F-choline positron emission tomography/computed tomography-driven high-dose salvage radiation therapy in patients with biochemical progression after radical prostatectomy: feasibility study in 60 patients

• Published in: International journal of radiation oncology, biology, physics Vol. 90; no. 2; pp. 296 - 302
• Main Authors: D'Angelillo, Rolando M, Sciuto, Rosa, Ramella, Sara, Papalia, Rocco, Jereczek-Fossa, Barbara A, Trodella, Luca E, Fiore, Michele, Gallucci, Michele, Maini, Carlo L, Trodella, Lucio
• Format: Journal Article
• Language: English
• Published: United States 01.10.2014
• Subjects: Aged; Aged, 80 and over; ANTIGENS; CHOLINE; Choline - analogs & derivatives; DIAGNOSIS; Disease Progression; FEASIBILITY STUDIES; FLUORINE 18; Fluorine Radioisotopes; Gastrointestinal Tract - radiation effects; Humans; Male; Middle Aged; Multimodal Imaging - methods; Neoplasm Recurrence, Local - blood; Neoplasm Recurrence, Local - diagnostic imaging; Neoplasm Recurrence, Local - radiotherapy; PATIENTS; POSITRON COMPUTED TOMOGRAPHY; Positron-Emission Tomography - methods; PROSTATE; Prostate-Specific Antigen - blood; Prostatectomy; Prostatic Neoplasms - blood; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - radiotherapy; Prostatic Neoplasms - surgery; RADIATION DOSES; RADIOLOGY AND NUCLEAR MEDICINE; RADIOTHERAPY; Radiotherapy Dosage; Radiotherapy, Image-Guided - methods; Retrospective Studies; REVIEWS; Salvage Therapy - adverse effects; Salvage Therapy - methods; Tomography, X-Ray Computed - methods; TOXICITY; Urogenital System - radiation effects
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2014.05.050

To retrospectively review data of a cohort of patients with biochemical progression after radical prostatectomy, treated according to a uniform institutional treatment policy, to evaluate toxicity and feasibility of high-dose salvage radiation therapy (80 Gy). Data on 60 patients with biochemical progression after radical prostatectomy between January 2009 and September 2011 were reviewed. The median value of prostate-specific antigen before radiation therapy was 0.9 ng/mL. All patients at time of diagnosis of biochemical recurrence underwent dynamic (18)F-choline positron emission tomography/computed tomography (PET/CT), which revealed in all cases a local recurrence. High-dose salvage radiation therapy was delivered up to total dose of 80 Gy to 18F-choline PET/CT-positive area. Toxicity was recorded according to the Common Terminology Criteria for Adverse Events, version 3.0, scale. Treatment was generally well tolerated: 54 patients (90%) completed salvage radiation therapy without any interruption. Gastrointestinal grade ≥2 acute toxicity was recorded in 6 patients (10%), whereas no patient experienced a grade ≥2 genitourinary toxicity. No grade 4 acute toxicity events were recorded. Only 1 patient (1.7%) experienced a grade 2 gastrointestinal late toxicity. With a mean follow-up of 31.2 months, 46 of 60 patients (76.6%) were free of recurrence. The 3-year biochemical progression-free survival rate was 72.5%. At early follow-up, (18)F-choline PET/CT-driven high-dose salvage radiation therapy seems to be feasible and well tolerated, with a low rate of toxicity.