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68Ga-PSMA-PET/CT imaging of localized primary prostate cancer patients for intensity modulated radiation therapy treatment planning with integrated boost

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The purpose of our study was to show the feasibility and potential benefits of using 68Ga-PSMA-PET/CT imaging for radiation therapy treatment planning of patients with primary prostate cancer using either integrated boost on the PET-positive volume or localized treatment of the PET-positive volume. The potential gain of such an approach, the improvement of tumor control, and reduction of the dose to organs-at-risk at the same time was analyzed using the QUANTEC biological model.

Methods

Twenty-one prostate cancer patients (70 years average) without previous local therapy received 68Ga-PSMA-PET/CT imaging. Organs-at-risk and standard prostate target volumes were manually defined on the obtained datasets. A PET active volume (PTV_PET) was segmented with a 40% of the maximum activity uptake in the lesion as threshold followed by manual adaption. Five different treatment plan variations were calculated for each patient. Analysis of derived treatment plans was done according to QUANTEC with in-house developed software. Tumor control probability (TCP) and normal tissue complication probability (NTCP) was calculated for all plan variations.

Results

Comparing the conventional plans to the plans with integrated boost and plans just treating the PET-positive tumor volume, we found that TCP increased to (95.2 ± 0.5%) for an integrated boost with 75.6 Gy, (98.1 ± 0.3%) for an integrated boost with 80 Gy, (94.7 ± 0.8%) for treatment of PET-positive volume with 75 Gy, and to (99.4 ± 0.1%) for treating PET-positive volume with 95 Gy (all p < 0.0001). For the integrated boost with 80 Gy, a significant increase of the median NTCP of the rectum was found, for all other plans no statistical significant increase in the NTCP neither of the rectum nor the bladder was found.

Conclusions

Our study demonstrates that the use of 68Ga-PSMA-PET/CT image information allows for more individualized prostate treatment planning. TCP values of identified active tumor volumes were increased, while rectum and bladder NTCP values either remained the same or were even lower. However, further studies need to clarify the clinical benefit for the patients applying these techniques.

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References

  1. Lei JH, Liu LR, Wei Q, Yan SB, Song TR, Lin FS, et al. Systematic review and meta-analysis of the survival outcomes of first-line treatment options in high-risk prostate cancer. Sci Rep. 2014;5:7713.

    Article  CAS  Google Scholar 

  2. Ohri N, Dicker AP, Showalter TN. Late toxicity rates following definitive radiotherapy for prostate cancer. Can J Urol. 2012;19:6373–80.

    PubMed  PubMed Central  Google Scholar 

  3. Viani GA, Stefano EJ, Afonso SL. Higher-than-conventional radiation doses in localized prostate cancer treatment: a meta-analysis of randomized, controlled trials. Int J Radiat Oncol Biol Phys. 2009;74:1405–18.

    Article  PubMed  Google Scholar 

  4. Bentzen SM, Gregoire V. Molecular imaging-based dose painting: a novel paradigm for radiation therapy prescription. Semin Radiat Oncol. 2011;21:101–10.

    Article  PubMed  PubMed Central  Google Scholar 

  5. van Lin EN, Futterer JJ, Heijmink SW, van der Vight LP, Hoffmann AL, van Kollenburg P, et al. IMRT boost dose planning on dominant intraprostatic lesions: gold marker-based three-dimensional fusion of CT with dynamic contrast-enhanced and 1H-spectroscopic MRI. Int J Radiat Oncol Biol Phys. 2006;65:291–303.

    Article  PubMed  Google Scholar 

  6. Pinkawa M, Piroth MD, Holy R, Klotz J, Djukic V, Corral NE, et al. Dose-escalation using intensity-modulated radiotherapy for prostate cancer - evaluation of quality of life with and without (18)F-choline PET-CT detected simultaneous integrated boost. Radiat Oncol (London, England). 2012;7:14.

    Article  CAS  Google Scholar 

  7. Chang JH, Lim Joon D, Lee ST, Gong SJ, Anderson NJ, Scott AM, et al. Intensity modulated radiation therapy dose painting for localized prostate cancer using (1)(1)C-choline positron emission tomography scans. Int J Radiat Oncol Biol Phys. 2012;83:e691–6.

    Article  PubMed  Google Scholar 

  8. Feng Y, Welsh D, McDonald K, Carruthers L, Cheng K, Montgomery D, et al. Identifying the dominant prostate cancer focal lesion using image analysis and planning of a simultaneous integrated stereotactic boost. Acta Oncol (Stockholm, Sweden). 2015;54:1543–50.

    Article  Google Scholar 

  9. Bundschuh RA, Wendl CM, Weirich G, Eiber M, Souvatzoglou M, Treiber U, et al. Tumour volume delineation in prostate cancer assessed by [(11)C]choline PET/CT: validation with surgical specimens. Eur J Nucl Med Mol Imaging. 2013;40:824–31.

    Article  PubMed  Google Scholar 

  10. Wibmer AG, Burger IA, Sala E, Hricak H, Weber WA, Vargas HA. Molecular imaging of prostate cancer. Radiographics. 2016;36:142–59.

    Article  PubMed  Google Scholar 

  11. Eiber M, Maurer T, Souvatzoglou M, Beer AJ, Ruffani A, Haller B, et al. Evaluation of hybrid (6)(8)Ga-PSMA Ligand PET/CT in 248 patients with biochemical recurrence after radical prostatectomy. J Nucl Med. 2015;56:668–74.

    Article  PubMed  Google Scholar 

  12. Maurer T, Beer AJ, Wester HJ, Kubler H, Schwaiger M, Eiber M. Positron emission tomography/magnetic resonance imaging with 68gallium-labeled ligand of prostate-specific membrane antigen: promising novel option in prostate cancer imaging? Int J Urol. 2014;21:1286–8.

    Article  PubMed  CAS  Google Scholar 

  13. Maurer T, Gschwend JE, Rauscher I, Souvatzoglou M, Haller B, Weirich G, et al. Diagnostic Efficacy of Gallium-PSMA Positron Emission Tomography Compared to Conventional Imaging in Lymph Node Staging of 130 Consecutive Patients with Intermediate to High Risk Prostate Cancer. J Urol. 2015.

  14. Eiber M, Nekolla SG, Maurer T, Weirich G, Wester HJ, Schwaiger M. (68)Ga-PSMA PET/MR with multimodality image analysis for primary prostate cancer. Abdom Imaging. 2015;40:1769–71. https://doi.org/10.1007/s00261-014-0301-z.

    Article  PubMed  Google Scholar 

  15. Dewes S, Schiller K, Sauter K, Eiber M, Maurer T, Schwaiger M, et al. INtegration of (68)Ga-PSMA-PET imaging in planning of primary definitive radiotherapy in prostate cancer: a retrospective study. Radiat Oncol (London, England). 2016;11:73. https://doi.org/10.1186/s13014-016-0646-2.

  16. Giesel FL, Sterzing F, Schlemmer HP, Holland-Letz T, Mier W, Rius M, et al. Intra-individual comparison of (68)Ga-PSMA-11-PET/CT and multi-parametric MR for imaging of primary prostate cancer. Eur J Nucl Med Mol Imaging. 2016;43:1400–6. https://doi.org/10.1007/s00259-016-3346-0.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  17. Zamboglou C, Wieser G, Hennies S, Rempel I, Kirste S, Soschynski M, et al. MRI versus (6)(8)Ga-PSMA PET/CT for gross tumour volume delineation in radiation treatment planning of primary prostate cancer. Eur J Nucl Med Mol Imaging. 2016;43:889–97. https://doi.org/10.1007/s00259-015-3257-5.

    Article  PubMed  CAS  Google Scholar 

  18. Rahbar K, Weckesser M, Huss S, Semjonow A, Breyholz HJ, Schrader AJ, et al. Correlation of Intraprostatic tumor extent with Ga-68-PSMA distribution in patients with prostate cancer. J Nucl Med. 2016;57:563–7. https://doi.org/10.2967/jnumed.115.169243.

    Article  PubMed  CAS  Google Scholar 

  19. Zamboglou C, Schiller F, Fechter T, Drendel V, Mix M, Meyer PT, et al. A voxel-wise comparison of (68)ga-Hbed-CC-PSMA PET/CT versus histopathology in primary localized prostate cancer: implementations for radiation therapy treatment planning. Int J Radiat Oncol. 2016;96:E253–E4.

    Article  Google Scholar 

  20. Zschaeck S, Wust P, Beck M, Wlodarczyk W, Kaul D, Rogasch J, et al. Intermediate-term outcome after PSMA-PET guided high-dose radiotherapy of recurrent high-risk prostate cancer patients. Radiat Oncol (London, England). 2017;12:140.

    Article  Google Scholar 

  21. Gay HA, Niemierko A. A free program for calculating EUD-based NTCP and TCP in external beam radiotherapy. Phys Med. 2007;23:115–25. https://doi.org/10.1016/j.ejmp.2007.07.001.

    Article  PubMed  Google Scholar 

  22. Wu Q, Mohan R, Niemierko A, Schmidt-Ullrich R. Optimization of intensity-modulated radiotherapy plans based on the equivalent uniform dose. Int J Radiat Oncol Biol Phys. 2002;52:224–35.

    Article  PubMed  Google Scholar 

  23. Ahmed HU, Pendse D, Illing R, Allen C, van der Meulen JH, Emberton M. Will focal therapy become a standard of care for men with localized prostate cancer? Nat Clin Pract. 2007;4:632–42.

    Article  Google Scholar 

  24. Zamboglou C, Schiller F, Fechter T, Wieser G, Jilg CA, Chirindel A, et al. (68)Ga-HBED-CC-PSMA PET/CT versus histopathology in primary localized prostate cancer: a voxel-wise comparison. Theranostics. 2016;6:1619–28. https://doi.org/10.7150/thno.15344.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  25. Nestle U, Schaefer-Schuler A, Kremp S, Groeschel A, Hellwig D, Rube C, et al. Target volume definition for 18F-FDG PET-positive lymph nodes in radiotherapy of patients with non-small cell lung cancer. Eur J Nucl Med Mol Imaging. 2007;34:453–62.

    Article  PubMed  Google Scholar 

  26. Daisne JF, Duprez T, Weynand B, Lonneux M, Hamoir M, Reychler H, et al. Tumor volume in pharyngolaryngeal squamous cell carcinoma: comparison at CT, MR imaging, and FDG PET and validation with surgical specimen. Radiology. 2004;233:93–100.

    Article  PubMed  Google Scholar 

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Funding

This project was funded in part by the Deutsche Forschungsgemeinschaft (BU 3395/1–1).

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Authors and Affiliations

  1. Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany

    Lena Thomas, Florian C. Gaertner, Markus Essler & Ralph A. Bundschuh

  2. Department of Radiation Medicine, Oregon Health and Science University, Portland, OR, USA

    Lena Thomas, Arthur Hung & Debra Monaco

  3. LMU Munich, Department of Radiation Oncology, Munich, Germany

    Steffi Kantz

  4. Radiologische Klinik, Universitätsklinikum Bonn, Bonn, Germany

    Holger Strunk

  5. Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Wolfram Laub

Authors
  1. Lena Thomas
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  2. Steffi Kantz
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  3. Arthur Hung
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  4. Debra Monaco
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  5. Florian C. Gaertner
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  6. Markus Essler
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  7. Holger Strunk
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  8. Wolfram Laub
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  9. Ralph A. Bundschuh
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Corresponding author

Correspondence to Lena Thomas.

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Conflict of interest

RB has a research contract with Mediso GmbH Germany. Mediso GmbH Germany provided the Mediso Interview Fusion Tool for image analysis within this project. RB and ME are members of the advisory board of Bayer Healthcare, Leverkusen, Germany. All other authors declare that they have no conflicts of interest.

Ethical approval

Due to the retrospective character of the study, ethical approval was waived by the institutional ethics committee.

Informed consent

All patients gave written informed consent about the performed procedures and the fact that all data may be used for retrospective scientific analyses.

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Thomas, L., Kantz, S., Hung, A. et al. 68Ga-PSMA-PET/CT imaging of localized primary prostate cancer patients for intensity modulated radiation therapy treatment planning with integrated boost. Eur J Nucl Med Mol Imaging 45, 1170–1178 (2018). https://doi.org/10.1007/s00259-018-3954-y

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  • DOI: https://doi.org/10.1007/s00259-018-3954-y

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