Heat maps of prostatic fossa recurrence PET PSMA in patients with recurrence limited to prostatic fossa (miTr N0 M0, n=127), pelvic lymph node disease (miTr N1 M0, n=30), distant organs / extrapelvic lymph node disease (miTr N0 M1, n = 32) and pelvic lymph node plus distant organs/extrapelvic lymph node disease (miTr N1 M1, n = 37). The yellow outline represents the RTOG CTV. Credit: Ida Sonni et al, Abstract 486, SNMMI Annual Meeting 2022, https://www.xcdsystem.com/snmmi/program/2ATlJc8/index.cfm?pgid=237&qfixed=1&sessiontype=Oncology:%20Clinical%20Therapy
Current guidelines used to plan salvage radiation therapy in patients with local recurrence of prostate cancer should be updated to take into account information derived from new imaging modalities, such as PET PSMA, research suggests. presented at the Society of Nuclear Medicine and Molecular Imaging 2022 Annual Meeting. The study showed that PSMA-PET was effective in identifying recurrences that fell partially or completely outside the clinical target volume as determined by current guidelines. This suggests that PET PSMA can be an invaluable tool for therapy planning.
After a biochemical recurrence of prostate cancer, salvage radiotherapy can be a curative approach. This therapy was conducted in accordance with bypass guidelines based on expert consensus, such as the Radiation Therapy Oncology Group (RTOG) guidelines. In the current era of precision medicinethe study authors sought to determine whether PET PSMA imaging could provide more detailed data on patterns of recurrence to inform treatment planning.
Patients with prostate cancer who experienced biochemical recurrence after Radical prostatectomy were included in the analysis if their PSMA PET/CT imaging showed recurrence in the prostate bed. To analyze recurrence patterns, two nuclear medicine physicians documented areas of recurrence on PSMA PET/CT, and four radiation oncologists (obscured by PSMA PET/CT results) delineated clinical target volume using RTOG guidelines on CT images of PET/CT . PSMA recurrence locations were then compared to RTOG-based clinical target volumes.
PSMA recurrences were fully covered by clinical target volumes in 54% of patients. In 34% of patients, PSMA recurrence was only partially covered, and in 13% of patients, PSMA recurrence was entirely outside the clinical target volume.
“This study has the potential to redefine prostate bed contour guidelines to improve therapeutic ratio for patients receiving postoperative radiation therapy,” said Ida Sonni, MD, project scientist in the Department of Radiology at the University of California at Los Angeles. “Nuclear medicine and molecular imaging advances, such as PET PSMA, have the ability to guide individualized, tailored treatments that will ultimately benefit all of our patients. ยป
Ida Sonni et al, PSMA PET Mapping of Postoperative Local Recurrence and Impact on Prostatic Pit Contour Guidelines for Salvage Radiation Therapy, Abstract 486SNMMI 2022 Annual Meeting.
Provided by the Society for Nuclear Medicine and Molecular Imaging
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