Abstract：
OBJECTIVE: To study prostate specific membrane antigen - positron emission tomography (Ga68PSMA-PETCT) based patterns of relapse at biochemical failure (BCF) after prostate-only radiotherapy (PORT) in high-risk (HR) prostate cancer and its implications on pelvic contouring recommendations.
METHODS: Patients with clinico-radiological high-risk node-negative prostate cancer treated with curative PORT and androgen deprivation therapy (ADT), either within the POP-RT randomised trial or off trial, who underwent a Ga68PSMA-PETCT upon BCF were included. Patterns of regional and distant recurrence on Ga68PSMA-PETCT were studied. Pelvic nodal recurrences were mapped with reference to the superior border of pubic symphysis. Pelvic lymph nodal caudal border (PLNcb) recommendations in the published contouring guidelines (RTOGcb, GETUGcb, PIVOTALcb, NRGcb, GFRUcb) were evaluated.
RESULTS: Of the total 262 patients screened, 68 eligible patients were included (POP-RT trial 35 patients; off-trial 33 patients). Median follow-up was 91 months (IQR, 72-117) and median time to BCF was 65 months (IQR, 49-83). Regional and distant recurrence was seen in 31 (46%) and 31 (46%) patients, respectively. Of the nodal recurrences, nearly half (46%, 14/31) had no distant metastases and 64% (20/31) had a failure in the common iliac nodal region. The lower-most nodal recurrence was 20 mm cranial to the top of pubic symphysis (RTOGcb, GETUGcb, GFRUcb) and 10 mm cranial to the PIVOTALcb. The PLNcb recommended by NRG guideline (NRGcb) had an inter-patient variability of 32 mm, ranging from 16 mm above to 16 mm below the top of pubic symphysis, and the lower most nodal recurrence ranged from 4 mm to 36 mm cranial to NRGcb.
CONCLUSIONS: Pelvic failures accounted for a major proportion of recurrences after prostate-only radiotherapy, with the caudal most nodal recurrence being 20 mm cranial to the top of pubic symphysis. This could have implications in defining the caudal border of contouring recommendations.
METHODS: Patients with clinico-radiological high-risk node-negative prostate cancer treated with curative PORT and androgen deprivation therapy (ADT), either within the POP-RT randomised trial or off trial, who underwent a Ga68PSMA-PETCT upon BCF were included. Patterns of regional and distant recurrence on Ga68PSMA-PETCT were studied. Pelvic nodal recurrences were mapped with reference to the superior border of pubic symphysis. Pelvic lymph nodal caudal border (PLNcb) recommendations in the published contouring guidelines (RTOGcb, GETUGcb, PIVOTALcb, NRGcb, GFRUcb) were evaluated.
RESULTS: Of the total 262 patients screened, 68 eligible patients were included (POP-RT trial 35 patients; off-trial 33 patients). Median follow-up was 91 months (IQR, 72-117) and median time to BCF was 65 months (IQR, 49-83). Regional and distant recurrence was seen in 31 (46%) and 31 (46%) patients, respectively. Of the nodal recurrences, nearly half (46%, 14/31) had no distant metastases and 64% (20/31) had a failure in the common iliac nodal region. The lower-most nodal recurrence was 20 mm cranial to the top of pubic symphysis (RTOGcb, GETUGcb, GFRUcb) and 10 mm cranial to the PIVOTALcb. The PLNcb recommended by NRG guideline (NRGcb) had an inter-patient variability of 32 mm, ranging from 16 mm above to 16 mm below the top of pubic symphysis, and the lower most nodal recurrence ranged from 4 mm to 36 mm cranial to NRGcb.
CONCLUSIONS: Pelvic failures accounted for a major proportion of recurrences after prostate-only radiotherapy, with the caudal most nodal recurrence being 20 mm cranial to the top of pubic symphysis. This could have implications in defining the caudal border of contouring recommendations.
摘要：
目的：研究基于前列腺特异性膜抗原-正电子发射断层扫描（Ga68PSMA-PETCT）的高危（HR）前列腺癌单纯前列腺放疗（PORT）后生化衰竭（BCF）复发模式及其对盆腔轮廓检查建议的影响。
方法：接受根治性PORT和雄激素剥夺治疗（ADT）的临床放射学高危淋巴结阴性前列腺癌患者，在POP-RT随机试验或非试验中，纳入了在BCF后接受Ga68PSMA-PETCT的患者。研究了Ga68PSMA-PETCT的区域和远处复发模式。参照耻骨联合的上边界绘制了盆腔淋巴结复发图。已发布的轮廓指南中的盆腔淋巴结尾边界（PLNcb）建议（RTOGcb，GETUGcb,PIVOTALcb,NRGcb,GFRUcb)进行了评估。
结果：在筛查的262名患者中，纳入68例符合条件的患者（POP-RT试验35例；试验外33例）。中位随访时间为91个月(IQR，72-117)，BCF的中位时间为65个月(IQR，49-83).31例（46%）和31例（46%）患者出现区域性和远处复发，分别。在淋巴结复发中，近一半(46%，14/31）无远处转移，64％（20/31）的髂总结区失败。最低的淋巴结复发是颅骨至耻骨联合顶部20毫米（RTOGcb，GETUGcb,GFRUcb）和头颅10毫米。NRG指南推荐的PLNcb（NRGcb）的患者间变异性为32mm，耻骨联合顶部从16毫米以上到16毫米以下，最低的淋巴结复发范围从4毫米到36毫米颅至NRGcb。
结论：盆腔衰竭占单纯前列腺放疗后复发的主要比例，尾部大部分结节复发为颅骨至耻骨联合顶部20毫米。这可能对定义轮廓建议的尾边界产生影响。
方法：接受根治性PORT和雄激素剥夺治疗（ADT）的临床放射学高危淋巴结阴性前列腺癌患者，在POP-RT随机试验或非试验中，纳入了在BCF后接受Ga68PSMA-PETCT的患者。研究了Ga68PSMA-PETCT的区域和远处复发模式。参照耻骨联合的上边界绘制了盆腔淋巴结复发图。已发布的轮廓指南中的盆腔淋巴结尾边界（PLNcb）建议（RTOGcb，GETUGcb,PIVOTALcb,NRGcb,GFRUcb)进行了评估。
结果：在筛查的262名患者中，纳入68例符合条件的患者（POP-RT试验35例；试验外33例）。中位随访时间为91个月(IQR，72-117)，BCF的中位时间为65个月(IQR，49-83).31例（46%）和31例（46%）患者出现区域性和远处复发，分别。在淋巴结复发中，近一半(46%，14/31）无远处转移，64％（20/31）的髂总结区失败。最低的淋巴结复发是颅骨至耻骨联合顶部20毫米（RTOGcb，GETUGcb,GFRUcb）和头颅10毫米。NRG指南推荐的PLNcb（NRGcb）的患者间变异性为32mm，耻骨联合顶部从16毫米以上到16毫米以下，最低的淋巴结复发范围从4毫米到36毫米颅至NRGcb。
结论：盆腔衰竭占单纯前列腺放疗后复发的主要比例，尾部大部分结节复发为颅骨至耻骨联合顶部20毫米。这可能对定义轮廓建议的尾边界产生影响。
