Genitourinary Cancer

PV QA 1 - Poster Viewing Q&A 1

SU_22_2227 - Application of 18-F Fluciclovine PET/CT in Guiding Salvage Radiation Therapy for Recurrent Prostate Cancer

Sunday, October 21
1:15 PM - 2:45 PM
Location: Innovation Hub, Exhibit Hall 3

Application of 18-F Fluciclovine PET/CT in Guiding Salvage Radiation Therapy for Recurrent Prostate Cancer
J. Ahmed1, M. Muhleman1, J. Chong1, A. Tewari1, W. Oh1, L. Kostakoglu1, and R. G. Stock2; 1Icahn School of Medicine at Mount Sinai, New York, NY, 2Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY

Purpose/Objective(s): 18F-fluciclovine is a new PET radiotracer that has shown diagnostic utility in detecting prostate cancer recurrence1. The purpose of this retrospective review is to summarize our experience using 18F-fluciclovine PET-CT in radiation field design for recurrent prostate cancer.

Materials/Methods: Patients with Axumin scans obtained prior to radiation treatment planning from January-October 2017 were included in this retrospective review. Patients had prior definitive therapy with either radical prostatectomy(RP), external beam radiotherapy with or without brachytherapy (EBRT±BT), or RP with adjuvant/salvage EBRT. PSA levels taken within 6 weeks of the Axumin scan were tabulated. Treatment plans and summaries for all patients were reviewed and tabulated. A pelvic field was considered extended if it included regions outside of standard pelvic field borders (superior border L5-S1) or resulted in asymmetric fields targeted to positive lesions seen on Axumin PET/CT.

Results: The results of this review are summarized in the table below. Forty-one patients met inclusion criteria. The Axumin scan guided extended fields in post RP patients primarily (55%) and covered paraaortic/paracaval nodes or bone metastasis if present. In 63% of patients that had previously been treated with RP and adjuvant/salvage EBRT, and 54% of those that had prior EBRT to the prostate bed, the Axumin scan identified lesions that were treated with SBRT with doses of 20-30Gy given in 5 fractions. Surveillance was recommended for two patients who had no lesions identified.
Status post RP Status post RP and EBRT Status post EBRT(+/-BT)
Number of patients 11 16 11
Median Pre-Axumin PSA (ng/mL, range) 0.34 (0.13-44.1) 2.8 (.002-18.26) 3.2 (0.91-19)
Gleason score (7-9) (7-9) (7-9)
T stage pT2b-pT3b pT2b-pT3b T1c-T2a
Axumin PET/CT findings (# patients)
Recurrence detected in prostate bed 1(9%) 2 (13%) 5(45%)
Recurrence detected in lymph nodes 7(63%) 14(87%) 9(81%)
Recurrence detected in bone 2(18%) 5(31%) 1(9%)
Summary of treatment plans(#patients)
Received EBRT post Axumin 10 (90%) 13(81%) 9 (82%)
Received EBRT to prostate/PB 8 (73%) 0 0
Received EBRT to pelvis 8(73%) 2.5 (16%) 4(36%)
Axumin extended RT fields 6(55%) 2(13%) 2(18%)
Axumin defined SBRT/boost target 1(9%) 10 (63%) 6(54%)
SBRT Dose 25Gy 20-25Gy 20-30Gy
Surveillance 0 0 2

Conclusion: Axumin PET/CT was beneficial in guiding radiotherapy decision making. More than half of the Pelvic EBRT fields were extended in Post RP patients based on Axumin PET/CT. Axumin PET/CT identified targetable lesions in 54-63% of patients who had prior EBRT to the prostate. Our experience reviewed here echoes prior reports on the utility of the Axumin scan in recurrent prostate cancer. Further study and follow up is needed to determine the efficacy of this approach.

Author Disclosure: J. Ahmed: Employee; Insight Data Science. M. Muhleman: None. J. Chong: None. A. Tewari: None. W. Oh: None. L. Kostakoglu: None. R.G. Stock: Independent Contractor; BARD. Honoraria; BARD.

Jalal Ahmed, MD, PhD, BS

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