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NaF PET/CT for response assessment of prostate cancer bone metastases treated with single fraction stereotactic ablative body radiotherapy
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NaF PET/CT for response assessment of prostate cancer bone metastases treated with single fraction stereotactic ablative body radiotherapy
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Journal Article
NaF PET/CT for response assessment of prostate cancer bone metastases treated with single fraction stereotactic ablative body radiotherapy
2019
Overview
Introduction
In prostate cancer patients, imaging of bone metastases is enhanced through the use of sodium fluoride positron emission tomography (
18
F-NaF PET/CT). This imaging technique shows areas of enhanced osteoblastic activity and blood flow. In this work,
18
F-NaF PET/CT was investigated for response assessment to single fraction stereotactic ablative body radiotherapy (SABR) to bone metastases in prostate cancer patients.
Methods
Patients with bone metastases in a prospective trial treated with single fraction SABR received a
18
F-NaF PET/CT scan prior to and 6 months post-SABR. The SUV
max
in the tumour was determined and the difference between before and after SABR determined. The change in uptake in the non-tumour bone was also measured as a function of the received SABR dose.
Results
Reduction in SUV
max
was observed in 29 of 33 lesions 6 months after SABR (mean absolute decrease in SUV
max
17.7, 95% CI 25.8 to − 9.4,
p
= 0.0001). Of the three lesions with increased SUV
max
post-SABR, two were from the same patient and located in the vertebral column. Both were determined to be local progression in addition to one fracture. The third lesion (in a rib) was shown to be controlled locally but suffered from a fracture at 24 months. Progression adjacent to the treated volume was observed in two patients. The non-tumour bone irradiated showed increased loss in uptake with increasing dose, with a median loss in uptake of 23.3% for bone receiving 24 Gy.
Conclusion
18
F-NaF PET/CT for response assessment of bone metastases to single fraction SABR indicates high rates of reduction of osteoblastic activity in the tumour and non-tumour bone receiving high doses. The occurrence of marginal recurrence indicates use of larger clinical target volumes may be warranted in treatment of bone metastases.
Trial registration
POPSTAR, ‘Pilot Study of patients with Oligometastases from Prostate cancer treated with STereotactic Ablative Radiotherapy’, Universal Trial Number
U1111-1140-7563
, Registered 17th April 2013.
Publisher
BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
Subject
/ Biomedical and Life Sciences
/ Bone Neoplasms - diagnostic imaging
/ Dose Fractionation, Radiation
/ Humans
/ Imaging
/ Lesions
/ Male
/ NaF
/ Oncology
/ Patients
/ PET
/ Positron emission tomography
/ Positron Emission Tomography Computed Tomography - methods
/ Prostatic Neoplasms - diagnostic imaging
/ Prostatic Neoplasms - pathology
/ Prostatic Neoplasms - surgery
/ SABR
/ Sodium
/ Tumors
