PSMA-PET based radiotherapy: a review of initial experiences, survey on current practice and future perspectives
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REVIEW
Open Access
PSMA-PET based radiotherapy: a review of initial experiences, survey on current practice and future perspectives Sebastian Zschaeck1,17* , Fabian Lohaus2,3, Marcus Beck1, Gregor Habl4,5, Stephanie Kroeze6, Constantinos Zamboglou7,8, Stefan Alexander Koerber9,10, Jürgen Debus9,10, Tobias Hölscher2,3, Peter Wust1, Ute Ganswindt13, Alexander D. J. Baur14, Klaus Zöphel15, Nikola Cihoric16, Matthias Guckenberger6, Stephanie E. Combs4,5,12, Anca Ligia Grosu7,8, Pirus Ghadjar1 and Claus Belka11,12
Abstract 68
Gallium prostate specific membrane antigen (PSMA) ligand positron emission tomography (PET) is an increasingly used imaging modality in prostate cancer, especially in cases of tumor recurrence after curative intended therapy. Owed to the novelty of the PSMA-targeting tracers, clinical evidence on the value of PSMA-PET is moderate but rapidly increasing. State of the art imaging is pivotal for radiotherapy treatment planning as it may affect dose prescription, target delineation and use of concomitant therapy. This review summarizes the evidence on PSMA-PET imaging from a radiation oncologist’s point of view. Additionally a short survey containing twelve examples of patients and 6 additional questions was performed in seven mayor academic centers with experience in PSMA ligand imaging and the findings are reported here. Keywords: PSMA-PET, Prostate-cancer, Salvage radiotherapy, Primary radiotherapy, Image guided treatment planning, Review, Survey
Background Positron emission tomography (PET) imaging with 68 Gallium-labeled prostate specific membrane antigen ligands (PSMA) for prostate cancer patients has entered clinical practice for staging prior to radiotherapeutic treatment, especially for high-risk tumors and patients suffering biochemical recurrence after surgery. As PET is usually performed in combination with computed tomography (CT) for attenuation correction and anatomical information, the term PSMA PET is subsequently used as an abbreviation for this combined examination, unless otherwise stated. PSMA-PET has a higher specificity and sensitivity for the detection of tumor lesions compared to stand alone CT, magnetic resonance imaging (MRI) and Choline-PET. It offers * Correspondence: [email protected] 1 Department of Radiation Oncology, Klinik für Radioonkologie und Strahlentherapie, Charité Universitätsmedizin Berlin, Berlin, Germany 17 Charité Universitätsmedizin Berlin, Klinik für Radioonkologie und Strahlentherapie, Augustenburger Platz 1, 13353 Berlin, Germany Full list of author information is available at the end of the article
promising opportunities for treatment individualization [1, 2]. PSMA-PET (CT/MRI) was introduced in 2012 [3–5]. Its clinical use and the scientific interest in PSMA-PET imaging increased almost exponentially as suggested by a Pubmed search using the terms PSMA PET (Fig. 1). Due to the relative novelty of this radiotracer there is a steadily increasing clinical evidence for the implementation of PSMA PET for clinical decision making and radio
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