Focal Salvage Guided by T2 -Weighted and Dynamic Contrast-Enhanced Magnetic Resonance Imaging for Prostate Cancer Recurrences

• Published in: International journal of radiation oncology, biology, physics Vol. 76; no. 3; pp. 741 - 746
• Main Authors: Moman, Maaike R., M.D, van den Berg, Cornelis A.T., Ph.D, Boeken Kruger, Arto E., M.D, Battermann, Jan J., M.D., Ph.D, Moerland, Marinus A., Ph.D, van der Heide, Uulke A., Ph.D, van Vulpen, Marco, M.D., Ph.D
• Format: Journal Article
• Language: English
• Published: United States 01-03-2010
• Subjects: Aged; Contrast Media; Hematology, Oncology and Palliative Medicine; Humans; Image Enhancement - methods; Magnetic Resonance Imaging - methods; Male; Middle Aged; Neoplasm Recurrence, Local - blood; Neoplasm Recurrence, Local - diagnosis; Neoplasm Recurrence, Local - radiotherapy; Prostate-Specific Antigen - blood; Prostatic Neoplasms - blood; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - radiotherapy; Radiology; Radiotherapy Dosage; Salvage Therapy - methods; recurrence; focal treatment; prostate cancer; DCE-MRI; salvage; Dynamic contrast-enhance magnetic resonance imaging
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2009.02.055

Purpose Salvage treatment of the entire prostate for local recurrent cancer after primary radiotherapy is associated with high toxicity rates. Our goal was to show that, using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for the visualization of a recurrence, focal salvage treatment can be performed, with, potentially, a reduction in toxicity. Methods and Materials We performed MRI, including a DCE sequence, in 7 patients with biopsy-proven locally recurrent prostate cancer. The specific regions of interest suspect for containing tumor were delineated using DCE and T2 -weighted MRI scans. Subsequently, focal salvage high-dose-rate brachytherapy plans were created to illustrate the principle of focal salvage. Total salvage treatment plans were also created for comparison. Results The transfer constant (Ktrans ) values from the DCE were 0.33–0.67 min−1 for areas suspect for tumor and 0.07–0.25 min−1 for normal tissue. In 4 cases, a focal salvage plan could be generated; 93–100% of the gross tumor volume was covered with the prescribed dose, with relative sparing of the bladder, rectum, and urethra. In the total salvage plans, 24–53% of the gross tumor volume was covered, and the organs at risk received high doses. In 3 cases, a focal salvage plan could not be created because of multifocal tumor, seminal vesicle extension, or capsular extension. Conclusion Focal salvage treatment plans can be created in patients with local recurrent prostate cancer after radiotherapy. DCE-MRI supports the localization of the target area. This could lead to less toxicity in patients with local recurrent prostate cancer.