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@ARTICLE{Medici:304093,
      author       = {F. Medici and D. M. Aebersold and J. Casuscelli and L.
                      Emmett and S. Fanti and A. Farolfi and M. Guckenberger and
                      G. Hruby and S. A. Koerber and S. A. Thoma and J. C.
                      Peeken$^*$ and P. Rogowski and S. Scharl and M. Shelan and
                      S. K. B. Spohn$^*$ and I. Strouthos and M. Vogel$^*$ and T.
                      Wiegel and C. Zamboglou$^*$ and N.-S. Schmidt-Hegemann and
                      A. G. Morganti and S. Cilla},
      title        = {{R}efining prognostic stratification in salvage
                      radiotherapy for prostate cancer: {A} retrospective
                      multicenter cohort study using {PSMA}-{PET} and machine
                      learning.},
      journal      = {Radiotherapy and oncology},
      volume       = {nn},
      issn         = {0167-8140},
      address      = {Amsterdam [u.a.]},
      publisher    = {Elsevier Science},
      reportid     = {DKFZ-2025-01761},
      pages        = {nn},
      year         = {2025},
      note         = {epub},
      abstract     = {Salvage radiotherapy (SRT) is the standard treatment for
                      biochemical recurrence (bREC) after radical prostatectomy
                      (RP), yet optimal radiation dose, field size, and the role
                      of advanced imaging like PSMA-PET remain unclear. This study
                      assessed the impact of SRT dose and the prognostic role of
                      PSMA-PET on 2-year biochemical relapse-free survival (bRFS)
                      in patients with localized disease.In this retrospective
                      multicenter study, 255 patients treated with SRT across 11
                      centers were selected from a database of 1,201 cases.
                      Inclusion criteria included PSA persistence/recurrence
                      (≥0.1 ng/mL) post-RP and negative PSMA-PET for nodal or
                      distant metastases. Patients receiving androgen deprivation
                      therapy or with PSA > 0.5 ng/mL pre-SRT were excluded.
                      Prognostic factors were identified using LASSO analysis and
                      modeled with CART analysis. The primary endpoint was 2-year
                      bRFS.With a median follow-up of 33 months, 2-year bRFS was
                      88.2 $\%.$ Lower pre-SRT PSA (<0.2 ng/mL), PSMA-PET
                      negativity, longer PSA doubling time, older age, favorable
                      ISUP grades (1-2), and shorter intervals from surgery to
                      bREC were associated with improved bRFS. CART analysis
                      demonstrated that PSMA-PET findings significantly influenced
                      prognosis in patients with PSA levels below 0.2 ng/mL, while
                      PSA-doubling time was predictive in patients with PSA
                      0.2-0.5 ng/mL. SRT dose and elective nodal irradiation did
                      not significantly affect bRFS.This study underscores the
                      complexity of prognostic modeling in SRT for prostate
                      cancer, highlighting the value of PSMA-PET and CART for
                      refined risk stratification.},
      keywords     = {Androgen deprivation therapy (Other) / Biochemical
                      recurrence (Other) / Biochemical relapse-free survival
                      (Other) / ISUP grade (Other) / Metastasis-free survival
                      (Other) / PSMA-PET (Other) / Pathological T stage (Other) /
                      Prognostic factors (Other) / Prophylactic lymph node
                      irradiation (Other) / Prostate cancer (Other) / Radical
                      prostatectomy (Other) / Radiotherapy dosing (Other) /
                      Salvage radiotherapy (Other) / Therapeutic intensification
                      (Other)},
      cin          = {MU01 / FR01},
      ddc          = {610},
      cid          = {I:(DE-He78)MU01-20160331 / I:(DE-He78)FR01-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:40849083},
      doi          = {10.1016/j.radonc.2025.111113},
      url          = {https://inrepo02.dkfz.de/record/304093},
}