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68Ga-PSMA ligand PET/CT-based radiotherapy in locally recurrent and recurrent oligometastatic prostate cancer

Early efficacy after primary therapy

68Ga-PSMA-PET/CT-basierte Strahlentherapie beim lokal rezidivierten und oligometastasierten Prostatakarzinom

Frühe Effektivität nach Primärtherapie

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Abstract

Purpose

The goal of this work was to evaluate the early efficacy of 68Ga-PSMA ligand PET/CT imaging for radiotherapy of locally recurrent and/or oligometastatic prostate cancer.

Patients and methods

A total of 29 patients with biochemical recurrence received a 68Ga-PSMA ligand PET/CT for restaging of disease, followed by 3D conformal radiotherapy of metastases or intensity-modulated radiation therapy of the prostate bed. Prostate-specific antigen (PSA) levels and imaging procedures served as the reference standard to assess the treatment efficacy.

Results

PET/CT was positive in 96.6% of patients and revealed that 13.8% of patients had locally recurrent disease, 58.6% had isolated lymph node metastases, 20.7% had isolated bone metastases, and 3.4% showed lymph node metastases and a vertebral metastasis. The median follow-up was 8.3 months (range 3.0–17.3 months). The median PSA prior to radiotherapy was 1.47 ng/ml (range 0.52–32.01 ng/ml) and showed a statistically significant decrease to 0.58 ng/ml (range < 0.07 to 6.33 ng/ml, p < 0.001). Two patients (6.8%) developed progressive disease outside the radiation field after 12.0 and 12.7 months, yielding a local control rate of 100% at the median follow-up. No grade III acute toxicity or late toxicity grade II was observed. Only 2 patients (6.8%) reported persisting grade I diarrhoea according to the LENT-SOMA criteria 3 months after radiotherapy. Deterioration of the urinary or faecal continence was not observed.

Conclusion

Preliminary results in the presented cohort suggest that radiotherapy based on 68Ga-PSMA ligand PET/CT yields effective local control and significant treatment response in terms of PSA levels in the absence of clinically important side effects. Furthermore, this approach delayed the necessity of androgen deprivation therapy or systemic therapy.

Zusammenfassung

Ziel

Beurteilt werden sollte die frühe Effektivität einer 68Ga-PSMA-Liganden-PET/CT-gestützten Strahlentherapie beim lokal rezidivierten und/oder oligometastasierten Prostatakarzinom.

Patienten und Methodik

Neunundzwanzig Patienten mit kontinuierlich steigenden PSA-Werten erhielten ein 68Ga-PSMA-Liganden-PET/CT zum Restaging, gefolgt von einer 3‑D-konformalen Strahlentherapie von Metastasen bzw. einer intensitätsmodulierten Strahlentherapie des Prostatabettes. PSA-Werte und Bildgebungsresultate dienten als Referenzstandard zur Beurteilung der frühen Effektivität.

Ergebnisse

Das PSMA-PET/CT zeigte bei 96,6% der Patienten eine pathologische Tracer-Bindung, 13,8% der Patienten hatten ein Lokalrezidiv der Prostataloge, 58,6% isolierte Lymphknotenmetastasen, 20,7% isolierte Knochenmetastasen und 3,4% pelvine Lymphknotenmetastasen sowie eine singuläre Wirbelkörpermetastase. Das mediane Follow-up betrug 8,3 Monate (Spannbreite 3,0–17,3). Der mediane PSA-Wert vor Strahlentherapie war 1,47 ng/ml (0,52–32,01) und ging statistisch signifikant zurück auf 0,58 ng/ml (<0,07–6,33; p < 0,001). Zwei Patienten (6,8%) zeigte nach 12,0 bzw. 12,7 Monaten einen Progress außerhalb des Bestrahlungsbereiches mit paraaortalen Lymphknotenmetastasen, sodass sich eine lokale Kontrollrate von 100% im medianen Follow-up-Zeitraum ergibt. Es wurden weder Akuttoxizitäten Grad III nach CTCAE noch Spättoxizitäten Grad II nach LENT-SOMA beobachtet. Zwei Patienten (6.8%) hatten 3 Monate nach Bestrahlung eine persistierende Diarrhö Grad I nach LENT-SOMA. Darüber hinaus trat bei keinem Patienten eine Verschlechterung der Harn- oder Stuhlkontinenz auf.

Schlussfolgerung

Nach 68Ga-PSMA-Liganden-PET/CT-basierter Strahlentherapie zeigten sich eine effektive lokale Kontrolle und ein signifikantes PSA-Ansprechen, klinisch relevanten Nebenwirkungen gab es nicht. Zudem wurde der Beginn einer antihormonellen bzw. systemischen Behandlung verzögert.

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Authors and Affiliations

  1. Department of Radiation and Special Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Christoph Henkenberens M.D. & Hans Christiansen M.D.

  2. Department of Urology and Urologic Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Christoph A. von Klot M.D.

  3. Department of Nuclear Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Tobias L. Ross Ph.D., Frank M. Bengel M.D. & Thorsten Derlin M.D.

  4. Pharmaceutical Radiochemistry, Technische Universität München, Walther-Meißner-Str. 3, 85748, Garching, Germany

    Hans-Jürgen Wester Ph.D.

  5. Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany

    Axel S. Merseburger M.D.

  6. Department of Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Jens Vogel-Claussen M.D.

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  1. Christoph Henkenberens M.D.
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Correspondence to Christoph Henkenberens M.D..

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Conflict of interest

H.-J. Wester is the CEO of Scintomics. C. Henkenberens, C.A. von Klot, T.L. Ross, F.M. Bengel, A.S. Merseburger, J. Vogel-Claussen, H. Christiansen, and T. Derlin state that there are no conflicts of interest.

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Henkenberens, C., von Klot, C.A., Ross, T.L. et al. 68Ga-PSMA ligand PET/CT-based radiotherapy in locally recurrent and recurrent oligometastatic prostate cancer. Strahlenther Onkol 192, 431–439 (2016). https://doi.org/10.1007/s00066-016-0982-z

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