Joachim Chan1, Antony Carver1, John N H Brunt1, Sobhan Vinjamuri2, Isabel Syndikus1. 1. 1 Radiotherapy Department, Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, UK. 2. 2 Nuclear Medicine Department, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.
Abstract
OBJECTIVE: Prostate dose painting radiotherapy requires the accurate identification of dominant intraprostatic lesions (DILs) to be used as boost volumes; these can be identified on multiparametric MRI (mpMRI) or choline positron emission tomography (PET)/CT. Planning scans are usually performed after 2-3 months of androgen deprivation therapy (ADT). We examine the effect of ADT on choline tracer uptake and boost volumes identified on choline PET/CT. METHODS: Fluoroethylcholine (18F choline) PET/CT was performed for dose painting radiotherapy planning in patients with intermediate- to high-risk prostate cancer. Initially, they were performed at planning. Owing to low visual tracer uptake, PET/CT for subsequent patients was performed at staging. We compared these two approaches on intraprostatic lesions obtained on PET using both visual and automatic threshold methods [prostate maximum standardized uptake value (SUVmax) 60%] when compared with mpMRI. RESULTS: PET/CT was performed during ADT in 11 patients (median duration of 85 days) and before ADT in 29 patients. ADT significantly reduced overall prostate volume by 17%. During ADT, prostate SUVmax was lower although it did not reach statistical significance (4.2 vs 6.6, p = 0.06); three patients had no visually identifiable PET DIL; and visually defined PET DILs were significantly smaller than corresponding mpMRI DILs (p = 0.03). However, all patients scanned before ADT had at least one visually identifiable PET DIL, with no significant size difference between MRI and visually defined PET DILs. In both groups, threshold PET produced larger DILs than visual PET. Both PET methods have moderate sensitivity (0.50-0.68) and high specificity (0.85-0.98) for identifying MRI-defined disease. CONCLUSION: For visual contouring of boost volumes in prostate dose painting radiotherapy, 18F choline PET/CT should be performed before ADT. For threshold contouring of boost volumes using our PET/CT scanning protocol, threshold levels of above 60% prostate SUVmax may be more suitable. Additional use of PET with MRI for radiotherapy planning can significantly change the overall boost volumes compared with using MRI alone. Advances in knowledge: For prostate dose painting radiotherapy, the additional use of 18F choline PET with MRI can significantly change the overall boost volumes, and PET should be performed before hormone therapy, especially if boost volumes are visually identified.
OBJECTIVE: Prostate dose painting radiotherapy requires the accurate identification of dominant intraprostatic lesions (DILs) to be used as boost volumes; these can be identified on multiparametric MRI (mpMRI) or choline positron emission tomography (PET)/CT. Planning scans are usually performed after 2-3 months of androgen deprivation therapy (ADT). We examine the effect of ADT on choline tracer uptake and boost volumes identified on choline PET/CT. METHODS:Fluoroethylcholine (18F choline) PET/CT was performed for dose painting radiotherapy planning in patients with intermediate- to high-risk prostate cancer. Initially, they were performed at planning. Owing to low visual tracer uptake, PET/CT for subsequent patients was performed at staging. We compared these two approaches on intraprostatic lesions obtained on PET using both visual and automatic threshold methods [prostate maximum standardized uptake value (SUVmax) 60%] when compared with mpMRI. RESULTS: PET/CT was performed during ADT in 11 patients (median duration of 85 days) and before ADT in 29 patients. ADT significantly reduced overall prostate volume by 17%. During ADT, prostate SUVmax was lower although it did not reach statistical significance (4.2 vs 6.6, p = 0.06); three patients had no visually identifiable PET DIL; and visually defined PET DILs were significantly smaller than corresponding mpMRI DILs (p = 0.03). However, all patients scanned before ADT had at least one visually identifiable PET DIL, with no significant size difference between MRI and visually defined PET DILs. In both groups, threshold PET produced larger DILs than visual PET. Both PET methods have moderate sensitivity (0.50-0.68) and high specificity (0.85-0.98) for identifying MRI-defined disease. CONCLUSION: For visual contouring of boost volumes in prostate dose painting radiotherapy, 18F choline PET/CT should be performed before ADT. For threshold contouring of boost volumes using our PET/CT scanning protocol, threshold levels of above 60% prostate SUVmax may be more suitable. Additional use of PET with MRI for radiotherapy planning can significantly change the overall boost volumes compared with using MRI alone. Advances in knowledge: For prostate dose painting radiotherapy, the additional use of 18F choline PET with MRI can significantly change the overall boost volumes, and PET should be performed before hormone therapy, especially if boost volumes are visually identified.
Authors: Laura Van den Bergh; Michel Koole; Sofie Isebaert; Steven Joniau; Christophe M Deroose; Raymond Oyen; Evelyne Lerut; Tom Budiharto; Felix Mottaghy; Guy Bormans; Hendrik Van Poppel; Karin Haustermans Journal: Int J Radiat Oncol Biol Phys Date: 2012-01-26 Impact factor: 7.038
Authors: Markus Hartenbach; Sabrina Hartenbach; Winfried Bechtloff; Burkhardt Danz; Klaus Kraft; Burkhard Klemenz; Christoph Sparwasser; Marcus Hacker Journal: Clin Cancer Res Date: 2014-04-24 Impact factor: 12.531
Authors: Joe H Chang; Daryl Lim Joon; Sze Ting Lee; Sylvia J Gong; Andrew M Scott; Ian D Davis; David Clouston; Damien Bolton; Christopher S Hamilton; Vincent Khoo Journal: Radiother Oncol Date: 2011-05-18 Impact factor: 6.280
Authors: Martin Dolezel; Karel Odrazka; Miloslava Vaculikova; Jaroslav Vanasek; Jana Sefrova; Petr Paluska; Milan Zouhar; Jan Jansa; Zuzana Macingova; Lida Jarosova; Milos Brodak; Petr Moravek; Igor Hartmann Journal: Strahlenther Onkol Date: 2010-03-26 Impact factor: 3.621
Authors: Laura Evangelista; Alberto Briganti; Stefano Fanti; Stephen Joniau; Sven Reske; Riccardo Schiavina; Christian Stief; George N Thalmann; Maria Picchio Journal: Eur Urol Date: 2016-02-02 Impact factor: 20.096
Authors: Irene M Lips; Uulke A van der Heide; Karin Haustermans; Emile N J T van Lin; Floris Pos; Stefan P G Franken; Alexis N T J Kotte; Carla H van Gils; Marco van Vulpen Journal: Trials Date: 2011-12-05 Impact factor: 2.279
Authors: David P Dearnaley; Gordana Jovic; Isabel Syndikus; Vincent Khoo; Richard A Cowan; John D Graham; Edwin G Aird; David Bottomley; Robert A Huddart; Chakiath C Jose; John H L Matthews; Jeremy L Millar; Claire Murphy; J Martin Russell; Christopher D Scrase; Mahesh K B Parmar; Matthew R Sydes Journal: Lancet Oncol Date: 2014-02-26 Impact factor: 41.316