Dose-escalation using intensity-modulated radiotherapy for prostate cancer - evaluation of quality of life with and without 18F-choline PET-CT detected simultaneous integrated boost

Radiation Oncology

Michael J Eble²  Felix M Mottaghy¹  Thomas Krohn¹  Oliver H Winz¹  Mariana Caffaro²  Nuria Escobar Corral²  Victoria Djukic²  Jens Klotz²  Richard Holy²  Marc D Piroth²  Michael Pinkawa² 

[1] Department of Nuclear Medicine, RWTH Aachen University, Pauwelsstrasse 30, 52072 Aachen, Germany;Department of Radiation Oncology, RWTH Aachen University, Pauwelsstrasse 30, 52072 Aachen, Germany

关键词: quality of life;    choline PET;    simultaneous integrated boost;    intensity-modulated radiotherapy;    prostate cancer;   

Others  :  1160902
DOI  :  10.1186/1748-717X-7-14

 received in 2011-11-29, accepted in 2012-01-30,  发布年份 2012

【 摘 要 】

Background

In comparison to the conventional whole-prostate dose escalation, an integrated boost to the macroscopic malignant lesion might potentially improve tumor control rates without increasing toxicity. Quality of life after radiotherapy (RT) with vs. without ¹⁸F-choline PET-CT detected simultaneous integrated boost (SIB) was prospectively evaluated in this study.

Methods

Whole body image acquisition in supine patient position followed 1 h after injection of 178-355MBq ¹⁸F-choline. SIB was defined by a tumor-to-background uptake value ratio > 2 (GTV_PET). A dose of 76Gy was prescribed to the prostate (PTV_prostate) in 2Gy fractions, with or without SIB up to 80Gy. Patients treated with (n = 46) vs. without (n = 21) SIB were surveyed prospectively before (A), at the last day of RT (B) and a median time of two (C) and 19 month (D) after RT to compare QoL changes applying a validated questionnaire (EPIC - expanded prostate cancer index composite).

Results

With a median cut-off standard uptake value (SUV) of 3, a median GTV_PET of 4.0 cm³ and PTV_boost (GTV_PET with margins) of 17.3 cm³ was defined. No significant differences were found for patients treated with vs. without SIB regarding urinary and bowel QoL changes at times B, C and D (mean differences ≤3 points for all comparisons). Significantly decreasing acute urinary and bowel score changes (mean changes > 5 points in comparison to baseline level at time A) were found for patients with and without SIB. However, long-term urinary and bowel QoL (time D) did not differ relative to baseline levels - with mean urinary and bowel function score changes < 3 points in both groups (median changes = 0 points). Only sexual function scores decreased significantly (> 5 points) at time D.

Conclusions

Treatment planning with ¹⁸F-choline PET-CT allows a dose escalation to a macroscopic intraprostatic lesion without significantly increasing toxicity.

【 授权许可】

   
2012 Pinkawa et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Viani GA, Stefano EJ, Alfonso SL: Higher-than-conventional radiation doses in localized prostate cancer treatment: a meta-analysis of randomized, controlled trials. Int J Radiat Oncol Biol Phys 2009, 74:1405-1418.
• [2]Pinkawa M, Piroth MD, Fischedick K, Nussen S, Klotz J, Holy R, Eble MJ: Self-assessed bowel toxicity after external beam radiotherapy for prostate cancer--predictive factors on irritative symptoms, incontinence and rectal bleeding. Radiat Oncol 2009, 4:36. BioMed Central Full Text
• [3]Pinkawa M, Holy R, Piroth MD, Fischedick K, Schaar S, Székely-Orbànm Eble MJ: Consequential late effets after radiotherapy for prostate cancer - a prospective longitudianl quality of life study. Radiat Oncol 2010, 5:27. BioMed Central Full Text
• [4]Cellini N, Morganti AG, Mattiucci GC, Valentini V, Leone M, Luzi S, Manfredi R, Dinapoli N, Digesu C, Smaniotto D: Analysis of intraprostatic failures in patients treated with hormonal therapy and radiotherapy: implications for conformal therapy planning. Int J Radiat Oncol Biol Phys 2002, 53:595-599.
• [5]Chen ME, Johnston DA, Tang K, Babaian RJ, Troncoso P: Detailed mapping of prostate carcinoma foci: biopsy strategy implications. Cancer 2000, 89:1800-1809.
• [6]Farsad M, Schiavina R, Castellucci P, Nanni C, Corti B, Martorana G, Canini R, Grigioni W, Boschi S, Marengo M, Pettinato C, Salizzoni E, Monetti N, Franchi R, Fanti S: Detection and localization of prostate cancer: correlation of (11)C-choline PET/CT with histopathologic step-section analysis. J Nucl Med 2005, 46:1642-1649.
• [7]Kwee SA, Wei H, Sesterhenn I, Yun D, Coel MN: Localization of primary prostate cancer with dual-phase 18F-fluorocholine PET. J Nucl Med 2006, 47:262-269.
• [8]Pinkawa M, Attieh C, Piroth MD, Holy R, Nussen S, Klotz J, Hawickhorst R, Schäfer W, Eble MJ: Dose-escalation using intensity-modulated radiotherapy for prostate cancer--evaluation of the dose distribution with and without 18F-choline PET-CT detected simultaneous integrated boost. Radiother Oncol 2009, 93:213-219.
• [9]Pinkawa M, Pursch-Lee M, Asadpour B, Gagel B, Piroth MD, Klotz J, Nussen S, Eble MJ: Image-guided radiotherapy for prostate cancer. Implementation of ultrasound-based prostate localization for the analysis of inter- and intrafraction motion. Strahlenther Onkol 2008, 184:679-685.
• [10]Burman C, Kutcher GJ, Emami B, Goitein M: Fitting of normal tissue tolerance data to an analytic function. Int J Radiat Oncol Biol Phys 1991, 21:123-135.
• [11]Emami B, Lyman JT, Brown A, Coia L, Goitein M, Munzenrider JE, Shank B, Solin LJ, Wesson M: Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 1991, 21:109-122.
• [12]Wei JT, Dunn RL, Litwin MS, Sandler HM, Sanda MG: Development and validation of the expanded prostate cancer index composite (epic) for comprehensive assessment of health-related quality of life in men with prostate cancer. Urology 2000, 56:899-905.
• [13]Volz-Sidiropoulou E, Pinkawa M, Fischedick K, Jakse G, Gauggel S, Eble MJ: Factor analysis of the Expanded Prostate Cancer Index Composite (EPIC) in a patient group after primary (external beam radiotherapy and permanent iodine-125 brachytherapy) and postoperative radiotherapy for prostate cancer. Curr Urol 2008, 2:122-129.
• [14]Pinkawa M, Holy R, Piroth DM, Klotz J, Pfister D, Heidenreich A, Eble MJ: Interpreting the clinical significance of quality of life score changes after radiotherapy for localized prostate cancer. Curr Urol 2011, 5:137-144.
• [15]Pinkawa M, Eble MJ, Mottaghy FM: PET and PET/CT in radiation treatment planning for prostate cancer. Expert Rev Anticancer Ther 2011, 7:1035-1041.
• [16]Fonteyne V, Villeirs G, Speleers B, De Neve W, De Wagter C, Lumen N, De Meerleer G: Intensity-modulated radiotherapy as primary therapy for prostate cancer: report on acute toxicity after dose escalation with simultaneous integrated boost to intraprostatic lesion. Int J Radiat Oncol Biol Phys 2008, 72:799-807.
• [17]Rinnab L, Mottaghy FM, Blumstein NM, Resje SN, Hautmann RE, Hohl K, Möller P, Wiegel T, Kuefer R, Gschwend JE: Evaluation of [11C]-choline positron-emission/computed tomography in patients with increasing prostate-specific antigen levels after primary treatment for prostate cancer. BJU Int 2007, 100:786-93.
• [18]Emonds KM, Swinnen JV, Mortelmanns L, Mottaghy FM: Molecular imaging of prostate cancer. Methods 2009, 48:193-199.
• [19]Wang J, Bai S, Chen N, Xu F, Jiang X, Li Y, Xu Q, Shen Y, Zhang H, Gong Y, Zhong R, Jiang Q: The clinical feasibility of online cone beam computer tomography-guided intensity-modulated radiotherapy for nasopharyngeal cancer. Radiother Oncol 2009, 90:221-227.
• [20]Bartelink H, Horiot JC, Poortmans PM, Struikmans H, Van den Bogaert W, Fourquet A, Jager JJ, Hoogenraad WJ, Oei SB, Wárlám-Rodenhuis CC, Pierart M, Collette L: Impact of higher radiation dose on local control and survival after breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 trial. J Clin Oncol 2007, 25:3259-3265.
• [21]Pinkawa M, Holy R, Piroth DM, Klotz J, Nussen S, Krohn T, Mottaghy FM, Weibrecht M, Eble MJ: Intensity-modulated radiotherapy for prostate cancer implementing molecular imaging with 18F-choline PET-CT to define a simultaneous integrated boost. Strahlenther Onkol 2011, 186:600-606.
• [22]Sutinen E, Nurmi M, Roivainen A, Roivainen A, Varpula M, Tolvanen T, Lehikoinen P, Minn H: Kinetics of [(11)C]choline uptake in prostate cancer: a PET study. Eur J Nucl Med Mol Imaging 2004, 31:317-324.
• [23]Piert M, Park H, Khan A, Siddiqui J, Hussain H, Chenevert T, Wood D, Johnson T, Shah RB, Meyer C: Detection of aggressive primary prostate cancer with 11C-choline PET/CT using multimodality fusion techniques. J Nucl Med 2009, 50:1585-1593.
• [24]De Meerleer G, Villeirs G, Bral S, Paelinck L, De Gersem W, Dekuyper P, De Neve W: The magnetic resonance detected intraprostatic lesion in prostate cancer: planning and delivery of intensity-modulated radiotherapy. Radiother Oncol 2005, 75:325-333.