Colin Belliveau, Mustafa-Karim Benhacene-Boudam, Daniel Juneau, Nicolas Plouznikoff, Damien Olivié, Stephanie Alley, Maroie Barkati, Guila Delouya, Daniel Taussky, Carole Lambert, Marie-Claude Beauchemin, Cynthia Ménard
{"title":"F18-DCFPyL PSMA-PET/CT与MRI：确定放射治疗中肿瘤剂量增加复发风险最高的前列腺癌区域","authors":"Colin Belliveau, Mustafa-Karim Benhacene-Boudam, Daniel Juneau, Nicolas Plouznikoff, Damien Olivié, Stephanie Alley, Maroie Barkati, Guila Delouya, Daniel Taussky, Carole Lambert, Marie-Claude Beauchemin, Cynthia Ménard","doi":"10.1016/j.prro.2024.09.017","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Local recurrence of prostate cancer (PCa) after radiation therapy (RT) typically occurs at the site of dominant tumor burden, and recent evidence confirms that magnetic resonance imaging (MRI) guided tumor dose escalation improves outcomes. With the emergence of prostate-specific membrane antigen (PSMA) positron emission tomography (PET), we hypothesize that PSMA-PET and MRI may not equally depict the region most at risk of recurrence after RT.</p><p><strong>Methods and materials: </strong>Patients with intermediate- to high-risk PCa and MRI plus PSMA-PET performed before RT were identified. The sextant most at risk of recurrence was defined as the pathologically dominant region with peak biopsy percentage core length involvement and any sextant with ≥ 40% percentage core length involvement (pathologic gross tumor volume [pGTV], per prior work). Imaging methods were reviewed independently to compare GTVs with pGTVs most at risk of recurrence. A paired chi-square test was employed for analysis.</p><p><strong>Results: </strong>Eighty-eight patients (n = 88) were identified. Overall, there were no differences in the sensitivity of MRI and PSMA-PET for identifying the pGTV most at risk of recurrence. However, PSMA-PET demonstrated a trend of improved sensitivity for high-risk PCa compared with MRI (n = 46, 96% vs 87%, P = .06), while MRI outperformed PSMA-PET for the intermediate-risk group (n = 42, 93% vs 81%, P = .03). PSMA-PET showed lower specificity, misidentifying GTV in uninvolved pathologic sextants for 12% of intermediate-risk patients, whereas MRI was faultless (12% vs 0%, P = .03). MRI and PSMA-PET each misidentified uninvolved sextants for 9% of patients in the high-risk group.</p><p><strong>Conclusions: </strong>MRI demonstrates superior sensitivity in identifying the region most at risk of RT recurrence for intermediate-risk PCa, whereas PSMA-PET may add value for some high-risk patients. Informed by sextant biopsy information and MRI, clinicians should consider integrating PSMA-PET for patients with high-risk diseases when delineating GTVs.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4000,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"F<sup>18</sup>-DCFPyL PSMA-PET/CT Versus MRI: Identifying the Prostate Cancer Region Most at Risk of Radiation Therapy Recurrence for Tumor Dose Escalation.\",\"authors\":\"Colin Belliveau, Mustafa-Karim Benhacene-Boudam, Daniel Juneau, Nicolas Plouznikoff, Damien Olivié, Stephanie Alley, Maroie Barkati, Guila Delouya, Daniel Taussky, Carole Lambert, Marie-Claude Beauchemin, Cynthia Ménard\",\"doi\":\"10.1016/j.prro.2024.09.017\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Local recurrence of prostate cancer (PCa) after radiation therapy (RT) typically occurs at the site of dominant tumor burden, and recent evidence confirms that magnetic resonance imaging (MRI) guided tumor dose escalation improves outcomes. With the emergence of prostate-specific membrane antigen (PSMA) positron emission tomography (PET), we hypothesize that PSMA-PET and MRI may not equally depict the region most at risk of recurrence after RT.</p><p><strong>Methods and materials: </strong>Patients with intermediate- to high-risk PCa and MRI plus PSMA-PET performed before RT were identified. The sextant most at risk of recurrence was defined as the pathologically dominant region with peak biopsy percentage core length involvement and any sextant with ≥ 40% percentage core length involvement (pathologic gross tumor volume [pGTV], per prior work). Imaging methods were reviewed independently to compare GTVs with pGTVs most at risk of recurrence. A paired chi-square test was employed for analysis.</p><p><strong>Results: </strong>Eighty-eight patients (n = 88) were identified. Overall, there were no differences in the sensitivity of MRI and PSMA-PET for identifying the pGTV most at risk of recurrence. However, PSMA-PET demonstrated a trend of improved sensitivity for high-risk PCa compared with MRI (n = 46, 96% vs 87%, P = .06), while MRI outperformed PSMA-PET for the intermediate-risk group (n = 42, 93% vs 81%, P = .03). PSMA-PET showed lower specificity, misidentifying GTV in uninvolved pathologic sextants for 12% of intermediate-risk patients, whereas MRI was faultless (12% vs 0%, P = .03). MRI and PSMA-PET each misidentified uninvolved sextants for 9% of patients in the high-risk group.</p><p><strong>Conclusions: </strong>MRI demonstrates superior sensitivity in identifying the region most at risk of RT recurrence for intermediate-risk PCa, whereas PSMA-PET may add value for some high-risk patients. Informed by sextant biopsy information and MRI, clinicians should consider integrating PSMA-PET for patients with high-risk diseases when delineating GTVs.</p>\",\"PeriodicalId\":54245,\"journal\":{\"name\":\"Practical Radiation Oncology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.4000,\"publicationDate\":\"2024-12-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Practical Radiation Oncology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.prro.2024.09.017\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Practical Radiation Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.prro.2024.09.017","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}
F18-DCFPyL PSMA-PET/CT Versus MRI: Identifying the Prostate Cancer Region Most at Risk of Radiation Therapy Recurrence for Tumor Dose Escalation.
Purpose: Local recurrence of prostate cancer (PCa) after radiation therapy (RT) typically occurs at the site of dominant tumor burden, and recent evidence confirms that magnetic resonance imaging (MRI) guided tumor dose escalation improves outcomes. With the emergence of prostate-specific membrane antigen (PSMA) positron emission tomography (PET), we hypothesize that PSMA-PET and MRI may not equally depict the region most at risk of recurrence after RT.
Methods and materials: Patients with intermediate- to high-risk PCa and MRI plus PSMA-PET performed before RT were identified. The sextant most at risk of recurrence was defined as the pathologically dominant region with peak biopsy percentage core length involvement and any sextant with ≥ 40% percentage core length involvement (pathologic gross tumor volume [pGTV], per prior work). Imaging methods were reviewed independently to compare GTVs with pGTVs most at risk of recurrence. A paired chi-square test was employed for analysis.
Results: Eighty-eight patients (n = 88) were identified. Overall, there were no differences in the sensitivity of MRI and PSMA-PET for identifying the pGTV most at risk of recurrence. However, PSMA-PET demonstrated a trend of improved sensitivity for high-risk PCa compared with MRI (n = 46, 96% vs 87%, P = .06), while MRI outperformed PSMA-PET for the intermediate-risk group (n = 42, 93% vs 81%, P = .03). PSMA-PET showed lower specificity, misidentifying GTV in uninvolved pathologic sextants for 12% of intermediate-risk patients, whereas MRI was faultless (12% vs 0%, P = .03). MRI and PSMA-PET each misidentified uninvolved sextants for 9% of patients in the high-risk group.
Conclusions: MRI demonstrates superior sensitivity in identifying the region most at risk of RT recurrence for intermediate-risk PCa, whereas PSMA-PET may add value for some high-risk patients. Informed by sextant biopsy information and MRI, clinicians should consider integrating PSMA-PET for patients with high-risk diseases when delineating GTVs.
期刊介绍：
The overarching mission of Practical Radiation Oncology is to improve the quality of radiation oncology practice. PRO''s purpose is to document the state of current practice, providing background for those in training and continuing education for practitioners, through discussion and illustration of new techniques, evaluation of current practices, and publication of case reports. PRO strives to provide its readers content that emphasizes knowledge "with a purpose." The content of PRO includes:
Original articles focusing on patient safety, quality measurement, or quality improvement initiatives
Original articles focusing on imaging, contouring, target delineation, simulation, treatment planning, immobilization, organ motion, and other practical issues
ASTRO guidelines, position papers, and consensus statements
Essays that highlight enriching personal experiences in caring for cancer patients and their families.
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