Ashesh B Jani1, Eduard Schreibmann2, Peter J Rossi2, Joseph Shelton2, Karen Godette2, Peter Nieh3, Viraj A Master3, Omer Kucuk4, Mark Goodman5, Raghuveer Halkar5, Sherrie Cooper2, Zhengjia Chen6, David M Schuster5. 1. Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia abjani@emory.edu. 2. Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia. 3. Department of Urology, Emory University, Atlanta, Georgia. 4. Department of Hematology/Oncology, Emory University, Atlanta, Georgia. 5. Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia; and. 6. Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia.
Abstract
The purpose of this study was to evaluate the role of the synthetic amino acid PET radiotracer 18F-fluciclovine in modifying the defined clinical and treatment-planning target volumes in postprostatectomy patients undergoingsalvage radiotherapy and to evaluate the resulting dosimetric consequences to surrounding organs at risk. Methods:Ninety-six patients were enrolled in a randomized, prospective intention-to-treat clinical trial for potential salvage radiotherapy for recurrent prostate cancer after prostatectomy. The initial treatment plan was based on the results from conventional abdominopelvic CT and MRI. The 45 patients in the experimental arm also underwentabdominopelvic 18F-fluciclovine PET/CT, and the images were registered with the conventional images to determine whether the results would modify the initial treatment plan. The 51 patients in the control arm did not undergo 18F-fluciclovine PET/CT. For each patient, the clinical and treatment-planning target volumes that would have been treated before 18F-fluciclovine registration were compared with those after registration. For organs at risk (rectum, bladder, and penile bulb), the volumes receiving 40 Gy and 65 Gy before registration were compared with those after registration. Statistical comparisons were made using the paired t test. Acute genitourinary and gastrointestinal toxicity as defined by the Radiation Therapy Oncology Group was compared between the control and experimental arms using the χ2 test. Results: In 24 cases, radiotherapy was planned to a clinical target volume consisting of the prostate bed alone (CTV) (64.8-66.6 Gy). In 21 cases, radiotherapy was planned to a clinical target volume consisting of the pelvis (CTV1) (45.0 Gy) followed by a boost to the prostate bed (CTV2) (19.8-25.2 Gy). In each case, the respective treatment-planning target volume expansion (PTV, PTV1, or PTV2) was 0.8 cm (0.6 cm posterior). With the exception of PTV2, all postregistration volumes were significantly larger than the corresponding preregistration volumes. Analysis of the rectum, bladder, and penile bulb volumes receiving 40 Gy and 60 Gy demonstrated that only the penile bulb volumes were significantly higher after registration. No significant differences in acute genitourinary or gastrointestinal toxicity were observed. Conclusion: Including information from 18F-fluciclovine PET in the treatment-planning process led to significant differences in the defined target volume, with higher doses to the penile bulb but no significant differences in rectal or bladder dose or in acute genitourinary or gastrointestinal toxicity. Longer follow-up is needed to determine the impact of 18F-fluciclovine PET on cancer control and late toxicity endpoints.
RCT Entities:
The purpose of this study was to evaluate the role of the synthetic amino acid PET radiotracer 18F-fluciclovine in modifying the defined clinical and treatment-planning target volumes in postprostatectomy patients undergoing salvage radiotherapy and to evaluate the resulting dosimetric consequences to surrounding organs at risk. Methods: Ninety-six patients were enrolled in a randomized, prospective intention-to-treat clinical trial for potential salvage radiotherapy for recurrent prostate cancer after prostatectomy. The initial treatment plan was based on the results from conventional abdominopelvic CT and MRI. The 45 patients in the experimental arm also underwent abdominopelvic 18F-fluciclovine PET/CT, and the images were registered with the conventional images to determine whether the results would modify the initial treatment plan. The 51 patients in the control arm did not undergo 18F-fluciclovine PET/CT. For each patient, the clinical and treatment-planning target volumes that would have been treated before 18F-fluciclovine registration were compared with those after registration. For organs at risk (rectum, bladder, and penile bulb), the volumes receiving 40 Gy and 65 Gy before registration were compared with those after registration. Statistical comparisons were made using the paired t test. Acute genitourinary and gastrointestinal toxicity as defined by the Radiation Therapy Oncology Group was compared between the control and experimental arms using the χ2 test. Results: In 24 cases, radiotherapy was planned to a clinical target volume consisting of the prostate bed alone (CTV) (64.8-66.6 Gy). In 21 cases, radiotherapy was planned to a clinical target volume consisting of the pelvis (CTV1) (45.0 Gy) followed by a boost to the prostate bed (CTV2) (19.8-25.2 Gy). In each case, the respective treatment-planning target volume expansion (PTV, PTV1, or PTV2) was 0.8 cm (0.6 cm posterior). With the exception of PTV2, all postregistration volumes were significantly larger than the corresponding preregistration volumes. Analysis of the rectum, bladder, and penile bulb volumes receiving 40 Gy and 60 Gy demonstrated that only the penile bulb volumes were significantly higher after registration. No significant differences in acute genitourinary or gastrointestinal toxicity were observed. Conclusion: Including information from 18F-fluciclovine PET in the treatment-planning process led to significant differences in the defined target volume, with higher doses to the penile bulb but no significant differences in rectal or bladder dose or in acute genitourinary or gastrointestinal toxicity. Longer follow-up is needed to determine the impact of 18F-fluciclovine PET on cancer control and late toxicity endpoints.
Authors: David M Schuster; Bital Savir-Baruch; Peter T Nieh; Viraj A Master; Raghuveer K Halkar; Peter J Rossi; Melinda M Lewis; Jonathon A Nye; Weiping Yu; F DuBois Bowman; Mark M Goodman Journal: Radiology Date: 2011-04-14 Impact factor: 11.105
Authors: David M Schuster; John R Votaw; Peter T Nieh; Weiping Yu; Jonathon A Nye; Viraj Master; F DuBois Bowman; Muta M Issa; Mark M Goodman Journal: J Nucl Med Date: 2007-01 Impact factor: 10.057
Authors: Jeff M Michalski; Colleen Lawton; Issam El Naqa; Mark Ritter; Elizabeth O'Meara; Michael J Seider; W Robert Lee; Seth A Rosenthal; Thomas Pisansky; Charles Catton; Richard K Valicenti; Anthony L Zietman; Walter R Bosch; Howard Sandler; Mark K Buyyounouski; Cynthia Ménard Journal: Int J Radiat Oncol Biol Phys Date: 2009-04-23 Impact factor: 7.038
Authors: Andrew J Stephenson; Peter T Scardino; Michael W Kattan; Thomas M Pisansky; Kevin M Slawin; Eric A Klein; Mitchell S Anscher; Jeff M Michalski; Howard M Sandler; Daniel W Lin; Jeffrey D Forman; Michael J Zelefsky; Larry L Kestin; Claus G Roehrborn; Charles N Catton; Theodore L DeWeese; Stanley L Liauw; Richard K Valicenti; Deborah A Kuban; Alan Pollack Journal: J Clin Oncol Date: 2007-05-20 Impact factor: 44.544
Authors: Gregory P Swanson; Michael A Hussey; Catherine M Tangen; Joseph Chin; Edward Messing; Edith Canby-Hagino; Jeffrey D Forman; Ian M Thompson; E David Crawford Journal: J Clin Oncol Date: 2007-06-01 Impact factor: 44.544
Authors: Christopher J Kane; Christopher L Amling; Peter A S Johnstone; Nali Pak; Raymond S Lance; J Brantley Thrasher; John P Foley; Robert H Riffenburgh; Judd W Moul Journal: Urology Date: 2003-03 Impact factor: 2.649
Authors: S M Schwarzenböck; J Kurth; Ch Gocke; T Kuhnt; G Hildebrandt; B J Krause Journal: Eur J Nucl Med Mol Imaging Date: 2013-04-11 Impact factor: 9.236
Authors: Ashesh B Jani; Michael J Blend; Russell Hamilton; Charles Brendler; Charles Pelizzari; Lani Krauz; Bipin Sapra; Srinivasan Vijayakumar; Azhar Awan; Ralph R Weichselbaum Journal: J Nucl Med Date: 2004-08 Impact factor: 10.057
Authors: F Casas; I Valduvieco; G Oses; L Izquierdo; I Archila; M Costa; K S Cortes; T Barreto; F Ferrer Journal: Clin Transl Oncol Date: 2018-08-20 Impact factor: 3.405
Authors: Gerald L Andriole; Lale Kostakoglu; Albert Chau; Fenghai Duan; Umar Mahmood; David A Mankoff; David M Schuster; Barry A Siegel Journal: J Urol Date: 2019-02 Impact factor: 7.450
Authors: William L Hwang; Rahul D Tendulkar; Andrzej Niemierko; Shree Agrawal; Kevin L Stephans; Daniel E Spratt; Jason W Hearn; Bridget F Koontz; W Robert Lee; Jeff M Michalski; Thomas M Pisansky; Stanley L Liauw; Matthew C Abramowitz; Alan Pollack; Drew Moghanaki; Mitchell S Anscher; Robert B Den; Anthony L Zietman; Andrew J Stephenson; Jason A Efstathiou Journal: JAMA Oncol Date: 2018-05-10 Impact factor: 31.777
Authors: Ashesh B Jani; Eduard Schreibmann; Subir Goyal; Raghuveer Halkar; Bruce Hershatter; Peter J Rossi; Joseph W Shelton; Pretesh R Patel; Karen M Xu; Mark Goodman; Viraj A Master; Shreyas S Joshi; Omer Kucuk; Bradley C Carthon; Mehmet A Bilen; Olayinka A Abiodun-Ojo; Akinyemi A Akintayo; Vishal R Dhere; David M Schuster Journal: Lancet Date: 2021-05-07 Impact factor: 79.321
Authors: Olayinka A Abiodun-Ojo; Ashesh B Jani; Akinyemi A Akintayo; Oladunni O Akin-Akintayo; Oluwaseun A Odewole; Funmilayo I Tade; Shreyas S Joshi; Viraj A Master; Bridget Fielder; Raghuveer K Halkar; Chao Zhang; Subir Goyal; Mark M Goodman; David M Schuster Journal: J Nucl Med Date: 2021-01-30 Impact factor: 10.057
Authors: Samuel J Galgano; Andrew M McDonald; Soroush Rais-Bahrami; Kristin K Porter; Gagandeep Choudhary; Constantine Burgan; Pradeep Bhambhvani; Jeffrey W Nix; Desiree E Morgan; Yufeng Li; John V Thomas; Jonathan McConathy Journal: AJR Am J Roentgenol Date: 2020-10-14 Impact factor: 6.582