PMID- 34772320
OWN - NLM
STAT- MEDLINE
DCOM- 20220121
LR  - 20220430
IS  - 1651-226X (Electronic)
IS  - 0284-186X (Linking)
VI  - 61
IP  - 1
DP  - 2022 Jan
TI  - Long-term outcome of biologically guided dose-escalated radiotherapy of localized 
      prostate cancer.
PG  - 97-103
LID - 10.1080/0284186X.2021.1998613 [doi]
AB  - BACKGROUND: Biologically created subvolumes enable non-uniform dose distributions 
      in prostate cancer radiotherapy (RT) thus potentially improving therapeutic ratio 
      and reducing toxicity. We present the long-term outcome of men receiving focal 
      boosting of carbon-11 acetate (ACE) PET-CT metabolically active areas in prostate 
      carcinoma. MATERIAL AND METHODS: Thirty men with hormone naive localized prostate 
      carcinoma underwent ACE PET/CT for RT planning. There were five low-, 17 
      intermediate-, and eight high-risk patients. Based on thresholding of the 
      standardized uptake values (SUVs) metabolic target volumes (MTVs) corresponding 
      to intraprostatic lesions (IPLs) were contoured. Two planning target volumes 
      (PTVs) were applied i.e., PTV(low-risk) for the whole prostate with 8-10 mm 
      margin and PTV(high-risk) for the MTV. Pelvic nodes were not irradiated. Late 
      toxicity of biologically guided RT was reviewed after a median of 63 months and 
      outcome after a median follow-up of 124 months. RESULTS: Median doses to 
      PTV(low-risk), PTV(high-risk,) prostate, and MTV were 72.9 Gy, 79.4 Gy, 76.6 Gy, 
      and 80.4 Gy, respectively, in 38 fractions. The 10-year cancer-specific survival 
      was 86% and the biochemical failure-free ratio 68%, respectively. The median 
      biochemical progression-free survival (PFS) was 37, 108, and 119 months in the 
      high, intermediate, and low-risk groups, respectively, the difference being 
      significant between high and intermediate-risk groups (p = 0.02). One patient 
      (3%) presented with locoregional and 5 (17%) with distant nodal metastases. Five 
      patients (17%) had a biochemical relapse. A larger MTV was associated with 
      shorter PFS (r = -0.41, p = 0.02), but had no influence on OS. No other 
      statistically significant differences in the dose painting parameters were 
      observed between recurrence-free and recurring patients. CONCLUSIONS: Biological 
      guidance for dose-escalated prostate RT is feasible with ACE PET/CT. Since a 
      larger MTV may be associated with a higher risk for progression, we encourage 
      further study of dose-escalation to ACE-positive lesions considering the low 
      toxicity of our protocol.
FAU - Kuisma, Anna
AU  - Kuisma A
AD  - Department of Oncology, Turku University Hospital, Turku, Finland.
FAU - Wright, Pauliina
AU  - Wright P
AD  - Department of Oncology, Turku University Hospital, Turku, Finland.
AD  - Department of Medical Physics, Turku University Hospital, Turku, Finland.
FAU - Suilamo, Sami
AU  - Suilamo S
AD  - Department of Oncology, Turku University Hospital, Turku, Finland.
AD  - Department of Medical Physics, Turku University Hospital, Turku, Finland.
FAU - Seppala, Jan
AU  - Seppala J
AD  - Cancer Center, Kuopio University Hospital, Turku, Finland.
FAU - Koivisto, Mari
AU  - Koivisto M
AD  - Department of biostatistics, University of Turku, Turku, Finland.
FAU - Lindholm, Paula
AU  - Lindholm P
AD  - Department of Oncology, Turku University Hospital, Turku, Finland.
FAU - Minn, Heikki
AU  - Minn H
AUID- ORCID: 0000-0002-5878-4333
AD  - Department of Oncology, Turku University Hospital, Turku, Finland.
AD  - Turku PET Centre, Turku University Hospital, University of Turku, Turku, Finland.
LA  - eng
PT  - Journal Article
DEP - 20211112
PL  - Sweden
TA  - Acta Oncol
JT  - Acta oncologica (Stockholm, Sweden)
JID - 8709065
SB  - IM
MH  - Humans
MH  - Lymph Nodes
MH  - Male
MH  - Positron Emission Tomography Computed Tomography
MH  - *Prostatic Neoplasms/radiotherapy
MH  - Radiotherapy Dosage
MH  - *Radiotherapy, Intensity-Modulated/adverse effects
OTO - NOTNLM
OT  - IMRT/radiotherapy
OT  - PET-CT
OT  - Prostate cancer
OT  - SIB
OT  - late-toxicity
EDAT- 2021/11/14 06:00
MHDA- 2022/01/22 06:00
CRDT- 2021/11/13 05:23
PHST- 2021/11/14 06:00 [pubmed]
PHST- 2022/01/22 06:00 [medline]
PHST- 2021/11/13 05:23 [entrez]
AID - 10.1080/0284186X.2021.1998613 [doi]
PST - ppublish
SO  - Acta Oncol. 2022 Jan;61(1):97-103. doi: 10.1080/0284186X.2021.1998613. Epub 2021 
      Nov 12.