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Radiation Oncology
Published in: Radiation Oncology 1/2018

Open Access 01-12-2018 | Research

The dose distribution in dominant intraprostatic tumour lesions defined by multiparametric MRI and PSMA PET/CT correlates with the outcome in patients treated with primary radiation therapy for prostate cancer

Authors: Constantinos Zamboglou, Christina Marie Klein, Benedikt Thomann, Thomas Franz Fassbender, Hans C. Rischke, Simon Kirste, Karl Henne, Natalja Volegova-Neher, Michael Bock, Mathias Langer, Philipp T. Meyer, Dimos Baltas, Anca L. Grosu

Published in: Radiation Oncology | Issue 1/2018

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Abstract

Background

We hypothesized that dominant intraprostatic lesions (DILs) could be depictured by multimodal imaging techniques (MRI and/or PSMA PET/CT) in patients with primary prostate cancer (PCa) and investigated possible effects of radiotherapy (RT) dose distribution within the DILs on the patients’ outcome.

Methods

One hundred thirty-eight patients with localized prostate cancer (PCa) and visible DIL underwent primary external beam RT between 2008 and 2016 with an aimed prescription dose of 76 Gy to the whole prostate. Seventy-five patients (54%) additionally received androgen deprivation therapy. Three volumes were retrospectively generated: DIL using pretreatment MRI and/or PSMA PET/CT, prostatic gland (PG) and the subtraction between PG and DIL (SPG). The minimum dose (Dmin), maximum dose (Dmax) and mean dose (Dmean) in the three respective volumes were calculated. Biochemical recurrence free survival (BRFS) was considered in uni- and multivariate Cox regression analyses. An explorative analysis was performed to determine cut-off values for the three dose parameters in the three respective volumes.

Results

With a median follow-up of 45 months (14–116 months) 15.9% of patients experienced BR. Dmin (cut-off: 70.6 Gy, HR = 0.39, p = 0.036) applied to the DIL had an impact on BRFS in multivariate analysis, in contrast to the Dmin delivered to PG and SPG which had no significant impact (p > 0.05). Dmin was significantly (p < 0.004) lower in patients with BR than in patients without BR. Dmax within DIL-imaging (cut-off: 75.8 Gy, HR = 0.31, p = 0.009) and in both PG und SPG (cut-off: 76 Gy, HR = 0.32, p = 0.009) had a significant impact on the BRFS. 95% of patients with a Dmax ≥76 Gy in SPG had a Dmin ≥70.6 Gy in DIL-imaging. Dmean in all of the three volumes had no significant impact on BRFS (p > 0.05).

Conclusions

The dose distribution within DILs defined by PSMA PET/CT and/or MRI is an independent risk factor for BR after primary RT in patients with PCa. These findings support the implementation of imaging based DIL interpretation for RT treatment planning, although further validation in larger patient cohorts with longer follow-up is needed.
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Metadata
Title
The dose distribution in dominant intraprostatic tumour lesions defined by multiparametric MRI and PSMA PET/CT correlates with the outcome in patients treated with primary radiation therapy for prostate cancer
Authors
Constantinos Zamboglou
Christina Marie Klein
Benedikt Thomann
Thomas Franz Fassbender
Hans C. Rischke
Simon Kirste
Karl Henne
Natalja Volegova-Neher
Michael Bock
Mathias Langer
Philipp T. Meyer
Dimos Baltas
Anca L. Grosu
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2018
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-018-1014-1

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