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@ARTICLE{Hotta:274582,
author = {M. Hotta and A. Gafita and V. Murthy and M. R. Benz and I.
Sonni and I. A. Burger and M. Eiber and L. Emmett and A.
Farolfi and W. P. Fendler$^*$ and M. M. Weber$^*$ and M. S.
Hofman and T. A. Hope and C. Kratochwil and J. Czernin and
J. Calais},
title = {{PSMA} {PET} {T}umor-to-{S}alivary {G}land {R}atio to
{P}redict {R}esponse to [177{L}u]{PSMA} {R}adioligand
{T}herapy: {A}n {I}nternational {M}ulticenter
{R}etrospective {S}tudy.},
journal = {Journal of nuclear medicine},
volume = {64},
number = {7},
issn = {0097-9058},
address = {New York, NY},
publisher = {Soc.},
reportid = {DKFZ-2023-00659},
pages = {1024-1029},
year = {2023},
note = {2023 Jul;64(7):1024-1029},
abstract = {Prostate-specific membrane antigen (PSMA)-targeted
radioligand therapy can improve the outcome of patients with
advanced metastatic castration-resistant prostate cancer,
but patients do not respond uniformly. We hypothesized that
using the salivary glands as a reference organ can enable
selective patient stratification. We aimed to establish a
PSMA PET tumor-to-salivary gland ratio (PSG score) to
predict outcomes after [177Lu]PSMA. Methods: In total, 237
men with metastatic castration-resistant prostate cancer
treated with [177Lu]PSMA were included. A quantitative PSG
(qPSG) score (SUVmean ratio of whole-body tumor to parotid
glands) was semiautomatically calculated on baseline
[68Ga]PSMA-11 PET images. Patients were divided into 3
groups: high (qPSG > 1.5), intermediate (qPSG = 0.5-1.5),
and low (qPSG < 0.5) scores. Ten readers interpreted the
3-dimensional maximum-intensity-projection baseline
[68Ga]PSMA- 11 PET images and classified patients into 3
groups based on visual PSG (vPSG) score: high (most of the
lesions showed higher uptake than the parotid glands)
intermediate (neither low nor high), and low (most of the
lesions showed lower uptake than the parotid glands).
Outcome data included a more than $50\%$ prostate-specific
antigen decline, prostate-specific antigen (PSA)
progression-free survival, and overall survival (OS).
Results: Of the 237 patients, the numbers in the high,
intermediate, and low groups were 56 $(23.6\%),$ 163
$(68.8\%),$ and 18 $(7.6\%),$ respectively, for qPSG score
and 106 $(44.7\%),$ 96 $(40.5\%),$ and 35 $(14.8\%),$
respectively, for vPSG score. The interreader
reproducibility of the vPSG score was substantial (Fleiss
weighted k, 0.68). The more than $50\%$ prostate-specific
antigen decline was better in patients with a higher PSG
score (high vs. intermediate vs. low, $69.6\%$ vs. $38.7\%$
vs. $16.7\%,$ respectively, for qPSG [P < 0.001] and
$63.2\%$ vs $33.3\%$ vs $16.1\%,$ respectively, for vPSG [P
< 0.001]). The median PSA progression-free survival of the
high, intermediate, and low groups by qPSG score was 7.2,
4.0, and 1.9 mo (P < 0.001), respectively, by qPSG score and
6.7, 3.8, and 1.9 mo (P < 0.001), respectively, by vPSG
score. The median OS of the high, intermediate, and low
groups was 15.0, 11.2, and 13.9 mo (P = 0.017),
respectively, by qPSG score and 14.3, 9.6, and 12.9 mo (P =
0.018), respectively, by vPSG score. Conclusion: The PSG
score was prognostic for PSA response and OS after
[177Lu]PSMA. The visual PSG score assessed on 3-dimensional
maximum-intensity-projection PET images yielded substantial
reproducibility and comparable prognostic value to the
quantitative score.},
keywords = {Oncology: GU (Other) / PET (Other) / PET/CT (Other) / PSMA
PET (Other) / Radionuclide Therapy (Other) / [177Lu]PSMA
(Other) / parotid glands (Other) / radioligand therapy
(Other) / visual criteria (Other)},
cin = {ED01},
ddc = {610},
cid = {I:(DE-He78)ED01-20160331},
pnm = {899 - ohne Topic (POF4-899)},
pid = {G:(DE-HGF)POF4-899},
typ = {PUB:(DE-HGF)16},
pubmed = {pmid:36997329},
doi = {10.2967/jnumed.122.265242},
url = {https://inrepo02.dkfz.de/record/274582},
}