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000276223 1001_ $$0P:(DE-HGF)0$$aZamboglou, Constantinos$$b0
000276223 245__ $$aDevelopment and Validation of a Multi-institutional Nomogram of Outcomes for PSMA-PET-Based Salvage Radiotherapy for Recurrent Prostate Cancer.
000276223 260__ $$aChicago, Ill.$$bAmerican Medical Association$$c2023
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000276223 520__ $$aProstate-specific antigen membrane positron-emission tomography (PSMA-PET) is increasingly used to guide salvage radiotherapy (sRT) after radical prostatectomy for patients with recurrent or persistent prostate cancer.To develop and validate a nomogram for prediction of freedom from biochemical failure (FFBF) after PSMA-PET-based sRT.This retrospective cohort study included 1029 patients with prostate cancer treated between July 1, 2013, and June 30, 2020, at 11 centers from 5 countries. The initial database consisted of 1221 patients. All patients had a PSMA-PET scan prior to sRT. Data were analyzed in November 2022.Patients with a detectable post-radical prostatectomy prostate-specific antigen (PSA) level treated with sRT to the prostatic fossa with or without additional sRT to pelvic lymphatics or concurrent androgen deprivation therapy (ADT) were eligible.The FFBF rate was estimated, and a predictive nomogram was generated and validated. Biochemical relapse was defined as a PSA nadir of 0.2 ng/mL after sRT.In the nomogram creation and validation process, 1029 patients (median age at sRT, 70 years [IQR, 64-74 years]) were included and further divided into a training set (n = 708), internal validation set (n = 271), and external outlier validation set (n = 50). The median follow-up was 32 months (IQR, 21-45 months). Based on the PSMA-PET scan prior to sRT, 437 patients (42.5%) had local recurrences and 313 patients (30.4%) had nodal recurrences. Pelvic lymphatics were electively irradiated for 395 patients (38.4%). All patients received sRT to the prostatic fossa: 103 (10.0%) received a dose of less than 66 Gy, 551 (53.5%) received a dose of 66 to 70 Gy, and 375 (36.5%) received a dose of more than 70 Gy. Androgen deprivation therapy was given to 325 (31.6%) patients. On multivariable Cox proportional hazards regression analysis, pre-sRT PSA level (hazard ratio [HR], 1.80 [95% CI, 1.41-2.31]), International Society of Urological Pathology grade in surgery specimen (grade 5 vs 1+2: HR, 2.39 [95% CI, 1.63-3.50], pT stage (pT3b+pT4 vs pT2: HR, 1.91 [95% CI, 1.39-2.67]), surgical margins (R0 vs R1+R2+Rx: HR, 0.60 [95% CI, 0.48-0.78]), ADT use (HR, 0.49 [95% CI, 0.37-0.65]), sRT dose (>70 vs ≤66 Gy: HR, 0.44 [95% CI, 0.29-0.67]), and nodal recurrence detected on PSMA-PET scans (HR, 1.42 [95% CI, 1.09-1.85]) were associated with FFBF. The mean (SD) nomogram concordance index for FFBF was 0.72 (0.06) for the internal validation cohort and 0.67 (0.11) in the external outlier validation cohort.This cohort study of patients with prostate cancer presents an internally and externally validated nomogram that estimated individual patient outcomes after PSMA-PET-guided sRT.
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000276223 7001_ $$0P:(DE-HGF)0$$aPeeken, Jan C$$b1
000276223 7001_ $$aJanbain, Ali$$b2
000276223 7001_ $$aKatsahian, Sandrine$$b3
000276223 7001_ $$aStrouthos, Iosif$$b4
000276223 7001_ $$aFerentinos, Konstantinos$$b5
000276223 7001_ $$aFarolfi, Andrea$$b6
000276223 7001_ $$aKoerber, Stefan A$$b7
000276223 7001_ $$0P:(DE-HGF)0$$aDebus, Juergen$$b8
000276223 7001_ $$0P:(DE-HGF)0$$aVogel, Marco E$$b9
000276223 7001_ $$0P:(DE-HGF)0$$aCombs, Stephanie E$$b10
000276223 7001_ $$aVrachimis, Alexis$$b11
000276223 7001_ $$aMorganti, Alessio Giuseppe$$b12
000276223 7001_ $$0P:(DE-HGF)0$$aSpohn, Simon K B$$b13
000276223 7001_ $$aShelan, Mohamed$$b14
000276223 7001_ $$aAebersold, Daniel M$$b15
000276223 7001_ $$0P:(DE-HGF)0$$aGrosu, Anca-Ligia$$b16
000276223 7001_ $$aCeci, Francesco$$b17
000276223 7001_ $$aHenkenberens, Christoph$$b18
000276223 7001_ $$aKroeze, Stephanie G C$$b19
000276223 7001_ $$aGuckenberger, Matthias$$b20
000276223 7001_ $$aFanti, Stefano$$b21
000276223 7001_ $$aBelka, Claus$$b22
000276223 7001_ $$aBartenstein, Peter$$b23
000276223 7001_ $$aHruby, George$$b24
000276223 7001_ $$aScharl, Sophia$$b25
000276223 7001_ $$aWiegel, Thomas$$b26
000276223 7001_ $$aEmmett, Louise$$b27
000276223 7001_ $$aArnoux, Armelle$$b28
000276223 7001_ $$aSchmidt-Hegemann, Nina-Sophie$$b29
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