Radiation Therapy Post Prostatectomy Using Axumin Imaging for Target Definition

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Julie Trifone, CMD Maureen Britton, RN CMD Joshua Taylor, CMD Marious Croos, RT(T) Thomas Quinn, RT(T) CMD Katie Figura, RT(T) Bashera Nochomowitz, CMD Shannon Higgins, CMD Linda O’Connor, CMD Sherri Suhl, CMD Kathleen Briggs, MSc Jean Quigley, RT(R)(T) Heather Reifler, RT(R)(T) Kenneth Ulin, PhD Koren S. Smith, MS, MBA, DABR Carla D. Bradford, PhD I-Lin Kuo, PhD Yankhua Fan, PhD Suhong Yu, PhD Harry Bushe, MS Jonathan Saleeby, MS, DABR Fenghong Liu, PhD Abdulnasser Khalifeh, PhD Linda Ding, PhD Maryann Bishop-Jodoin, MEd Thomas J. FitzGerald


Radiation therapy delivered post-prostatectomy can provide durable disease-free clinical outcomes. There remains debate as to whether the radiation should be applied to patients with high risk features post-surgery or deferred until there is biomarker evidence of clinical recurrence. Prior to the development of advanced-technology metabolic and anatomic imaging, the radiation therapy treatment fields were applied based on historical models of patterns of failure including the former capsule region, undersurface of the bladder, and the bladder urethral anastomosis. Although outcomes of therapy were good, the choice of the target was not image directed. Modern imaging has provided an advantage for targeting as radiation oncologists can be more secure of high-risk areas and in turn titrate dose to regions deemed of intermediate and low risk. In this paper we describe strategies for application of modern axumin imaging for patient care with radiation therapy post prostatectomy.

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TRIFONE, Julie et al. Radiation Therapy Post Prostatectomy Using Axumin Imaging for Target Definition. Medical Research Archives, [S.l.], v. 9, n. 12, dec. 2021. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2626>. Date accessed: 08 aug. 2022. doi: https://doi.org/10.18103/mra.v9i12.2626.
Case Reports


1. Jani A, Hellman S. Early prostate cancer: clinical decision-making. Lancet. 2003;361(9362):1045-1053.
2. Walz J, Epstein JI, Ganzer R, et al. A critical analysis of the current knowledge of surgical anatomy of the prostate related to optimisation of cancer control and preservation of continence and erection in candidates for radical prostatectomy: An update. Eur Urol. 2016;70(2):301-311.
3. Wenger H, Razmaria A, Eggener S, Raman JD. Nerve bundle hydrodissection and sexual function after robot prostatectomy. JSLS. 2017;21(4):e2017.00068.
4. Welch HG, Albertsen PC. Reconsidering prostate cancer mortality - The future of PSA screening. N Engl J Med. 2020;382(16):1557-1563.
5. Mahal BA, Yang DD, Sweeney C, Trinh QD, Feng FY, Nguyen PL. Identification of low prostate-specific antigen, high Gleason prostate cancer as a unique hormone-resistant entity with poor survival: a contemporary analysis of over 600,000 patients. Int J Radiat Oncol Biol Phys. 2017;99(2):Suppl:S133-S133.
6. Michalski JM, Lawton C, El Naqa I, et al. Development of RTOG consensus guidelines for the definition of the clinical target volume for postoperative conformal radiation therapy for prostate cancer. Int J Radiat Oncol Biol Phy. 2010;76(2):361-368.
7. Hamdy FC, Donovan JL, Lane JA, et al. 10-year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. N Engl J Med. 2016;375(15):1415-1424.
8. Lawton CA, Michalski J, El-Naqa I, et al. RTOG GU radiation oncology specialists reach consensus on pelvic lymph node volumes for high risk prostate cancer. Int J Radiat Oncol Biol Phy. 2009;74(2):383-387.
9. Robin S, Jolicoeur M, Palumbo S, et al. Prostate bed delineation guidelines for postoperative radiation therapy: On behalf of the Francophone group of urological radiation therapy. Int J Radiat Oncol Biol Phy. 2021;109(5):1243 1253.
10. Wang J, Kudchadker R, Choi S, et al. Local recurrence map to guide target volume delineation after radical prostatectomy. Pract Radiat Oncol. 2014;4(6):e239-246.
11. Bednarova S, Lindenberg ML, Vinsensia M, Zuiani C, Choyke PL, Turkbey B. Positron emission tomography (PET) in primary prostate cancer staging and risk assessment. Transl Androl Urol. 2017;6(3):413-423.
12. Parent EE, Schuster DM. Update on 18F-Fluciclovine PET for prostate cancer imaging. J Nucl Med. 2018;59(5):733-739.
13. Jani AB, Schreibmann E, Goyal S, et al. 18F-fluciclovine-PET/CT imaging versus conventional imaging alone to guide postprostatectomy salvage radiotherapy for prostate cancer (EMPIRE-1): a single centre, open-label, phase 2/3 randomised controlled trial. Lancet. 2021;397(10228):1895-1904.
14. Schreibmann E, Schuster DM, Rossi PJ, Shelton J, Cooper S, Jani AB. Image guided planning for prostate carcinomas with incorporation of anti-3-[18F]FACBC (Fluciclovine) positron emission tomography: workflow and initial findings from a randomized trial. Int J Radiat Oncol Biol Phy. 2016;96(1):206-213.
15. Pernthaler B, Kulnik R, Gstettner C, Salamon S, Aigner RM, Kvaternik H. A prospective head to head comparison of 18F-flucoclovine with 68Ga-PSMA-11 in biochemical recurrence of prostate cancer in PET/CT. Clin Nuc Med. 2019;44(10) e566-573.
16. Jani AB, Schreibmann E, Rossi PJ, et al. Impact of 18F-Fluciclovine PET on target volume definition for postprostatectomy salvage radiotherapy: Initial findings from a randomized trial. J Nucl Med. 2017;58(3):412-418.
17. FitzGerald TJ, Rosen MA, Bishop-Jodoin M. The influence of imaging in the modern practice of radiation oncology. Int J Radiat Oncol Biol Phys. 2018;102(4):680-682.
18. Vogel MME, Dewes S, Sage EK, et al. Feasibility and outcome of PSMA-PET based dose escalated salvage radiotherapy versus conventional salvage radiotherapy for patients with recurrent prostate cancer. Front Oncol. 2021;11:715020.
19. Jóhannesson V, Wieslander E, Nilsson P, et al. Adaptive sequential plan-on-plan optimization during prostate-specific antigen response guided radiotherapy of recurrent prostate cancer. Phys Imaging Radiat Oncol. 2021;18 5-10.
20. Cao M, Gao Y, Yoon SM, et al. Interfractional geometric variations and dosimetric benefits of stereotactic MRI guided online adaptive radiotherapy (SMART) of prostate bed after radical prostatectomy: Post-hoc analysis of a phase II trial. Cancers (Basel). 2021;13(11):2802.