TY - JOUR
T1 - Online Prostate-Specific Membrane Antigen and Positron Emission Tomography–Guided Radiation Therapy for Oligometastatic Prostate Cancer
AU - Hrinivich, William T.
AU - Phillips, Ryan
AU - Da Silva, Angela J.
AU - Radwan, Noura
AU - Gorin, Michael A.
AU - Rowe, Steven P.
AU - Pienta, Kenneth J.
AU - Pomper, Martin G.
AU - Wong, John
AU - Tran, Phuoc T.
AU - Kang-Hsin Wang, Ken
N1 - Funding Information:
Sources of support: This work was supported by a research grant from RefleXion Medical. Dr Hrinivich is funded by RefleXion Medical. Dr Phillips is funded by the RSNA. Dr Tran is funded by Ronald Rose, Joan Lazar, Movember Foundation, Prostate Cancer Foundation, RefleXion Medical; National Institutes of Health/National Cancer Institute (R01CA166348, U01CA212007, U01CA231776 and R21CA223403). Dr Wang is funded by Xstrahl Inc, RefleXion Medical, and National Cancer Institute (R21CA223403, R37CA230341, R01CA240811 and P30 CA006973). Disclosures: Drs Tran, Phillips, and Hrinivich have consulted for RefleXion Medical. Drs Hrinivich, Tran, and Wang have sponsored research with RefleXion Medical. Dr Da Silva is an employee of RefleXion Medical. Dr Tran reports grants from Astellas Pharm, grants from Bayer Health care, during the conduct of the study. In addition, Dr Tran has a patent Compounds and Methods of Use in Ablative Radiotherapy licensed to Natsar Pharm. Dr Pienta reports grants from Progenics, Inc, during the conduct of the study; personal fees from Cue Biopharma, Inc, outside the submitted work. Dr Rowe reports grants from grants from Progenics Pharmaceuticals, Inc, outside the submitted work. Dr Gorin reports grants, personal fees, and nonfinancial support from Progenics Pharmacuticals, Inc, during the conduct of the study. Dr Gorin also reports financial support from Nanospectra Biosciences, Inc and nonfinancial support from KOELIS, outside the submitted work. Dr Wong reports grants from Elekta, other from Elekta, grants from Xstrahl, personal fees and other from Xstrahl, outside the submitted work. In addition, Dr Wong has a patent Conebeam computed tomography with royalties paid to Elekta, and a patent SARRP licensed to Xstrahl. Dr Pomper reports other from Progenics Pharma, during the conduct of the study. In addition, Dr Pomper has a patent for the imaging agent with royalties paid to Progenics Pharma.
Publisher Copyright:
© 2019 The Author(s)
PY - 2020/3/1
Y1 - 2020/3/1
N2 - Purpose: Stereotactic ablative radiation therapy (SABR) for oligometastatic prostate cancer (OMPC) may improve clinical outcomes, but current challenges in intrafraction tracking of multiple small targets limits treatment accuracy. A biology-guided radiation therapy (BgRT) delivery system incorporating positron emission tomography (PET) detectors is being developed to use radiotracer uptake as a biologic fiducial for intrafraction tumor tracking to improve geometric accuracy. This study simulates prostate-specific membrane antigen (PSMA)-directed BgRT using a cohort from our phase II randomized trial of SABR in men with recurrent hormone sensitive OMPC and compares dose distributions to clinical SABR (CSABR). Methods and Materials: A research treatment planning system (RTPS) was used to replan 15 patients imaged with PSMA-targeted 18F-DCFPyL PET/computed tomography and previously treated with CSABR using conventional linear accelerators (linacs). The RTPS models a prototype ring-mounted linac incorporating PET and kilo-voltage computed tomography imaging subsystems and can be used to optimize BgRT plans, as well as research SABR (RSABR) plans, which use the prototype linac without radiotracer guidance. CSABR, RSABR, and BgRT plans were compared in terms of maximum planning target volume (PTV) dose (Dmax), mean dose to proximal organs at risk (DOAR), conformity index, as well as voxel-wise correlation of dose with PET specific uptake values to investigate possible dose-painting effects. Results: RSABR and BgRT plans resulted in mean ± standard deviation increases in Dmax of 4 ± 11% (P = .21) and 18 ± 15% (P < .001) and reductions in DOAR of –20 ± 19% (P <.001) and –10 ± 19% (P = .02) compared with CSABR. Similar target coverage was maintained with conformity indices of 0.81 ± 0.04 (P < .001) and 0.72 ± 0.08 (P = .44) for RSABR and BgRT compared with 0.74 ± 0.08 for CSABR. Dose and log (specific uptake values) had Pearson correlation coefficients of 0.10 (CSABR), 0.16 (RSABR), and 0.31 (BgRT). Conclusions: BgRT plans provided similar PTV coverage and conformity compared with CSABR while incorporating underlying PET activity. These results demonstrate feasibility of BgRT optimization enabling online PSMA-targeted, PET-based tracked dose delivery for OMPC.
AB - Purpose: Stereotactic ablative radiation therapy (SABR) for oligometastatic prostate cancer (OMPC) may improve clinical outcomes, but current challenges in intrafraction tracking of multiple small targets limits treatment accuracy. A biology-guided radiation therapy (BgRT) delivery system incorporating positron emission tomography (PET) detectors is being developed to use radiotracer uptake as a biologic fiducial for intrafraction tumor tracking to improve geometric accuracy. This study simulates prostate-specific membrane antigen (PSMA)-directed BgRT using a cohort from our phase II randomized trial of SABR in men with recurrent hormone sensitive OMPC and compares dose distributions to clinical SABR (CSABR). Methods and Materials: A research treatment planning system (RTPS) was used to replan 15 patients imaged with PSMA-targeted 18F-DCFPyL PET/computed tomography and previously treated with CSABR using conventional linear accelerators (linacs). The RTPS models a prototype ring-mounted linac incorporating PET and kilo-voltage computed tomography imaging subsystems and can be used to optimize BgRT plans, as well as research SABR (RSABR) plans, which use the prototype linac without radiotracer guidance. CSABR, RSABR, and BgRT plans were compared in terms of maximum planning target volume (PTV) dose (Dmax), mean dose to proximal organs at risk (DOAR), conformity index, as well as voxel-wise correlation of dose with PET specific uptake values to investigate possible dose-painting effects. Results: RSABR and BgRT plans resulted in mean ± standard deviation increases in Dmax of 4 ± 11% (P = .21) and 18 ± 15% (P < .001) and reductions in DOAR of –20 ± 19% (P <.001) and –10 ± 19% (P = .02) compared with CSABR. Similar target coverage was maintained with conformity indices of 0.81 ± 0.04 (P < .001) and 0.72 ± 0.08 (P = .44) for RSABR and BgRT compared with 0.74 ± 0.08 for CSABR. Dose and log (specific uptake values) had Pearson correlation coefficients of 0.10 (CSABR), 0.16 (RSABR), and 0.31 (BgRT). Conclusions: BgRT plans provided similar PTV coverage and conformity compared with CSABR while incorporating underlying PET activity. These results demonstrate feasibility of BgRT optimization enabling online PSMA-targeted, PET-based tracked dose delivery for OMPC.
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U2 - 10.1016/j.adro.2019.10.006
DO - 10.1016/j.adro.2019.10.006
M3 - Article
C2 - 32280826
AN - SCOPUS:85077153615
SN - 2452-1094
VL - 5
SP - 260
EP - 268
JO - Advances in Radiation Oncology
JF - Advances in Radiation Oncology
IS - 2
ER -