焦点增强放疗后的膀胱内复发:FLAME 试验中的位置和剂量图。

IF 4.9 1区 医学 Q1 ONCOLOGY Radiotherapy and Oncology Pub Date : 2024-09-13 DOI:10.1016/j.radonc.2024.110535
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引用次数: 0

摘要

简介FLAME 试验表明,前列腺癌患者肿瘤总体积(GTV)的剂量与肿瘤控制有关。这就提出了一个问题,即是否可以考虑对剩余前列腺进行剂量递减。因此,我们研究了前列腺内复发是否发生在GTV位置,以及在该位置投放的剂量:对于前列腺内复发的 FLAME 试验患者,我们收集了治疗前图像、GTV 划线、剂量分布和复发后图像。治疗前图像与复发后图像(PSMA-PET CT)进行了对比。GTV与PSMA-PET活动重叠被认为是原发肿瘤位置的膀胱内复发:结果:在FLAME试验的535名患者中,有28名患者出现了睾丸内复发。其中 24 名患者的复发位置可以确定。一名患者在GTV以外的前列腺内复发。GTV的D98%中位数为76.5 Gy(范围:73.3-86.5 Gy)。只有一名在 GTV 内复发的患者接受了 86.5 Gy 的大量病灶增强治疗。其余所有患者的 D98% 均为结论:接受放疗的中危和高危前列腺癌患者的膀胱内复发主要出现在原发肿瘤的位置。除一名患者外,其他患者的GTV均未接受高剂量治疗。前列腺内复发可能是原发肿瘤治疗不足的结果,而不是剩余前列腺治疗不足的结果。
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Intra-prostatic recurrences after radiotherapy with focal boost: Location and dose mapping in the FLAME trial

Introduction

The FLAME trial demonstrated that the dose to the gross tumor volume (GTV) is associated with tumour control in prostate cancer patients. This raises the question if dose de-escalation to the remaining prostate gland can be considered. Therefore, we investigated if intraprostatic recurrences occur at the location of the GTV and which dose was delivered at that location.

Materials and methods

For FLAME trial patients with an intra-prostatic recurrence, we collected pre-treatment images, GTV delineations, dose distributions and post-recurrence images. Pre-treatment images were registered to the post-recurrence images (PSMA-PET CT). An overlap between GTV and PSMA-PET activity was considered an intra-prostatic recurrence at the location of the primary tumor.

Results

Twenty eight out of 535 patients in the FLAME trial had an intra-prostatic recurrence. Its location could be determined for 24 patients. One patient recurred in the prostate gland outside the GTV. The median near-minimum dose to the GTV (D98%) was 76.5 Gy (range: 73.3–86.5 Gy). Only one patient with a recurrence in the GTV received a substantial focal boost of 86.5 Gy. The D98% of all remaining patients was < 81 Gy.

Conclusion

Intra-prostatic recurrences of intermediate- and high-risk prostate cancer patients treated with radiotherapy appeared predominantly at the location of the primary tumor. All but one patient did not receive a high dose to the GTV. Intra-prostatic failure is likely a consequence of the undertreatment of the primary tumor rather than the undertreatment of the remaining prostate gland.
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来源期刊
Radiotherapy and Oncology
Radiotherapy and Oncology 医学-核医学
CiteScore
10.30
自引率
10.50%
发文量
2445
审稿时长
45 days
期刊介绍: Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.
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