A prospective study assessing the pattern of response of local disease at DCE-MRI after salvage radiotherapy for prostate cancer

Marta Bottero, Adriana Faiella, Diana Giannarelli, Alessia Farneti, Pasqualina D'Urso, Luca Bertini, Valeria Landoni, Patrizia Vici, Giuseppe Sanguineti, Marta Bottero, Adriana Faiella, Diana Giannarelli, Alessia Farneti, Pasqualina D'Urso, Luca Bertini, Valeria Landoni, Patrizia Vici, Giuseppe Sanguineti

Abstract

Background: To assess the pattern of response of presumed local lesions at dynamic contrast enhancement magnetic resonance imaging (DCE-MRI) after salvage radiotherapy (sRT).

Methods: This is a prospective study conducted at a single Institution accruing patients with one or more local failures at DCE-MRI after radical prostatectomy between August 2017 and June 2020. Patients underwent exclusive sRT delivering 66-69 Gy and 73.5 Gy in 30 fractions to the whole prostatic fossa and to the local failure(s) seen at DCE-MRI, respectively.Patients were offered DCE-MRI at 3 months intervals after sRT until complete disappearance (CR) of the lesion(s) or up to a maximum of 4 revaluations.

Results: 62 patients with 72 nodules were enrolled. All patients underwent the 1st revaluation, and 33 patients (53.2%) showed a CR. The median time to CR was 4.7 months. Four patients did not undergo further testing before achieving a CR and even considering these patients as no responses, the vast majority (87.1%, 95%CI: 78.5-94.4%) of lesions would have completely disappeared by 12 months from the end of sRT.The volume of the lesion at pre-sRT DCE-MRI was an independent predictor of CR at the 1st revaluation (OR: 0.076, 95%CI: 0.009-0.667; p = 0.020) along with time elapsed from sRT (OR: 3.399, 95% CI: 1.156-9.993, p = 0.026).

Conclusions: The present study documents the complete disappearance of the vast majority of local lesions after dose-escalated sRT though this requires several months after sRT; timing of CR is at least in part predictable based on the volume of the lesion.Trial registration: Clinicaltrials.gov NCT04703543, registered July 15 2020, retrospectively registered, https://ichgcp.net/clinical-trials-registry/NCT04703543.

Keywords: Dynamic contrast enhancement magnetic resonance imaging; Local failure; Prostate cancer; Salvage radiotherapy.

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

© 2022 Published by Elsevier B.V. on behalf of European Society for Radiotherapy and Oncology.

Figures

Fig. 1
Fig. 1
Estimated cumulative incidence rates (95%CI) of CR after sRT. The actuarial method (red line) censors for the 4 patients who were lost to follow up before achieving a CR while the actual method (blue line) treats lost observations as persisting incomplete responses. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
Fig. 2
Fig. 2
Estimated cumulative incidence rates (95% CI) of CR by baseline volume at DCE-MRI. For lesions up to 4.5 cc, both the actuarial and the actual methods provide identical results since there are no censored observations: for lesions larger than 4.5 cc, both approaches (actuarial, solid line and actual, dashed line) are shown. The difference among both actuarial and actual curves is highly significant (p = 0.009 and p = 0.003 for the former and the latter ones, respectively).

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