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Open Access 27-09-2024 | Radiotherapy | Original Article

Early and repetitive novel-tracer PET-guided stereotactic body radiotherapy for nodal oligorecurrent prostate cancer after definitive first-line therapy

Authors: Arne Grün, MD, Selin Cumaoglu, Anne Kluge, Prof. Thorsten Schlomm, MD, Dirk Böhmer, MD PhD, Prof. Kurt Miller, MD, Holger Heidenreich, MD, Prof. Daniel Zips, MD, Goda Kalinauskaite, MD

Published in: Strahlentherapie und Onkologie

Abstract

Background

Prostate-specific membrane antigen (PSMA) positron-emission tomography (PET) imaging can detect prostate cancer (PCa) nodal oligorecurrences (NOR) at very low prostate-specific antigen (PSA) levels. Prospective studies on oligorecurrent (OR) PCa have been hampered by either dated diagnostics or inhomogeneous cohorts and/or treatment approaches. We hypothesized that early and—if necessary and feasible—repetitive PSMA-PET-based metastasis-directed therapy (MDT) using stereotactic body radiotherapy (SBRT) would improve freedom from palliative (systemic) therapy at low toxicity.

Methods

This study is a retrospective analysis of patients treated for OR PCa after definitive first-line therapy using PSMA-PET/CT-based SBRT. Endpoints were biochemical progression-free survival (bPFS), SBRT-free survival (SBRT-FS), androgen deprivation therapy (ADT)-free survival (ADT-FS), and toxicity.

Results

A total of 67 patients and 248 metastases (211 nodal) were treated. Patients on concurrent ADT were excluded. Median PSA at inclusion was 2.175 ng/ml. bPFS, SBRT-FS, and ADT-FS for multiple-course SBRT were 9.5, 19.5, and 35.0 months, respectively; 32 patients had ≥ 1 course of SBRT. Median PSA nadir was 0.585 ng/ml. There was no ≥ grade 2 toxicity.

Conclusion

Modern-tracer PET/CT-based early and repetitive focal SBRT yields promising results with regard to bPFS, SBRT-FS, and ADT-FS with low toxicity. The ability of this approach to postpone initiation of palliative treatment with low toxicity should be re-evaluated prospectively.

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Title: Early and repetitive novel-tracer PET-guided stereotactic body radiotherapy for nodal oligorecurrent prostate cancer after definitive first-line therapy
Authors: Arne Grün, MD
Selin Cumaoglu
Anne Kluge
Prof. Thorsten Schlomm, MD
Dirk Böhmer, MD PhD
Prof. Kurt Miller, MD
Holger Heidenreich, MD
Prof. Daniel Zips, MD
Goda Kalinauskaite, MD
Publication date: 27-09-2024
Publisher: Springer Berlin Heidelberg
Keywords: Radiotherapy
Metastasis
Prostate Cancer
Prostate Cancer
Published in: Strahlentherapie und Onkologie
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-024-02304-9

Keynote webinar | Spotlight on modern management of frailty

Springer Medicine

Early and repetitive novel-tracer PET-guided stereotactic body radiotherapy for nodal oligorecurrent prostate cancer after definitive first-line therapy

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on modern management of frailty

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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