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Open Access 01-12-2019 | Prostate Cancer | Research

NaF PET/CT for response assessment of prostate cancer bone metastases treated with single fraction stereotactic ablative body radiotherapy

Authors: Nicholas Hardcastle, Michael S. Hofman, Ching-Yu Lee, Jason Callahan, Lisa Selbie, Farshad Foroudi, Mark Shaw, Sarat Chander, Andrew Lim, Brent Chesson, Declan G. Murphy, Tomas Kron, Shankar Siva

Published in: Radiation Oncology | Issue 1/2019

Abstract

Introduction

In prostate cancer patients, imaging of bone metastases is enhanced through the use of sodium fluoride positron emission tomography (¹⁸F-NaF PET/CT). This imaging technique shows areas of enhanced osteoblastic activity and blood flow. In this work, ¹⁸F-NaF PET/CT was investigated for response assessment to single fraction stereotactic ablative body radiotherapy (SABR) to bone metastases in prostate cancer patients.

Methods

Patients with bone metastases in a prospective trial treated with single fraction SABR received a ¹⁸F-NaF PET/CT scan prior to and 6 months post-SABR. The SUV_max in the tumour was determined and the difference between before and after SABR determined. The change in uptake in the non-tumour bone was also measured as a function of the received SABR dose.

Results

Reduction in SUV_max was observed in 29 of 33 lesions 6 months after SABR (mean absolute decrease in SUV_max 17.7, 95% CI 25.8 to − 9.4, p = 0.0001). Of the three lesions with increased SUV_max post-SABR, two were from the same patient and located in the vertebral column. Both were determined to be local progression in addition to one fracture. The third lesion (in a rib) was shown to be controlled locally but suffered from a fracture at 24 months. Progression adjacent to the treated volume was observed in two patients. The non-tumour bone irradiated showed increased loss in uptake with increasing dose, with a median loss in uptake of 23.3% for bone receiving 24 Gy.

Conclusion

¹⁸F-NaF PET/CT for response assessment of bone metastases to single fraction SABR indicates high rates of reduction of osteoblastic activity in the tumour and non-tumour bone receiving high doses. The occurrence of marginal recurrence indicates use of larger clinical target volumes may be warranted in treatment of bone metastases.

Trial registration

POPSTAR, ‘Pilot Study of patients with Oligometastases from Prostate cancer treated with STereotactic Ablative Radiotherapy’, Universal Trial Number U1111-1140-7563, Registered 17th April 2013.

Available only for authorised users

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Title: NaF PET/CT for response assessment of prostate cancer bone metastases treated with single fraction stereotactic ablative body radiotherapy
Authors: Nicholas Hardcastle
Michael S. Hofman
Ching-Yu Lee
Jason Callahan
Lisa Selbie
Farshad Foroudi
Mark Shaw
Sarat Chander
Andrew Lim
Brent Chesson
Declan G. Murphy
Tomas Kron
Shankar Siva
Publication date: 01-12-2019
Publisher: BioMed Central
Keywords: Prostate Cancer
Metastasis
Prostate Cancer
Radiotherapy
Published in: Radiation Oncology / Issue 1/2019
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/s13014-019-1359-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

NaF PET/CT for response assessment of prostate cancer bone metastases treated with single fraction stereotactic ablative body radiotherapy

Abstract

Introduction

Methods

Results

Conclusion

Trial registration

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Trial registration

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