Purpose

Prostate pathology studies suggest in many cases a dominant cancer focus exists within the gland and may
be a driver of the aggressiveness of the cancer and the epicenter of recurrence following radiotherapy
treatment.
Advances in Positron Emission Tomography (PET) show promise in identifying prostate GTVs and advances
in precision radiotherapy.
We studies the role of integrated [11C]choline PET/CT to improve radiation treatment planning for
Cyberknife Stereotactic Hypofractionated Radiotherapy (SBRT) in patients with recurrent prostate cancer
following EBRT.
Methods and Materials
From December 2012 through June 2014 a cohort of 14 on 59 patients previously treated with salvage
stereotactic Cyberknife radiosurgery for locally-recurrent prostate cancer following external beam
radiotherapy were referred to our Department for second salvage Cyberknife SBRT.
Primary radiotherapy doses ranged from 74 to 79.2 Gy (median 76 Gy) followed by a Cyberknife
stereotactic radiotherapy treatment (sbrt) with doses that ranged between 30-35 Gy delivered in 5
consecutive fractions on the whole prostate gland.
The mean age of patients population at the time of Cyberknife re- treatment was 76 years (range 64 -84)
with a median pre-reirradiation PSA of 4,46 ng/ml (range,1,23 -13,04 ng/ml).
To reconstruct CTV and organ at risk, CT scan and MRI with T1-T2 sequences were performed and
[11C]choline PET/CT images were fuse for prostate GTVs definition.
3 patients received 3 fractions of 10 Gy (total Dose 30 Gy ), 11 patients received 3 fractions of 12 Gy DFT: 36
Gy delivered to the PET positive uptake prostate node with a median volume of 14,3 cc (range 5,75-65,04).
Results
The Cyberknife treatment was well tolerated without any rtog grade 3 acute or late toxicity. With a median
follow up of 11 months (range 3-22) we observed the following results: no in field recurrence, resulting in a
local control of 100%. In 3 patients, respectively at 11, 13 at 21 months we recorded biochemical
recurrence with a new PET positive uptake prostate node outside the irradiated field requiring a third
Cyberknife salvage treatment.
Conclusions
In clinical practice, advances in modern imaging show promise for improved detection and characterization
of prostate cancer at the different stage of its management including diagnosis, staging treatment planning
and follow up. Although our results are very encouraging with no in field clinical progression and low
toxicity profile, this approach cannot be considered the standard of care.
Prospective trials are needed to better define the role of differential prostate treatment on imaging defined
GTVs.
Outline:
1. [11C]choline
2. SBRT
3. recurrent prostate cancer