¹⁸F-choline positron emission tomography/computed tomography-driven high-dose salvage radiation therapy in patients with biochemical progression after radical prostatectomy: feasibility study in 60 patients

Int J Radiat Oncol Biol Phys. 2014 Oct 1;90(2):296-302. doi: 10.1016/j.ijrobp.2014.05.050. Epub 2014 Jul 29.


Purpose: To retrospectively review data of a cohort of patients with biochemical progression after radical prostatectomy, treated according to a uniform institutional treatment policy, to evaluate toxicity and feasibility of high-dose salvage radiation therapy (80 Gy).

Methods and materials: Data on 60 patients with biochemical progression after radical prostatectomy between January 2009 and September 2011 were reviewed. The median value of prostate-specific antigen before radiation therapy was 0.9 ng/mL. All patients at time of diagnosis of biochemical recurrence underwent dynamic (18)F-choline positron emission tomography/computed tomography (PET/CT), which revealed in all cases a local recurrence. High-dose salvage radiation therapy was delivered up to total dose of 80 Gy to 18F-choline PET/CT-positive area. Toxicity was recorded according to the Common Terminology Criteria for Adverse Events, version 3.0, scale.

Results: Treatment was generally well tolerated: 54 patients (90%) completed salvage radiation therapy without any interruption. Gastrointestinal grade ≥2 acute toxicity was recorded in 6 patients (10%), whereas no patient experienced a grade ≥2 genitourinary toxicity. No grade 4 acute toxicity events were recorded. Only 1 patient (1.7%) experienced a grade 2 gastrointestinal late toxicity. With a mean follow-up of 31.2 months, 46 of 60 patients (76.6%) were free of recurrence. The 3-year biochemical progression-free survival rate was 72.5%.

Conclusions: At early follow-up, (18)F-choline PET/CT-driven high-dose salvage radiation therapy seems to be feasible and well tolerated, with a low rate of toxicity.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Choline / analogs & derivatives*
  • Disease Progression
  • Feasibility Studies
  • Fluorine Radioisotopes*
  • Gastrointestinal Tract / radiation effects
  • Humans
  • Male
  • Middle Aged
  • Multimodal Imaging / methods
  • Neoplasm Recurrence, Local / blood
  • Neoplasm Recurrence, Local / diagnostic imaging*
  • Neoplasm Recurrence, Local / radiotherapy*
  • Positron-Emission Tomography / methods
  • Prostate-Specific Antigen / blood
  • Prostatectomy
  • Prostatic Neoplasms / blood
  • Prostatic Neoplasms / diagnostic imaging*
  • Prostatic Neoplasms / radiotherapy*
  • Prostatic Neoplasms / surgery
  • Radiotherapy Dosage
  • Radiotherapy, Image-Guided / methods
  • Retrospective Studies
  • Salvage Therapy / adverse effects
  • Salvage Therapy / methods*
  • Tomography, X-Ray Computed / methods
  • Urogenital System / radiation effects


  • Fluorine Radioisotopes
  • fluoromethylcholine
  • Prostate-Specific Antigen
  • Choline