based on our findings, [¹⁸F]FMCH PET/CT can identify oligometastatic prostate cancer patients suitable for SBRT, resulting in a systemic therapy-free survival of 39.1 months.

Mottet N, Bellmunt J, Bolla M, Briers E, Cumberbatch MG, De Santis M, et al. EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol. 2017;71:618–29. https://doi.org/10.1016/j.eururo.2016.08.003.CrossRefPubMed

Cornford P, Bellmunt J, Bolla M, Briers E, De Santis M, Gross T, et al. EAU-ESTRO-SIOG guidelines on prostate cancer. Part II: treatment of relapsing, metastatic, and castration-resistant prostate cancer. Eur Urol. 2017;71:630–42. https://doi.org/10.1016/j.eururo.2016.08.002.CrossRefPubMed

Mapelli P, Incerti E, Ceci F, Castellucci P, Fanti S, Picchio M. 11C- or 18F-choline PET/CT for imaging evaluation of biochemical recurrence of prostate cancer. J Nucl Med. 2016;57:43S–8S. https://doi.org/10.2967/jnumed.115.169755.CrossRefPubMed

Evangelista L, Zattoni F, Guttilla A, Saladini G, Zattoni F, Colletti PM, et al. Choline PET or PET/CT and biochemical relapse of prostate cancer: a systematic review and meta-analysis. Clin Nucl Med. 2013;38:305–14. https://doi.org/10.1097/RLU.0b013e3182867f3c.CrossRefPubMed

Pasqualetti F, Panichi M, Sainato A, Matteucci F, Galli L, Cocuzza P, et al. [(18)F]Choline PET/CT and stereotactic body radiotherapy on treatment decision making of oligometastatic prostate cancer patients: preliminary results. Radiat Oncol. 2016;11:9. https://doi.org/10.1186/s13014-016-0586-x.CrossRefPubMedPubMedCentral

Hellman S, Weichselbaum RR. Oligometastases. J Clin Oncol. 1995;13:8–10. https://doi.org/10.1200/JCO.1995.13.1.8.CrossRefPubMed

Pasqualetti F, Cocuzza P, Coraggio G, Ferrazza P, Derosa L, Galli L, et al. Long-term PSA control with repeated stereotactic body radiotherapy in a patient with oligometastatic castration-resistant prostate cancer. Oncol Res Treat. 2016;39:217–20. https://doi.org/10.1159/000444906.CrossRefPubMed

Berkovic P, De Meerleer G, Delrue L, Lambert B, Fonteyne V, Lumen N, et al. Salvage stereotactic body radiotherapy for patients with limited prostate cancer metastases: deferring androgen deprivation therapy. Clin Genitourin Cancer. 2013;11:27–32. https://doi.org/10.1016/j.clgc.2012.08.003.CrossRefPubMed

Khoo V. Is there another bite of the cherry? The case for radical local therapy for oligometastatic disease in prostate cancer. Eur Urol. 2016;69:13–4. https://doi.org/10.1016/j.eururo.2015.07.073.CrossRefPubMed

10.

Tree AC, Khoo VS, Eeles RA, Ahmed M, Dearnaley DP, Hawkins MA, et al. Stereotactic body radiotherapy for oligometastases. Lancet Oncol. 2013;14:e28–37. https://doi.org/10.1016/S1470-2045(12)70510-7.CrossRefPubMed

11.

Pasqualetti F, Panichi M, Sainato A, Baldaccini D, Cocuzza P, Gonnelli A, et al. Image-guided stereotactic body radiotherapy in metastatic prostate Cancer. Anticancer Res. 2018;38:3119–22. https://doi.org/10.21873/anticanres.12572.CrossRefPubMed

12.

Benedict SH, Yenice KM, Followill D, Galvin JM, Hinson W, Kavanagh B, et al. Stereotactic body radiation therapy: the report of AAPM Task Group 101. Med Phys. 2010;37:4078–101. https://doi.org/10.1118/1.3438081.CrossRefPubMed

13.

Franklin JM, Sharma RA, Harris AL, Gleeson FV. Imaging oligometastatic cancer before local treatment. Lancet Oncol. 2016;17:e406–14. https://doi.org/10.1016/S1470-2045(16)30277-7.CrossRefPubMed

14.

Triggiani L, Alongi F, Buglione M, Detti B, Santoni R, Bruni A, et al. Efficacy of stereotactic body radiotherapy in oligorecurrent and in oligoprogressive prostate cancer: new evidence from a multicentric study. Br J Cancer. 2017;116:1520–5. https://doi.org/10.1038/bjc.2017.103.CrossRefPubMedPubMedCentral

15.

Decaestecker K, De Meerleer G, Lambert B, Delrue L, Fonteyne V, Claeys T, et al. Repeated stereotactic body radiotherapy for oligometastatic prostate cancer recurrence. Radiat Oncol. 2014;9:135. https://doi.org/10.1186/1748-717X-9-135.CrossRefPubMedPubMedCentral

16.

Ost P, Bossi A, Decaestecker K, De Meerleer G, Giannarini G, Karnes RJ, et al. Metastasis-directed therapy of regional and distant recurrences after curative treatment of prostate cancer: a systematic review of the literature. Eur Urol. 2015;67:852–63. https://doi.org/10.1016/j.eururo.2014.09.004.CrossRefPubMed

17.

Calais J, Czernin J, Fendler WP, Elashoff D, Nickols NG. Randomized prospective phase III trial of (68)Ga-PSMA-11 PET/CT molecular imaging for prostate cancer salvage radiotherapy planning [PSMA-SRT]. BMC Cancer. 2019;19:18. https://doi.org/10.1186/s12885-018-5200-1.CrossRefPubMedPubMedCentral

18.

Schwenck J, Rempp H, Reischl G, Kruck S, Stenzl A, Nikolaou K, et al. Comparison of (68)Ga-labelled PSMA-11 and (11)C-choline in the detection of prostate cancer metastases by PET/CT. Eur J Nucl Med Mol Imaging. 2017;44:92–101. https://doi.org/10.1007/s00259-016-3490-6.CrossRefPubMed

19.

Bluemel C, Krebs M, Polat B, Linke F, Eiber M, Samnick S, et al. 68Ga-PSMA-PET/CT in patients with biochemical prostate cancer recurrence and negative 18F-choline-PET/CT. Clin Nucl Med. 2016;41:515–21. https://doi.org/10.1097/RLU.0000000000001197.CrossRefPubMedPubMedCentral

20.

Perera M, Papa N, Christidis D, Wetherell D, Hofman MS, Murphy DG, et al. Sensitivity, specificity, and predictors of positive. Eur Urol. 2016;70:926–37. https://doi.org/10.1016/j.eururo.2016.06.021.CrossRefPubMed

21.

Fendler WP, Eiber M, Beheshti M, Bomanji J, Ceci F, Cho S, et al. (68)Ga-PSMA PET/CT: joint EANM and SNMMI procedure guideline for prostate cancer imaging: version 1.0. Eur J Nucl Med Mol Imaging. 2017;44:1014–24. https://doi.org/10.1007/s00259-017-3670-z.CrossRefPubMed

22.

Henkenberens C, von Klot CA, Ross TL, Bengel FM, Wester HJ, Merseburger AS, et al. Ga-PSMA ligand PET/CT-based radiotherapy in locally recurrent and recurrent oligometastatic prostate cancer: early efficacy after primary therapy. Strahlenther Onkol. 2016;192(68):431–9. https://doi.org/10.1007/s00066-016-0982-z.CrossRefPubMed

23.

Guler OC, Engels B, Onal C, Everaert H, Van den Begin R, Gevaert T, et al. The feasibility of prostate-specific membrane antigen positron emission tomography(PSMA PET/CT)-guided radiotherapy in oligometastatic prostate cancer patients. Clin Transl Oncol. 2018;20:484–90. https://doi.org/10.1007/s12094-017-1736-9.CrossRefPubMed

24.

Savir-Baruch B, Zanoni L, Schuster DM. Imaging of prostate cancer using fluciclovine. Urol Clin North Am. 2018;45:489–502. https://doi.org/10.1016/j.ucl.2018.03.015.CrossRefPubMed

25.

Treglia G, Pereira Mestre R, Ferrari M, Bosetti DG, Pascale M, Oikonomou E, et al. Radiolabelled choline versus PSMA PET/CT in prostate cancer restaging: a meta-analysis. Am J Nucl Med Mol Imaging. 2019;9:127–39.PubMedPubMedCentral

26.

Slaoui A, Albisinni S, Aoun F, Assenmacher G, Al Hajj Obeid W, Diamand R, et al. A systematic review of contemporary management of oligometastatic prostate cancer: fighting a challenge or tilting at windmills? World J Urol. 2019. https://doi.org/10.1007/s00345-019-02652-7.CrossRefPubMed

27.

Triggiani L, Mazzola R, Magrini SM, Ingrosso G, Borghetti P, Trippa F, et al. Metastasis-directed stereotactic radiotherapy for oligoprogressive castration-resistant prostate cancer: a multicenter study. World J Urol. 2019. https://doi.org/10.1007/s00345-019-02717-7.CrossRefPubMed

28.

Tilki D, Reich O, Graser A, Hacker M, Silchinger J, Becker AJ, et al. 18F-Fluoroethylcholine PET/CT identifies lymph node metastasis in patients with prostate-specific antigen failure after radical prostatectomy but underestimates its extent. Eur Urol. 2013;63:792–6. https://doi.org/10.1016/j.eururo.2012.08.003.CrossRefPubMed

29.

Winter A, Henke RP, Wawroschek F. Targeted salvage lymphadenectomy in patients treated with radical prostatectomy with biochemical recurrence: complete biochemical response without adjuvant therapy in patients with low volume lymph node recurrence over a long-term follow-up. BMC Urol. 2015;15:10. https://doi.org/10.1186/s12894-015-0004-y.CrossRefPubMedPubMedCentral

30.

Giovacchini G, Picchio M, Coradeschi E, Bettinardi V, Gianolli L, Scattoni V, et al. Predictive factors of [(11)C]choline PET/CT in patients with biochemical failure after radical prostatectomy. Eur J Nucl Med Mol Imaging. 2010;37:301–9. https://doi.org/10.1007/s00259-009-1253-3.CrossRefPubMed

Title: [18F]Fluorocholine PET/CT-guided stereotactic body radiotherapy in patients with recurrent oligometastatic prostate cancer
Authors: Francesco Pasqualetti
Marco Panichi
Martina Sollini
Aldo Sainato
Luca Galli
Riccardo Morganti
Serena Chiacchio
Andrea Marciano
Roberta Zanca
Lorenzo Mannelli
Gabriele Coraggio
Andrea Sbrana
Paola Cocuzza
Sabrina Montrone
Davide Baldaccini
Alessandra Gonnelli
Alessandro Molinari
Martina Cantarella
Valentina Mazzotti
Sergio Ricci
Fabiola Paiar
Paola Anna Erba
Publication date: 01-01-2020
Publisher: Springer Berlin Heidelberg
Keywords: Prostate Cancer
Systemic Therapy
Prostate Cancer
Radiotherapy
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 1/2020
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-019-04482-6

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

[¹⁸F]Fluorocholine PET/CT-guided stereotactic body radiotherapy in patients with recurrent oligometastatic prostate cancer

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2020

18F-F13640 PET imaging of functional receptors in humans

Physiological 68Ga-RM2 uptake in patients with biochemically recurrent prostate cancer: an atlas of semi-quantitative measurements

Comparison of 18F-FDG PET/MRI, MRI, and 18F-FDG PET/CT for the detection of synchronous cancers and distant metastases in patients with oropharyngeal and hypopharyngeal squamous cell carcinoma

Duccio Volterrani, Paola Anna Erba, Ignasi Carrió, H. William Strauss, Giuliano Mariani. Nuclear Medicine Textbook Methodology and Clinical Application, 2 Volumes. Springer Nature Switzerland AG 2019, ISBN 978-3-319-95563-6

18F-FDG PET/CT in lung B lymphoid hyperplasia-type Castleman disease

Influence of androgen deprivation therapy on PSMA expression and PSMA-ligand PET imaging of prostate cancer patients