Intensity-modulated salvage radiotherapy with simultaneous integrated boost for local recurrence of prostate carcinoma: a pilot study on the place of PET-Choline for guiding target volume delineation.

The aim of this study was to report the first cases of salvage radiotherapy using the Intensity-Modulated Radiotherapy (IMRT) with Simultaneous Integrated Boost (SIB) targeted on choline PET uptake in a local recurrent prostate cancer, after a radical prostatectomy.

4 patients received salvage irradiation for biochemical relapse that occurred after the initial radical prostatectomy. The relapse occurred from 10 months to 6 years with PSA levels ranging from 2. 35 to 4. 86 ng/ml. For each patient, a (18)F-Choline PET-CT showed a focal choline uptake in prostatic fossa, with standardized uptake value calculated on the basis of predicted lean body mass (SUL) max of 3. 3-6. 8. No involved lymph node or distant metastases were diagnosed. IMRT doses were of 62. 7 Gy (1. 9 Gy/fraction, 33 fractions), with a SIB of 69. 3 Gy (2,1 Gy/fraction, 33 fractions) to a PET-guided target volume.

Acute toxicities were limited. We observed no gastrointestinal toxicity ≥grade 2 and only one grade 2 genitourinary toxicity. At one month follow-up evaluation, no complication and a decrease in PSA level (6. 8% to 43. 8% of the pre-therapeutic leve) were reported. After 4 months, a decrease in PSA level was obtained for all the patients, ranging from 30 to 70%. At a median follow up of 15 months, PSA level was controlled for all the patients, but one of them experienced a distant lymph node recurrence.

Salvage irradiation to the prostate bed with SIB guided by PET-CT is feasible, with biological efficacy and no major acute toxicity. Advance in knowledge: IMRT with PET oriented SIB for salvage treatment of prostate cancer is possible, without major acute toxicity.

The British journal of radiology. 2015 Dec 09 [Epub ahead of print]

Aurélien Wahart, Jean-Baptiste Guy, Alexis Vallard, Benjamin Geissler, Majed Ben Mrad, Alexander T Falk, Nathalie Prevot, Guy de Laroche, Chloé Rancoule, Cyrus Chargari, Nicolas Magné

1 Department of Radiotherapy, Institut de cancérologie de la Loire - Lucien Neuwirth, 108 bis, Avenue Albert Raimond, BP 60008, 42271 Saint-Priest en Jarez, France. , 1 Department of Radiotherapy, Institut de cancérologie de la Loire - Lucien Neuwirth, 108 bis, Avenue Albert Raimond, BP 60008, 42271 Saint-Priest en Jarez, France. , 1 Department of Radiotherapy, Institut de cancérologie de la Loire - Lucien Neuwirth, 108 bis, Avenue Albert Raimond, BP 60008, 42271 Saint-Priest en Jarez, France. , 3 Centre d'Imagerie Nucléaire, Hôpital Privé de la Loire, Saint Etienne, France. , 1 Department of Radiotherapy, Institut de cancérologie de la Loire - Lucien Neuwirth, 108 bis, Avenue Albert Raimond, BP 60008, 42271 Saint-Priest en Jarez, France. , 4 Department of Radiotherapy, Centre Antoine Lacassagne, Nice, France. , 2 Department of Nuclear Medicine, Hôpital Nord, CHU de Saint Etienne, France. , 1 Department of Radiotherapy, Institut de cancérologie de la Loire - Lucien Neuwirth, 108 bis, Avenue Albert Raimond, BP 60008, 42271 Saint-Priest en Jarez, France. , 1 Department of Radiotherapy, Institut de cancérologie de la Loire - Lucien Neuwirth, 108 bis, Avenue Albert Raimond, BP 60008, 42271 Saint-Priest en Jarez, France. , 5 Radiation Oncology, Hôpital d'Instruction des Armées du Val-de-Grâce, Paris, France. , 1 Department of Radiotherapy, Institut de cancérologie de la Loire - Lucien Neuwirth, 108 bis, Avenue Albert Raimond, BP 60008, 42271 Saint-Priest en Jarez, France.

PubMed