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ASTRO 2020: Using Fluciclovine PET Imaging to Guide Prostate Cancer Radiotherapy

By: Lauren Harrison, MS
Posted: Thursday, November 5, 2020

Adding the radiotracer fluciclovine to PET imaging to direct prostate cancer radiotherapy after prostatectomy resulted in an improvement in disease-free survival rates for up to 4 years. Ashesh B. Jani, MD, of Emory University, Atlanta, presented the results of the phase II/III EMPIRE-1 trial on behalf of his colleagues at the 2020 American Society for Radiation Oncology (ASTRO) Annual Meeting (Abstract LBA 1).

“What this research has found is that integrating advanced molecular imaging into the treatment planning process allows us to do a better job of selecting patients for radiation therapy, guiding radiation treatment decisions and planning, and ultimately keeping patients’ cancer under control,” said Dr. Jani in an ASTRO press release.

The study enrolled 165 patients with prostate cancer who had detectable PSA levels after prostatectomy. All patients underwent conventional imaging (CT or MRI) for initial treatment planning before being randomly assigned to radiotherapy directed by either conventional imaging or PET using fluciclovine. Radiotherapy was rigidly determined by PET findings: no radiotherapy was given to those with extrapelvic uptake (4 patients), 45.0 to 54.0 Gy was given to patients with pelvic uptake (27 patients), and 64.8 to 70.2 Gy was given to those with uptake in the prostate bed (32 patients) or with no uptake (16 patients). This system led to a change in therapy among 35.4% of patients, including 4 patients who subsequently did not receive radiotherapy.

After a median follow-up of 2.5 years, the 3-year failure-free survival rate was 63% among patients whose radiotherapy was directed by traditional imaging and 75.5% among patients whose therapy was directed by fluciclovine PET. At 4 years, the failure-free survival rates were 51.2% and 75.5%, respectively. The toxicity was similar among both patient groups, suggesting the PET-guided treatment may be well tolerated.

“This is a jump ahead of the traditional way of looking at things,” said Dr. Jani. “It helps us to pinpoint the location of the prostate cancer recurrence.”

Disclosure: For full disclosures of the study authors, visit plan.core-apps.com.



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