Toxicity and efficacy of salvage carbon 11‐choline positron emission tomography/computed tomography‐guided radiation therapy in patients with lymph node recurrence of prostate cancer

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Abstract
Objective: To report the 3‐year toxicity and outcomes of carbon 11 (11C)‐choline‐positron emission tomography ( PET )/computed tomography ( CT )‐guided radiotherapy ( RT ), delivered via helical tomotherapy ( HTT ; Tomotherapy ® Hi‐Art II ® Treatment System, Accuray Inc., Sunnyvale, CA , USA ) after lymph node ( LN ) relapses in patients with prostate cancer. Patients and Methods: From January 2005 to March 2013, 81 patients with biochemical recurrence after surgery, with or without adjuvant/salvage RT or radical RT , and with evidence of LN 11C‐choline‐ PET / CT pathological uptake, underwent HTT (median [range] prostate‐specific antigen level 2.59 [0.61–187] ng/ mL ). Of the 81 patients, 72 were treated at the pelvic and/or lumbar‐aortic LN chain with HTT at 51.8 Gy/28 fr and with simultaneous integrated boost to a median dose of 65.5 Gy on the pathological uptake sites detected by 11C‐choline‐ PET / CT . Nine patients were treated without simultaneous integrated boost (50–65.5 Gy, 25–30 fr). Results: With a median (range) follow‐up of 36 (9–116) months, 91.4% of the patients had a PSA reduction 3 months after HTT . The 3‐year overall, local relapse‐free and clinical relapse‐free survival rates were 80.0, 89.8 and 61.8%, respectively. The 3‐year actuarial incidences of ≥grade 2 rectal and ≥grade 2 genitourinary toxicity were 6.6% (±2.9%) and 26.3% (±5.5%), respectively. A PSA nadir of ≥0.26 ng/ mL (hazard ratio [ HR ] 3.6, 95% confidence interval [ CI ] 1.7–7.7; P = 0.001), extrapelvic 11C‐choline‐ PET / CT ‐positive LN location ( HR 2.4, 95% CI 0.9–6.4; P = 0.07), RT previous to HTT ( HR 2.7; 95% CI 1.07–6.9, P = 0.04) and number of positive LN s ( HR 1.13, 95% CI 1.04–1.22; P = 0.003) were the main predictors of clinical relapse after HTT . Conclusions: 11C‐choline‐ PET / CT ‐guided HTT is safe and effective in the treatment of LN relapses of prostate cancer in previously treated patients.

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