| Zhang Huan,Qi Xin,Liao Xuhe,et al.Optimization of clinical target volume delineation for prostate cancer radiotherapy based on prostate bed occurrence patterns in prostate-specific membrane antigen positron emission tomography[J].Chinese Journal of Radiological Medicine and Protection,2025,45(10):966-972 |
| Optimization of clinical target volume delineation for prostate cancer radiotherapy based on prostate bed occurrence patterns in prostate-specific membrane antigen positron emission tomography |
| Received:November 03, 2024 |
| DOI：10.3760/cma.j.cn112271-20241103-00422 |
| KeyWords:Prostate cancer Prostate-specific membrane antigen positron emission tomography(PSMA PET) Prostate bed recurrence Postoperative radiotherapy Zoning |
| FundProject:首都卫生发展科研专项项目(2024-2-4075)；北京大学世纪金源“腾云临床研究专项”(TY2025001)；中央高水平医院临床研究建设项目(2023IR20，2024CX23)；2023癌症、心脑血管、呼吸和代谢性疾病防治研究国家科技重大专项(2023ZD0511300) |
| Author Name | Affiliation | E-mail | | Zhang Huan | Department of Radiation Oncology, Peking University First Hospital, Beijing 100032, China | | | Qi Xin | Department of Radiation Oncology, Peking University First Hospital, Beijing 100032, China | | | Liao Xuhe | Department of Nuclear Medicine, Peking University First Hospital, Beijing 100032, China | | | Chen Cheng | Department of Urology, Peking University First Hospital, Beijing 100032, China | | | Wu Jingyun | Department of Radiology, Peking University First Hospital, Beijing 100032, China | | | Zhang Jianhua | Department of Nuclear Medicine, Peking University First Hospital, Beijing 100032, China | | | Fan Yan | Department of Nuclear Medicine, Peking University First Hospital, Beijing 100032, China | | | Gao Xianshu | Department of Radiation Oncology, Peking University First Hospital, Beijing 100032, China | | | Li Hongzhen | Department of Radiation Oncology, Peking University First Hospital, Beijing 100032, China | hongzhen.li@pkufh.com |
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| Abstract:: |
| Objective To explore the optimization potential of clinical target volume (CTV) delineation proposed in the guidelines of the Oncology Group (RTOG), the Francophone Group of Urological Radiotherapy (GFRU), and the European Society for Radiotherapy and Oncology (ESTRO) based on prostate bed local occurrence patterns after radical prostatectomy identified using prostate-specific membrane antigen positron emission tomography (PSMA PET). Methods A retrospective analysis was conducted on patients with local prostate bed recurrence after radical prostatectomy who underwent PSMA PET at the Department of Nuclear Medicine, Peking University First Hospital from September 2021 to February 2024. The central point of each recurrence was marked. A six-zone method was established based on prostate bed anatomy and the characteristics of cross-sectional imaging. Then, the positional relationships (within or outside) were recorded with respect to recurrences and CTV defined by the RTOG, GFRU, and ESTRO (CTVRTOG, CTVGFRU, and CTVESTRO), followed the analysis of the recurrence rates and distribution characteristics of various zones. Results A total of 63 patients with prostate bed recurrence after radical prostatectomy were enrolled in this study, including 97 recurrences. The recurrence rates in the six zones were as follows: 10% of zone 1, 22% of zone 2, 29% of zone 3, 2% of zone 4, 12% of zone 5a, 18% of zone 5b, and 7% of zone 6. Among these zones, zones 2 and 3 showed the highest and second-highest recurrence rates, respectively. CTVGFRU and CTVESTRO completely covered zones 2 and 3, while CTVRTOG covered zone 2 completely and zone 3 partially. Zone 4, characterized by a low recurrence rate, was not covered by CTVGFRU and CTVESTRO but was entirely covered by CTVRTOG. Zone 5a, with a recurrence rate of 12%, was completely covered by CTVRTOG but was partially covered by CTVGFRU and CTVESTRO. The range of 1.3 cm in front of the posterior wall of the bladder covered all recurrences in zone 5a. Conclusions For CTV delineation of the prostate cancer surgical bed, zone 4, the anterior half of the bladder above the pubic symphysis midpoint, should be contracted due to the low recurrence rate in this zone. In contrast, the anterior boundary above the pubic symphysis midpoint should extend to 1.3 cm in front of the posterior wall of the bladder to completely cover the recurrence zones. |
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