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Intensity-modulated radiotherapy of prostate cancer with simultaneous integrated boost after molecular imaging with 18F-choline-PET/CT

Clinical results and quality of life

Intensitätsmodulierte Radiotherapie des Prostatakarzinoms mit simultanem integriertem Boost nach molekularer Bildgebung mit 18F-Cholin-PET/CT

Klinische Ergebnisse und Lebensqualität

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Abstract

Purpose

To analyze clinical results and quality of life of patients with localized prostate cancer after irradiation of the prostate with an 18F-choline-PET/CT-based simultaneous integrated boost (SIB) in comparison to a control group without SIB.

Methods

A total of 134 patients underwent intensity-modulated radiotherapy from 2007–2010. All patients received a total dose of 76 Gy with 2 Gy fractions to the prostate; 67 patients received an additional SIB of 80 Gy. The median follow-up was 65 months. Quality of life was evaluated with the EPIC (Expanded Prostate Cancer Index Composite) questionnaire.

Results

Baseline characteristics were similar in both groups (prostate-specific antigen 11 ng/ml vs. 8 ng/ml, p = 0.20, Gleason score <6 in 36% vs. 46%, p = 0.22, with vs. without SIB). No prostate cancer-related death was observed. No significant difference of quality of life scores was found. The largest difference after 5–6 years in comparison to baseline was reported for sexual bother (mean 15 vs. 17 points with vs. without SIB). Mean urinary scores did not decrease. Bowel bother scores changes were larger in the SIB group (mean 5 vs. 2 points, dependent on SIB volume), with increased bowel problems (15 vs. 2% big/moderate problem with bowel movements, p = 0.03). However, a trend towards higher efficacy with SIB resulted (biochemical recurrence-free survival of 92% vs. 85%, p = 0.17).

Conclusions

The first long-term analysis of patients treated with SIB based on molecular imaging with 18-F-choline-PET/CT showed an excellent biochemical recurrence-free survival, but a larger percentage of bowel problems in comparison to the control group.

Zusammenfassung

Zielsetzung

Untersuchung der klinischen Ergebnisse und der Lebensqualität von Patienten mit lokal begrenztem Prostatakarzinom nach Bestrahlung mit simultan integriertem Boost (SIB) nach molekularer Bildgebung mit 18F-Cholin-PET/CT im Vergleich zu einer Kontrollgruppe ohne Boost.

Methoden

In den Jahren 2007–2010 erhielten 134 Patienten eine intensitätsmodulierte Radiotherapie beim Prostatakarzinom: alle Patienten mit einer Gesamtdosis von 76 Gy in 2‑Gy-Einzeldosen und 67 mit einem zusätzlichen SIB bis 80 Gy. Die mediane Nachbeobachtungszeit betrug 65 Monate. Die Lebensqualität wurde mit dem EPIC-Fragebogen (Expanded Prostata Cancer Index Composite) evaluiert.

Ergebnisse

Basisdaten der Patienten waren in beiden Gruppen ähnlich (prostataspezifsches Antigen im Mittel 11 ng/ml vs. 8 ng/ml, p = 0,20; Gleason-Score <6 in 36 % vs. 46 %, p = 0,22, mit vs. ohne SIB). Kein Patient verstarb am Prostatakarzinom. Die Veränderungen der Lebensqualitätsscores waren nicht signifikant unterschiedlich. Die größte Veränderung zwischen Beginn und nach 5–6 Jahren zeigte sich bei sexuellen Problemen (durchschnittlich 15 vs. 17 Punkte mit vs. ohne SIB). Der Miktionsscore verschlechterte sich im Mittel nicht. Belastungsscores für den Stuhlgang waren mit SIB größer (durchschnittlich 5 vs. 2 Punkte, abhängig vom SIB-Volumen), mit vermehrten abdominellen Beschwerden (15 vs. 2 % starke/moderate Beschwerden mit dem Stuhlgang; p = 0,03). Es zeigte sich jedoch ein Trend für eine bessere Tumorkontrolle mit SIB (biochemisch rezidivfreies Überleben von 92 % vs. 85 %; p = 0,17).

Schlussfolgerung

Die erste klinische Langzeitnachbeobachtung von Patienten, die mit SIB nach molekularer Bildgebung mit 18F-Cholin-PET/CT bestrahlt wurden, ergab eine hervorragende biochemische Kontrolle, jedoch mit vermehrter Häufigkeit abdomineller Beschwerden als in der Kontrollgruppe.

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Authors and Affiliations

  1. Department of Radiation Oncology, RWTH Aachen University, Pauwelsstr. 30, 52072, Aachen, Germany

    Marsha Schlenter, Vanessa Berneking, Barabara Krenkel, Michael J. Eble &  Michael Pinkawa

  2. Department of Nuclear Medicine, RWTH Aachen University, Pauwelsstr. 30, 52072, Aachen, Germany

    Felix M. Mottaghy

  3. Department of Urology, RWTH Aachen University, Pauwelsstr. 30, 52072, Aachen, Germany

    Thomas-Alexander Vögeli

  4. Department of Radiation Oncology, MediClin Robert Janker Klinik, Villenstr. 8, 53129, Bonn, Germany

    Vanessa Berneking &  Michael Pinkawa

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  1. Marsha Schlenter
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Correspondence to Michael Pinkawa.

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M. Schlenter, V. Berneking, B. Krenkel, F.M. Mottaghy, T.-A. Vögeli, M.J. Eble and M. Pinkawa declare that they have no competing interests.

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Schlenter, M., Berneking, V., Krenkel, B. et al. Intensity-modulated radiotherapy of prostate cancer with simultaneous integrated boost after molecular imaging with 18F-choline-PET/CT. Strahlenther Onkol 194, 638–645 (2018). https://doi.org/10.1007/s00066-018-1282-6

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