Ten-Year Outcomes: The Clinical Utility of Single Photon Emission Computed Tomography/Computed Tomography Capromab Pendetide (Prostascint) in a Cohort Diagnosed With Localized Prostate Cancer

• Published in: International journal of radiation oncology, biology, physics Vol. 81; no. 1; pp. 29 - 34
• Main Authors: Ellis, Rodney J., Kaminsky, Deborah A., Zhou, Esther H., Fu, Pingfu, Chen, Wei-Dong, Brelin, Alaina, Faulhaber, Peter F., Bodner, Donald
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.09.2011; Elsevier
• Subjects: Aged; Antibodies, Monoclonal; ANTIGENS; Biological and medical sciences; BODY; BRACHYTHERAPY; Brachytherapy - methods; Capromab pendetide; COMPUTERIZED TOMOGRAPHY; Contrast media. Radiopharmaceuticals; DIAGNOSTIC TECHNIQUES; Disease-Free Survival; DISEASES; DOSES; EMISSION COMPUTED TOMOGRAPHY; GLANDS; Gynecology. Andrology. Obstetrics; HAZARDS; Hematology, Oncology and Palliative Medicine; Humans; Image-guided radiotherapy; Indium Radioisotopes; Kaplan-Meier Estimate; Male; Male genital diseases; MALE GENITALS; MATHEMATICS; Medical sciences; MEDICINE; METASTASES; MULTIVARIATE ANALYSIS; NEOPLASMS; Nephrology. Urinary tract diseases; NUCLEAR MEDICINE; ORGANS; Pharmacology. Drug treatments; Prostascint; PROSTATE; Prostate - diagnostic imaging; Prostate-Specific Antigen - blood; Prostate-specific membrane antigen; Prostatic Neoplasms - blood; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology; RADIATION DOSES; RADIOLOGY; RADIOLOGY AND NUCLEAR MEDICINE; RADIOTHERAPY; Regression Analysis; SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY; Staging; STATISTICS; THERAPY; TOMOGRAPHY; Tomography, Emission-Computed, Single-Photon - methods; Tomography, X-Ray Computed - methods; Tumors; Tumors of the urinary system; Urinary tract. Prostate gland; Capromab pendetide; Image-guided radiotherapy; Staging; Prostascint; Prostate-specific membrane antigen; Radionuclide study; Prognosis; Prostate disease; Monoclonal antibody; Diagnosis; Urogenital system; Male genital diseases; Pendetide; Urinary system disease; Radiodiagnosis; Malignant tumor; Single photon emission tomography; Radiotherapy; Diagnostic agent; Guidance; Treatment; Medical imagery; Computerized axial tomography; Capromab; Prostate cancer; Prostate; Cancer
• ISSN: 0360-3016; 1879-355X; 1879-355X
• DOI: 10.1016/j.ijrobp.2010.05.053

To evaluate the clinical utility of capromab pendetide imaging with single photon emission computed tomography coregistration with computed tomography (SPECT/CT) in primary prostate cancer (CaP) for pretreatment prognostic staging and localization of biologic target volumes (BTV) for individualized image-guided radiotherapy dose escalation (IGRT-DE). Patients consecutively presenting for primary radiotherapy (February 1997 to December 2002), having a clinical diagnosis of localized CaP, were evaluated for tumor stage using conventional staging and SPECT/CT ( N = 239). Distant metastatic uptake (mets) were identified by SPECT/CT in 22 (9.2%). None of the suspected mets could be clinically confirmed. Thus, all subjects were followed without alteration in disease management. The SPECT/CT pelvic images defined BTV for IGRT-DE (+150% brachytherapy dose) without ( n = 150) or with ( n = 89) external radiation of 45 Gy. The National Comprehensive Cancer Network criteria defined risk groups (RG). The median survivor follow-up was 7 years. Biochemical disease-free survival (bDFS) was reported by clinical nadir +2 ng/mL (CN+2) criteria. Statistical analyses included Kaplan-Meier, multivariate analysis, and Concordance-index models. At 10-year analyses, overall survival was 84.8% and bDFS was 84.6%. With stratification by RG, CN+2 bDFS was 93.5% for the low-RG ( n = 116), 78.7% for the intermediate-RG ( n = 94), and 68.8% for the high-RG ( n = 29), p = 0.0002. With stratification by pretreatment SPECT/CT findings, bDFS was 65.5% in patients with suspected mets ( n = 22) vs. 86.6% in patients with only localized uptake ( n = 217), p = 0.0014. CaP disease-specific survival (DSS) was 97.7% for the cohort. With stratification by SPECT/CT findings, DSS was 86.4% (with suspected mets) vs. 99.0% (localized only), p = 0.0001. Using multivariate analysis, the DSS hazard ratio for SPECT/CT findings (mets vs. localized) was 3.58 ( p = 0.0026). Concordance-index tests, based on all data, by CN+2 bDFS criteria were 0.710 for RG alone and 0.773 for SPECT/CT + RG. Through long-term outcomes we demonstrate statistically significant bDFS and DSS predictive value for pretreatment capromab pendetide SPECT/CT imaging in primary CaP. Dual clinical utility is demonstrated, using SPECT/CT to define BTV for individualized IGRT-DE.