Maarten L. Donswijk

The Impact of Adding Sentinel Node Biopsy to Extended Pelvic Lymph Node Dissection on Biochemical Recurrence in Prostate Cancer Patients Treated with Robot-Assisted Radical Prostatectomy

The benefit of adding sentinel node biopsy (SNB) to extended pelvic lymph node dissection (ePLND) remains controversial. The aim of our study was to evaluate biochemical recurrence (BCR) after robot-assisted radical prostatectomy and ePLND in prostate cancer patients, stratified by the application of SNB. The results were compared with the predictions of the updated Memorial Sloan Kettering Cancer Center nomogram. Methods: Between January 2006 and November 2016, 920 patients underwent robot-assisted radical prostatectomy and ePLND with or without SNB (184 and 736 patients, respectively). BCR was defined as 2 consecutive prostate-specific antigen rises of at least 0.2 ng/mL. The Kaplan–Meier method and Cox regression analyses were used to identify predictors of BCR. Results: Median follow-up was 28 mo (interquartile range, 13–56.7 mo). The 5-y BCR-free survival rate was 80.5% and 69.9% in the ePLND+SNB and ePLND groups, respectively. At multivariate analysis, prostate-specific antigen level, primary Gleason grade greater than 3, seminal vesicle invasion, and higher number of removed and positive nodes were independent predictors of BCR in the ePLND group. In the ePLND+SNB group, only the number of positive nodes was an independent predictor of BCR. The overall accuracy of the Memorial Sloan Kettering Cancer Center nomogram was higher in the ePLND+SNB than in the ePLND group. However, the nomogram was underestimating the probability of BCR-free status in the ePLND+SNB group, whereas the ePLND group was performing as predicted. Conclusion: Adding SNB to ePLND improves BCR-free survival, although the precise explanation of this observation remains speculative. Our results should be interpreted cautiously, given the nonrandomized nature and the selection bias of the study.

A novel semi-robotized device for high-precision (18)F-FDG-guided breast cancer biopsy.

PURPOSE To assess the 3D geometric sampling accuracy of a new PET-guided system for breast cancer biopsy (BCB) from areas within the tumour with high 18F-FDG uptake. MATERIALS AND METHODS In the context of the European Union project MammoCare, a prototype semi-robotic stereotactic prototype BCB-device was incorporated into a dedicated high resolution PET-detector for breast imaging. The system consists of 2 stacked rings, each containing 12 plane detectors, forming a dodecagon with a 186mm aperture for 3D reconstruction (1mm3 voxel). A vacuum-assisted biopsy needle attached to a robot-controlled arm was used. To test the accuracy of needle placement, the needle tip was labelled with 18F-FDG and positioned at 78 target coordinates distributed over a 35mm×24mm×28mm volume within the PET-detector field-of-view. At each position images were acquired from which the needle positioning accuracy was calculated. Additionally, phantom-based biopsy proofs, as well as MammoCare images of 5 breast cancer patients, were evaluated for the 3D automated locating of 18F-FDG uptake areas within the tumour. RESULTS Needle positioning tests revealed an average accuracy of 0.5mm (range 0-1mm), 0.6mm (range 0-2mm), and 0.4mm (range 0-2mm) for the x/y/z-axes, respectively. Furthermore, the MammoCare system was able to visualize and locate small (<10mm) regions with high 18F-FDG uptake within the tumour suitable for PET-guided biopsy after being located by the 3D automated application. CONCLUSIONS Accuracy testing demonstrated high-precision of this semi-automatic 3D PET-guided system for breast cancer core needle biopsy. Its clinical feasibility evaluation in breast cancer patients scheduled for neo-adjuvant chemotherapy will follow.

Vroege oncologische uitkomsten van [ 68 Ga]PSMA-PET/CT-gestuurde salvagetherapie bij mannen met biochemisch recidief na radicale prostatectomie

SamenvattingDeze studie toont de uitkomsten van [68Ga]PSMA-PET/CT-gestuurde salvagetherapie bij mannen (n = 142) na radicale prostatectomie (RP) met een stijging van het prostaatspecifiek antigeen (PSA; 0,05–0,5 ng/ml). De [68Ga]PSMA-PET/CT-scan was positief voor tumoractiviteit bij 84 mannen (36: prostaatfossa; 31: pelviene lymfeklieren ± prostaatfossa; 17: metastase op afstand). N = 88 ondergingen een salvagebehandeling (med. follow-up 12,5 mnd). Er was een PSA-respons (PSA < 0,01 of reductie >75 % in laatste PSA na salvagebehandeling) bij 69,3 % van de mannen (83 % met een negatieve PET/CT, 81 % met een positieve PET/CT in de prostaatfossa na radiotherapie op de fossa en 48,5 % bij een PET/CT die verdacht was voor een metastase in de pelviene lymfeklieren). [68Ga]PSMA-PET/CT-imaging is instaat om patiënten met een biochemisch recidief na RP te identificeren die beter reageren op salvagetherapie.AbstractThis study was performed to assess the value of [68Ga]PSMA PET/CT informed salvage therapy in men (n = 142) after radical prostatectomy with a rising prostate specific antigen PSA (0.05–0.5 ng/ml). [68Ga]PSMA PET/CT scan was positive for tumor activity in 84 men (36: prostate fossa, 31 pelvic lymph nodes ± prostate fossa; 17 distant metastases. 88 men underwent salvage therapy, with a median follow-up of 12.5 months. PSA response (PSA ≤ 0.01 or a >75% reduction in de latest PSA measured after salvage therapy) was recorded in 69.3% of men and found in 83% of men with a negative PET/CT, 81% of men with a positive PET/CT in the prostate fossa, and 48.5% of the men that were suspected of pelvic lymph nodes metastases on PET/CT. In conclusion, [68Ga]PSMA PET/CT imaging stratifies men who responds better to salvage therapy.

68Ga PSMA PET/CT predicts complete biochemical response from radical prostatectomy and lymph node dissection in intermediate and high‐risk prostate cancer

To determine the value of gallium‐68‐prostate‐specific membrane antigen (68Ga‐PSMA)‐11 positron emission tomography (PET) /computed tomography (CT) in men with newly diagnosed prostate cancer.

Lymphatic Drainage from Renal Tumors In Vivo: A Prospective Sentinel Node Study Using SPECT/CT Imaging

Purpose: Lymphatic drainage from renal tumors is unpredictable. In vivo drainage studies of primary lymphatic landing sites may reveal the variability and dynamics of lymphatic connections. The purpose of this study was to investigate the lymphatic drainage pattern of renal tumors in vivo with single photon emission/computerized tomography after intratumor radiotracer injection. Materials and Methods: We performed a phase II, prospective, single arm study to investigate the distribution of sentinel nodes from renal tumors on single photon emission/computerized tomography. Patients with cT1‐3 (less than 10 cm) cN0M0 renal tumors of any subtype were enrolled in analysis. After intratumor ultrasound guided injection of 0.4 ml 99mTc‐nanocolloid we performed preoperative imaging of sentinel nodes with lymphoscintigraphy and single photon emission/computerized tomography. Sentinel and locoregional nonsentinel nodes were resected with a &ggr; probe combined with a mobile &ggr; camera. The primary study end point was the location of sentinel nodes outside the locoregional retroperitoneal templates on single photon emission/computerized tomography. Using a Simon minimax 2‐stage design to detect a 25% extralocoregional retroperitoneal template location of sentinel nodes on imaging at &agr; = 0.05 and 80% power at least 40 patients with sentinel node imaging on single photon emission/computerized tomography were needed. Results: Of the 68 patients 40 underwent preoperative single photon emission/computerized tomography of sentinel nodes and were included in primary end point analysis. Lymphatic drainage outside the locoregional retroperitoneal templates was observed in 14 patients (35%). Eight patients (20%) had supradiaphragmatic sentinel nodes. Conclusions: Sentinel nodes from renal tumors were mainly located in the respective locoregional retroperitoneal templates. Simultaneous sentinel nodes were located outside the suggested lymph node dissection templates, including supradiaphragmatic sentinel nodes in more than a third of the patients.