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The Prognostic Value of DCE-MRI Findings before Salvage Radiotherapy after Radical Prostatectomy

Authors :
Alessia Farneti
Marta Bottero
Adriana Faiella
Diana Giannarelli
Luca Bertini
Valeria Landoni
Patrizia Vici
Pasqualina D’Urso
Giuseppe Sanguineti
Source :
Cancers, Volume 15, Issue 4, Pages: 1246
Publication Year :
2023
Publisher :
MDPI AG, 2023.

Abstract

Background: To investigate the predictive role of dynamic contrast-enhanced-magnetic resonance imaging (DCE-MRI) findings before salvage radiotherapy after radical prostatectomy (RP). Methods: This retrospective study selected patients with biochemical failure (BF) after RP restaged with DCE-MRI. Patients underwent sRT in 30 fractions delivering 66–69 Gy and 73.5 Gy to the prostatic fossa and to the local failure as per DCE-MRI, respectively. Pelvic nodes were treated to 54 Gy in selected patients. The endpoint was BF after sRT. Results: In total, 236 patients were analyzed and 146 (61.9%) had presumed local failure at DCE-MRI: 54.8%, 23.8% and 21.4% were found at the vesico-urethral anastomosis (VUA), the bladder neck and the retro-vesical space, respectively. The presence of a local failure at DCE-MRI halved the risk of BF; VUA-only location and lesion volume were independently correlated with survival without evidence of biochemical failure (bNED) at multivariable analysis. For patients with VUA-only disease up to 0.4 cc, the 4-year-bNED was 94.6% (95%CI: 80.2–98.6%) as opposed to 80.9% (95%CI: 71.6–87.4%) and 73.7% (95%CI: 63.1–81.8%) for other lesions and no macrodisease, respectively. Conclusions: DCE-MRI at restaging for BF after RP provides predictive and therapeutic information. Patients with small lesions at the VUA have an excellent prognosis after sRT.

Details

ISSN :
20726694
Volume :
15
Database :
OpenAIRE
Journal :
Cancers
Accession number :
edsair.doi.dedup.....65647aeec40d1f88a8039367254fb4b5
Full Text :
https://doi.org/10.3390/cancers15041246