PMID- 37186452
OWN - NLM
STAT- MEDLINE
DCOM- 20230630
LR  - 20230630
IS  - 1754-9485 (Electronic)
IS  - 1754-9477 (Linking)
VI  - 67
IP  - 4
DP  - 2023 Jun
TI  - PSMA-PET-guided dose-escalated volumetric arc therapy for newly diagnosed lymph 
      node-positive prostate cancer: 5 Year outcomes following the FROGG and EviQ 
      node-positive guidelines.
PG  - 456-462
LID - 10.1111/1754-9485.13534 [doi]
AB  - INTRODUCTION: The Royal Australian and New Zealand College of Radiologists 
      (RANZCR) Faculty of Radiation Oncology Genitourinary Group (FROGG) guidelines and 
      online EviQ protocols incorporate prostate-specific membrane antigen (PSMA) 
      positron emission tomography (PET)-guided dose-escalated intensity-modulated 
      radiation therapy (DE-IMRT) for newly diagnosed lymph node (LN) positive prostate 
      cancer. We evaluated late toxicity and efficacy outcomes following the FROGG and 
      EviQ approach. METHODS: Patients with LN-positive-only metastases on PSMA-PET 
      imaging were offered curative therapy with 3 months neoadjuvant androgen 
      deprivation therapy (ADT) followed by DE-IMRT and 3 years adjuvant ADT. IMRT was 
      delivered via volumetric arc therapy (VMAT). We aimed to deliver 81 Gy in 45 
      fractions (Fx) to the prostate and PET-positive LNs, and 60 Gy in 45 Fx to 
      elective pelvic nodes, contoured using the PIVOTAL guidelines. RESULTS: 
      Forty-five patients were included. The median number of PET-positive nodes 
      boosted was 2 (range 1-6) and median boost volume 1.16 cc (range 0.15-4.14). 
      Seventeen (38%) patients had PET-positive nodes outside of PIVOTAL contouring 
      guidelines. With 60 months median follow-up, disease-free, metastasis-free, 
      prostate cancer-specific and overall survival were 88.1%, 95.3%, 100% and 91.5%. 
      There were no in-field nodal failures. Late grade 1, 2 and 3 gastrointestinal 
      toxicities occurred in 4%, 2% and 0% of patients, and genitourinary toxicity in 
      18%, 18% and 4%. Lower limb grade 2 lymphoedema occurred in three patients (7%). 
      CONCLUSION: Outcomes following FROGG guidelines and EviQ are promising, with high 
      long-term disease control and low toxicity. Contouring guidelines require 
      modification due to the high rate of PET-positive nodes demonstrated beyond 
      recommended coverage.
CI  - (c) 2023 Royal Australian and New Zealand College of Radiologists.
FAU - Yap, Shaun Zheng Liang
AU  - Yap SZL
AD  - Department of Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour 
      Health Campus, Coffs Harbour, New South Wales, Australia.
FAU - Armstrong, Shreya
AU  - Armstrong S
AD  - Department of Radiation Oncology, North Coast Cancer Institute, Lismore Base 
      Hospital, Lismore, New South Wales, Australia.
FAU - Aherne, Noel
AU  - Aherne N
AUID- ORCID: 0000-0003-4603-951X
AD  - Department of Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour 
      Health Campus, Coffs Harbour, New South Wales, Australia.
FAU - Shakespeare, Thomas Philip
AU  - Shakespeare TP
AD  - Department of Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour 
      Health Campus, Coffs Harbour, New South Wales, Australia.
LA  - eng
PT  - Journal Article
DEP - 20230426
PL  - Australia
TA  - J Med Imaging Radiat Oncol
JT  - Journal of medical imaging and radiation oncology
JID - 101469340
RN  - 0 (Androgen Antagonists)
SB  - IM
MH  - Male
MH  - Humans
MH  - *Prostatic Neoplasms/diagnostic imaging/radiotherapy
MH  - Androgen Antagonists
MH  - Australia
MH  - Positron-Emission Tomography/methods
MH  - Lymphatic Metastasis
MH  - Lymph Nodes
MH  - Positron Emission Tomography Computed Tomography
MH  - Retrospective Studies
OTO - NOTNLM
OT  - lymphatic system imaging
OT  - nuclear imaging
OT  - quality assurance
OT  - radiation oncology
EDAT- 2023/05/15 19:12
MHDA- 2023/06/30 06:42
CRDT- 2023/05/15 14:30
PHST- 2022/07/04 00:00 [received]
PHST- 2023/04/01 00:00 [accepted]
PHST- 2023/06/30 06:42 [medline]
PHST- 2023/05/15 19:12 [pubmed]
PHST- 2023/05/15 14:30 [entrez]
AID - 10.1111/1754-9485.13534 [doi]
PST - ppublish
SO  - J Med Imaging Radiat Oncol. 2023 Jun;67(4):456-462. doi: 10.1111/1754-9485.13534. 
      Epub 2023 Apr 26.