% IMPORTANT: The following is UTF-8 encoded.  This means that in the presence
% of non-ASCII characters, it will not work with BibTeX 0.99 or older.
% Instead, you should use an up-to-date BibTeX implementation like “bibtex8” or
% “biber”.

@ARTICLE{Moar:307501,
      author       = {E. F. Moar and M. Keilholz and G. T. Sheikh and R. A.
                      Werner and C. Trapp and J. Casuscelli and M. Chaloupka and
                      W. G. Kunz and P. Kazmierczak and L. Widjaja and S. F. Brose
                      and C. Eze and F. Walter and C. Belka$^*$ and M. Li and P.
                      Rogowski and N.-S. Schmidt-Hegemann},
      title        = {{PSMA} {PET}-{P}ositive {L}ocal {R}ecurrences in the
                      {P}rostate {B}ed {R}egion and {T}heir {C}overage {B}ased on
                      {C}linical {T}arget {V}olume {D}elineation {G}uidelines from
                      {ESTRO}-{ACROP}, {PERYTON}, {FROGG}, {GFRU}, and {RTOG}.},
      journal      = {Journal of nuclear medicine},
      volume       = {nn},
      issn         = {0097-9058},
      address      = {New York, NY},
      publisher    = {Soc.},
      reportid     = {DKFZ-2026-00006},
      pages        = {nn},
      year         = {2025},
      note         = {epub},
      abstract     = {Accurate clinical target volume (CTV) delineation is
                      crucial for effective salvage radiotherapy (sRT) following
                      radical prostatectomy. Current delineation guidelines are
                      largely based on expert opinion and conventional imaging,
                      with limited incorporation of prostate-specific membrane
                      antigen (PSMA) PET/CT data. As PSMA PET/CT enables sensitive
                      detection of local recurrences (LR), this study aims to
                      evaluate the benefit of implementing PSMA PET/CT imaging
                      into CTV delineation guidelines by evaluating spatial
                      distribution of PSMA PET/CT-positive LR and their coverage
                      by 5 commonly used guidelines. Methods: We retrospectively
                      analyzed 77 postprostatectomy patients with 79 LR, staged
                      with PSMA PET/CT and treated with sRT between 2014 and 2023.
                      Planning CT scans on which the LR were delineated as gross
                      tumor volume were further analyzed. The gross tumor volumes
                      were mapped into a standard patient using a modified
                      3-dimensional prostate bed template according to the PSMA
                      PET-guided hypofractionated salvage prostate bed
                      radiotherapy of biochemical failure after radical
                      prostatectomy for prostate cancer (PERYTON) guideline.
                      Coverage of 5 commonly used CTV guidelines, namely, Groupe
                      Francophone de Radiothérapie Urologique (GFRU), European
                      Society for Radiotherapy and Oncology-Advisory Committee on
                      Radiation Oncology Practice (ESTRO-ACROP), PERYTON, Faculty
                      of Radiation Oncology Genito-Urinary Group (FROGG), and
                      Radiation Therapy Oncology Group (RTOG) was assessed.
                      Coverage was categorized as fully $(100\%$ coverage),
                      partially $(100\%$ < coverage > $0\%),$ or not covered
                      $(0\%$ coverage). Results: Most LR occurred in the
                      vesicourethral anastomotic region (52/79, $66\%)$ and
                      predominantly (73/79, $92\%)$ posteriorly to the midline of
                      the bladder. Full coverage of LR varied across guidelines:
                      RTOG (44/79, $56\%),$ PERYTON (41/79, $52\%),$ ESTRO-ACROP
                      (34/79, $43\%),$ GFRU (31/79, $39\%),$ and FROGG (30/79,
                      $38\%).$ Partial coverage accounted for the remaining cases,
                      except for 1 lesion each missed entirely by FROGG, GFRU, and
                      PERYTON. The posterior, posterolateral, and lateral borders
                      were the most frequent sites where recurrences exceeded
                      guideline-defined CTVs. Conclusion: Although current CTV
                      guidelines achieve acceptable overall coverage, especially
                      concerning the inferior, anterior, and superior border,
                      recurrences tend to extend beyond posterior, lateral, and
                      posterolateral borders, indicating potential areas for
                      refinement. Incorporation of PSMA PET/CT data into CTV
                      delineation may improve robustness and reduce the risk of
                      geographic misses in sRT.},
      keywords     = {PSMA PET/CT (Other) / clinical target volume delineation
                      (Other) / local recurrence distribution (Other) / prostate
                      cancer (Other) / salvage radiotherapy (Other)},
      cin          = {MU01},
      ddc          = {610},
      cid          = {I:(DE-He78)MU01-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:41469156},
      doi          = {10.2967/jnumed.125.271324},
      url          = {https://inrepo02.dkfz.de/record/307501},
}