Fusion Scanner / IRM entièrement automatique : perspective d'utilisation pour la radiothérapie

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TEP/TDM et récidive biologique d’adénocarcinome prostatique : apport du ⁶⁸Ga-PSMA-11 lorsque la ¹⁸F-fluorocholine n’est pas contributive

International audienceIntroduction: Since April 201, we have introduced PET/CT using a ligand of prostate-specific membrane antigen labeled with gallium-68 (PSMA-11). We aimed to evaluate its positivity rate and impact in patients presenting biochemical recurrence of prostate cancer whose 18F-fluorocholine (FCH) PET/CT was non-contributive.Patients and method: Patients were prospectively included between April and December 2016. PET/CT was performed 60 min after injection of 2 MBq/kg of body mass of 68Ga-PSMA-11. Three anatomical areas were considered: prostatic lodge, pelvic lymph nodes and distant locations. The impact of PSMA-11 PET/CT was assessed by comparing changes in therapeutic strategy decided during multidisciplinary meeting.Results: Thirty-three patients were included. The mean PSA serum level measured on the month of the PSMA-11 PET/CT was 2,8 ng/mL. Twenty-five (76%) PSMA-11 PET/CT were positive, 7 (21%) negative and 1 (3%) equivocal. Of 11 patients whose FCH PET/CT showed equivocal foci, PSMA-11 PET/CT confirmed those foci in 5 cases. Follow-up was available for 18 patients (55%). PSMA-11 PET/CT results led to a change in management in 12 patients (67%).Conclusion: 68Ga-PSMA-11 PET/CT is useful in detecting recurrence of prostate cancer, by identifying residual disease which was not detected on other imaging modalities and by changing management of 2 patients out of 3.Level of evidence: 5.Introduction: Depuis avril 2016, nous avons introduit la TEP/TDM avec ligand de l’antigène membranaire spécifique de la prostate marqué au gallium-68 (PSMA-11). Nous avons évalué son taux de positivité et son impact chez les patients en récidive biologique de cancer de prostate, sans lésion affirmable en TEP/TDM à la 18F-fluorocholine (FCH).Patients et méthodes: Ces patients ont été prospectivement inclus d’avril à décembre 2016. La TEP/TDM a été effectuée 60 min après injection de 2 MBq/kg de 68Ga-PSMA-11. Trois sites anatomiques ont été considérés : loge prostatique, ganglions pelviens, et localisations à distance. L’impact des résultats de la TEP/TDM-PSMA-11 sur la prise en charge a été évalué en comparant les stratégies thérapeutiques proposées lors des réunions de concertation pluridisciplinaires.Résultats: Trente-trois patients ont été inclus. La concentration sérique moyenne du PSA mesurée au cours du mois de la TEP/TDM-PSMA-11 était de 2,8 ng/mL. Vingt-cinq TEP/TDM-PSMA-11 (76 %) étaient positives, 7 (21 %) négatives et 1 (3 %) douteuse. Sur 11 patients dont la TEP/TDM-FCH était douteuse, la TEP/TDM-PSMA-11 a confirmé les lésions douteuses dans 5 cas. Un suivi était disponible pour 18 patients (55 %). Les résultats des TEP/TDM-PSMA-11 ont conduit à un changement de la prise en charge chez 12 patients (67 %).Conclusion: La TEP/TDM au 68Ga-PSMA-11 est efficace dans la localisation de la récidive du cancer de la prostate, identifiant des cibles de maladie résiduelle non visualisées par les autres méthodes d’imagerie, changeant ainsi la prise en charge de 2 patients sur 3.Niveau de preuve: 5

Uno studio di riferimento su 883 pazienti affetti da neoplasia della rinofaringe trattati in due Centri italiani dal 1977 al 2000. Parte I: evoluzione delle scelte tecniche e sopravvivenza

PurposE. The authors sought to define treatment results according to the different accrual periods and clinical- therapeutic features in a large series of nasopharyngeal cancer (NPC) patients treated in two Italian centres over more than two decades. Materials and methods. A total of 883 patients consecutively treated with radiotherapy between 1977 and 2000 at the Florence (FLO) and Brescia (IRA) Radiation Oncology centres were studied. Five-year overall (OS) and disease-specific (DSS) actuarial survival rates in the different pathological, clinical and therapeutic subgroups were calculated, along with the actuarial local-regional control (LRC) probabilitY. Results. At univariate analysis, survival and local control rates were significantly better in the more recent accrual periods and in the more favourable disease presentations; treatment-related parameters mainly affect LRC. At multivariate analysis, patient- and disease-related factors had a more evident prognostic effect than did therapeutic factors, although dose to the nasopharynx and treatment technique had a marginally significant impact on DSS and OS. Conclusions. Results of this benchmark study may be useful for understanding the development of new radio- therapy techniques for NPC, such as three-dimensional conformal radiotherapy (3D-CRT) and particularly intensity- modulated radiotherapy (IMRT). © Springer-Verlag 2011