Optimizing treatment for Gleason 10 prostate cancer: radiation dose escalation and ⁶⁸Ga-PSMA-PET/CT staging.

IF 2.7 3区医学 Q3 ONCOLOGY

Strahlentherapie und Onkologie Pub Date : 2025-02-28 DOI:10.1007/s00066-025-02376-1

Cem Onal, Ozan Cem Guler, Birhan Demirhan, Petek Erpolat, Aysenur Elmali, Melek Yavuz

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引用次数: 0

Abstract

Purpose: This study aimed to investigate the effects of dose escalation through focal boost (FB) to intraprostatic lesions (IPLs) as well as the role of gallium-68 prostate-specific membrane antigen positron-emission tomography (⁶⁸Ga-PSMA-PET/CT) for staging and treatment planning in patients with Gleason score (GS) 10 prostate cancer (PCa) receiving definitive radiotherapy (RT) and androgen deprivation therapy (ADT).

Materials and methods: We retrospectively analyzed data of 92 patients with GS 10 PCa who underwent definitive RT and ADT from March 2010 to October 2022. Freedom from biochemical failure (FFBF), prostate cancer-specific survival (PCSS), distant metastasis-free survival (DMFS), and overall survival (OS) rates were calculated using the Kaplan-Meier method. Survival outcomes were compared between patients staged with ⁶⁸Ga-PSMA-PET/CT and those staged with conventional imaging modalities as well as between those who received a simultaneous integrated boost (SIB) and those who did not.

Results: At a median follow-up time of 73 months, the 5‑year FFBF, PCSS, DMFS, and OS rates were 59.2%, 77.0%, 62.9%, and 67.6%, respectively. Disease progression was observed in 39 patients (42.4%), with most cases manifesting as distant metastasis (DM). A total of 56 patients (60.9%) were staged using ⁶⁸Ga-PSMA-PET/CT, while 43 patients (46.7%) received FB to IPLs. Patients staged with ⁶⁸Ga-PSMA-PET/CT had better FFBF and PCSS compared to those staged with conventional imaging. Patients undergoing an SIB had improved PCSS and DMFS. In the multivariable analysis, an ADT duration of 18 months or more was associated with improved FFBF, PCSS, DMFS, and OS. Application of an SIB was an additional independent predictor for improved FFBF, while staging with ⁶⁸Ga-PSMA-PET/CT was associated with better PCSS.

Conclusion: We found that long-term ADT, increasing the radiation dose to primary tumor, and staging with ⁶⁸Ga-PSMA-PET/CT improved clinical outcomes. Additional research is needed for validation.

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目的：本研究旨在探讨通过对前列腺内病灶（IPL）进行病灶增强（FB）来提高剂量的效果，以及镓-68前列腺特异性膜抗原正电子发射断层扫描（68Ga-PSMA-PET/CT）在接受明确放疗（RT）和雄激素剥夺治疗（ADT）的格里森评分（GS）10分前列腺癌（PCa）患者的分期和治疗计划中的作用：我们回顾性分析了2010年3月至2022年10月期间接受确定性RT和ADT治疗的92例GS 10 PCa患者的数据。采用 Kaplan-Meier 法计算了生化失败率 (FFBF)、前列腺癌特异性生存率 (PCSS)、无远处转移生存率 (DMFS) 和总生存率 (OS)。比较了使用68Ga-PSMA-PET/CT分期的患者与使用传统成像模式分期的患者之间的生存结果，以及接受同步综合增强（SIB）的患者与未接受同步综合增强的患者之间的生存结果：中位随访时间为73个月，5年FFBF、PCSS、DMFS和OS率分别为59.2%、77.0%、62.9%和67.6%。39名患者（42.4%）出现了疾病进展，大多数病例表现为远处转移（DM）。共有 56 名患者（60.9%）使用 68Ga-PSMA-PET/CT 进行了分期，43 名患者（46.7%）接受了 FB 至 IPL。与使用传统成像技术分期的患者相比，使用 68Ga-PSMA-PET/CT 分期的患者的 FFBF 和 PCSS 更好。接受SIB的患者PCSS和DMFS均有所改善。在多变量分析中，ADT持续时间达到或超过18个月与FFBF、PCSS、DMFS和OS的改善有关。应用SIB是FFBF改善的另一个独立预测因素，而68Ga-PSMA-PET/CT分期与PCSS改善相关：我们发现，长期 ADT、增加原发肿瘤的放射剂量和 68Ga-PSMA-PET/CT 分期可改善临床预后。需要进一步研究验证。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Strahlentherapie und Onkologie 医学-核医学

CiteScore

5.70

自引率

12.90%

发文量

141

审稿时长

3-8 weeks

期刊介绍： Strahlentherapie und Onkologie, published monthly, is a scientific journal that covers all aspects of oncology with focus on radiooncology, radiation biology and radiation physics. The articles are not only of interest to radiooncologists but to all physicians interested in oncology, to radiation biologists and radiation physicists. The journal publishes original articles, review articles and case studies that are peer-reviewed. It includes scientific short communications as well as a literature review with annotated articles that inform the reader on new developments in the various disciplines concerned and hence allow for a sound overview on the latest results in radiooncology research. Founded in 1912, Strahlentherapie und Onkologie is the oldest oncological journal in the world. Today, contributions are published in English and German. All articles have English summaries and legends. The journal is the official publication of several scientific radiooncological societies and publishes the relevant communications of these societies.