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@ARTICLE{Spohn:180464,
      author       = {S. K. B. Spohn$^*$ and V. Birkenmaier and J. Ruf and M. Mix
                      and A. Sigle and E. Haehl$^*$ and S. Adebahr$^*$ and T.
                      Sprave$^*$ and E. Gkika$^*$ and A. Rühle$^*$ and N. H.
                      Nicolay$^*$ and S. Kirste$^*$ and A. L. Grosu$^*$ and C.
                      Zamboglou$^*$},
      title        = {{R}isk {F}actors for {B}iochemical {R}ecurrence {A}fter
                      {PSMA}-{PET}-{G}uided {D}efinitive {R}adiotherapy in
                      {P}atients {W}ith {D}e {N}ovo {L}ymph {N}ode-{P}ositive
                      {P}rostate {C}ancer.},
      journal      = {Frontiers in oncology},
      volume       = {12},
      issn         = {2234-943X},
      address      = {Lausanne},
      publisher    = {Frontiers Media},
      reportid     = {DKFZ-2022-01343},
      pages        = {898774},
      year         = {2022},
      abstract     = {The National Comprehensive Cancer Network recommends
                      external beam radiotherapy (EBRT) combined with androgen
                      deprivation therapy (ADT) as the preferred treatment option
                      for newly diagnosed node-positive (cN1) prostate cancer
                      (PCa) patients. However, implementation of positron emission
                      tomography targeting prostate-specific membrane antigen
                      (PSMA-PET) in the staging of primary PCa patients has a
                      significant impact on RT treatment concepts. This study aims
                      to evaluate outcomes and their respective risk factors on
                      patients with PSMA-PET-based cN1 and/or cM1a PCa receiving
                      primary RT and ADT.Forty-eight patients with cN0 and/or cM1a
                      PCa staged by [18F]PSMA-1007-PET (n = 19) or
                      [68Ga]PSMA-11-PET (n = 29) were retrospectively included.
                      All patients received EBRT to the pelvis ± boost to
                      positive nodes, followed by boost to the prostate. The
                      impact of different PET-derived characteristics such as
                      maximum standard uptake value (SUVmax) and number of
                      PET-positive lymph nodes on biochemical recurrence-free
                      survival (BRFS) (Phoenix criteria) and metastasis-free
                      survival (MFS) was determined using Kaplan-Meier and Cox
                      proportional hazard regression analyses.Median follow-up was
                      24 months. Median initial serum prostate-specific antigen
                      was 20.2 ng/ml (IQR 10.2-54.2). Most patients had cT stage
                      ≥ 3 $(63\%)$ and ISUP grade ≥ 3 $(85\%).$ Median dose to
                      the prostate, elective nodes, and PET-positive nodes was 75
                      Gy, 45 Gy, and 55 Gy, respectively. Ninety percent of
                      patients received ADT with a median duration of 9 months
                      (IQR 6-18). In univariate analysis, cM1a stage (p = 0.03),
                      number of >2 pelvic nodes (p = 0.01), number of >1 abdominal
                      node (p = 0.02), and SUVmax values ≥ median (8.1 g/ml for
                      68Ga-PSMA-11 and 7.9 g/ml for 18F-PSMA-1007) extracted from
                      lymph nodes were significantly associated with unfavorable
                      BRFS, but classical clinicopathological features were not.
                      Number of >2 pelvic nodes (n = 0.03), number of >1 abdominal
                      node (p = 0.03), and SUVmax values ≥ median extracted from
                      lymph nodes were associated with unfavorable MFS. In
                      multivariate analysis, number of >2 pelvic lymph nodes was
                      significantly associated with unfavorable BRFS (HR 5.2, p =
                      0.01) and SUVmax values ≥ median extracted from lymph
                      nodes had unfavorable MFS (HR 6.3, p = 0.02).More than 2
                      PET-positive pelvic lymph nodes are associated with
                      unfavorable BRFS, and high SUVmax values are associated with
                      unfavorable MFS. Thus, the number of PET-positive lymph
                      nodes and the SUVmax value might be relevant prognosticators
                      to identify patients with favorable outcomes.},
      keywords     = {PSMA-PET/CT (Other) / lymph node positive (Other) /
                      personalization (Other) / prostate cancer (Other) /
                      radiotherapy (Other) / risk factors (Other)},
      cin          = {FR01 / E055},
      ddc          = {610},
      cid          = {I:(DE-He78)FR01-20160331 / I:(DE-He78)E055-20160331},
      pnm          = {315 - Bildgebung und Radioonkologie (POF4-315)},
      pid          = {G:(DE-HGF)POF4-315},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:35747822},
      pmc          = {pmc:PMC9209705},
      doi          = {10.3389/fonc.2022.898774},
      url          = {https://inrepo02.dkfz.de/record/180464},
}