背景：澳大利亚放射肿瘤学泌尿生殖系统组（FROGG）制定了前列腺床临床目标体积（CTV）轮廓指南，随后用于制定NationalEviQ指南，用于辅助和挽救前列腺切除术后放疗（PPRT）。这些准则主要基于协商一致协议。随着前列腺特异性膜抗原（PSMA）正电子发射断层扫描（PET）的出现，现在可以在前列腺癌根治术后发现低前列腺特异性抗原(PSA)水平的复发部位.我们评估了使用FROGG/EviQCTV治疗的患者的复发部位，以告知这些指南即将进行的修改。
方法：在我们的机构，我们使用FROGG/EviQ指南进行PPRT。从2015年开始，使用PSMAPET成像对PPRT后PSA失败的患者进行了重新分期。我们确定了患有局部PET狂热的患者，节点,和遥远的复发，将它们与原始治疗计划融合，以确定复发是在前列腺床CTV内还是外。对区域节点故障进行了审查，以确定它们是否在当前的可选节点轮廓指南范围内。
结果：94例患者PPRT后PSMAPET阳性。9例（9.6％）复发是局部的，七只本地。一次局部复发（1.1％）仅优于轮廓前列腺床CTV，位于输精管内。73例(77.7%)患者出现节点故障，56（59.6%）只发生节点故障。淋巴结复发的部位在60.3%的时间内被标准轮廓指南覆盖。
结论：当前的前列腺床CTV轮廓术指南之外的低复发率与使用当代轮廓术的其他研究一致，并验证了目前FROGG/EviQ前列腺床CTV清晰度的疗效。
BACKGROUND: The Australian Faculty of Radiation Oncology Genitourinary Group (FROGG) developed prostate bed clinical target volume (CTV) contouring
guidelines which were subsequently used to develop the National EviQ
guidelines for adjuvant and salvage post-prostatectomy radiotherapy (PPRT). These
guidelines were based mainly upon
consensus agreement. With the advent of prostate-specific membrane antigen (PSMA) positron emission tomography (PET), sites of recurrence can now be detected with low prostate-specific antigen (PSA) levels following radical prostatectomy. We evaluated sites of recurrence in patients treated with FROGG/EviQ CTVs to inform upcoming modifications of these guidelines.
METHODS: At our institution, we use the FROGG/EviQ
guidelines for PPRT. From 2015, patients with PSA failure following PPRT have been re-staged using PSMA PET imaging. We identified patients with PET-avid local, nodal, and distant recurrences, fusing them with original treatment plans to determine whether recurrences were within or outside the prostate bed CTV. Regional nodal failures were reviewed to determine if they were within current elective node contouring guidelines.
RESULTS: Ninety-four patients had positive PSMA PET following PPRT. Nine (9.6%) recurrences were local, seven being local-only. One local recurrence (1.1%) was just superior to the contoured prostate bed CTV, located within the vas deferens. Seventy-three (77.7%) patients had a component of node failure, with 56 (59.6%) having node-only failure. Sites of nodal relapses were covered by standard contouring
guidelines 60.3% of the time.
CONCLUSIONS: The low recurrence rate outside of current prostate bed CTV contouring guidelines is consistent with other studies using contemporary contouring, and validates the efficacy of the current FROGG/EviQ prostate bed CTV definition.
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