Metastasis-Free Survival and Patterns of Distant Metastatic Disease After Prostate-Specific Membrane Antigen Positron Emission Tomography (PSMA-PET)-Guided Salvage Radiation Therapy in Recurrent or Persistent Prostate Cancer After Prostatectomy.

Zamboglou, Constantinos; Strouthos, Iosif; Sahlmann, Joerg; Farolfi, Andrea; Serani, Francesca; Medici, Federica; Cavallini, Letizia; Morganti, Alessio Guiseppe; Trapp, Christian; Koerber, Stefan A; Peeken, Jan C; Vogel, Marco M E; Schiller, Kilian; Combs, Stephanie E; Eiber, Matthias; Vrachimis, Alexis; Ferentinos, Konstantinos; Spohn, Simon K B; Kirste, Simon; Gratzke, Christian; Ruf, Juri; Grosu, Anca-Ligia; Ceci, Francesco; Fendler, Wolfgang P; Miksch, Jonathan; Kroeze, Stephanie; Guckenberger, Matthias; Lanzafame, Helena; Fanti, Stefano; Hruby, George; Wiegel, Thomas; Emmett, Louise; Schmidt-Hegemann, Nina Sophie; Henkenberens, Christoph

doi:10.1016/j.ijrobp.2022.04.048

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2022

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Title:: Metastasis-Free Survival and Patterns of Distant Metastatic Disease After Prostate-Specific Membrane Antigen Positron Emission Tomography (PSMA-PET)-Guided Salvage Radiation Therapy in Recurrent or Persistent Prostate Cancer After Prostatectomy.
Document type:: Journal Article
Author(s):: Zamboglou, Constantinos; Strouthos, Iosif; Sahlmann, Joerg; Farolfi, Andrea; Serani, Francesca; Medici, Federica; Cavallini, Letizia; Morganti, Alessio Guiseppe; Trapp, Christian; Koerber, Stefan A; Peeken, Jan C; Vogel, Marco M E; Schiller, Kilian; Combs, Stephanie E; Eiber, Matthias; Vrachimis, Alexis; Ferentinos, Konstantinos; Spohn, Simon K B; Kirste, Simon; Gratzke, Christian; Ruf, Juri; Grosu, Anca-Ligia; Ceci, Francesco; Fendler, Wolfgang P; Miksch, Jonathan; Kroeze, Stephanie; Guckenberger, Matthias; Lanzafame, Helena; Fanti, Stefano; Hruby, George; Wiegel, Thomas; Emmett, Louise; Schmidt-Hegemann, Nina Sophie; Henkenberens, Christoph «
Zamboglou, Constantinos; Strouthos, Iosif; Sahlmann, Joerg; Farolfi, Andrea; Serani, Francesca; Medici, Federica; Cavallini, Letizia; Morganti, Alessio Guiseppe; Trapp, Christian; Koerber, Stefan A; Peeken, Jan C; Vogel, Marco M E; Schiller, Kilian; Combs, Stephanie E; Eiber, Matthias; Vrachimis, Alexis; Ferentinos, Konstantinos; Spohn, Simon K B; Kirste, Simon; Gratzke, Christian; Ruf, Juri; Grosu, Anca-Ligia; Ceci, Francesco; Fendler, Wolfgang P; Miksch, Jonathan; Kroeze, Stephanie; Guckenberg... »
Abstract:: PURPOSE: Prostate-specific membrane antigen positron emission tomography (PSMA-PET) is increasingly used to guide salvage radiation therapy (sRT) in patients with prostate cancer and biochemical recurrence/persistence after prostatectomy. This work examined (1) metastasis-free survival (MFS) after PSMA-PET guided sRT and (2) the metastatic patterns on PSMA-PET images after sRT. METHODS AND MATERIALS: This retrospective, multicenter (9 centers, 5 countries) study included patients referred for PSMA-PET due to recurrent/persistent disease after prostatectomy. Patients with distant metastases (DM) on PSMA-PET before sRT were excluded. Cox regression was performed to assess the effect of clinical parameters on MFS. The distribution of PSMA-PET detected DM after sRT and their respective risk factors were analyzed. RESULTS: All (n = 815) patients received intensity modulated RT to the prostatic fossa. In the case of PET-positive pelvic lymph nodes (PLN-PET) (n = 275, 34%), pelvic lymphatics had been irradiated. Androgen deprivation therapy had been given in 251 (31%) patients. The median follow-up after sRT was 36 months. The 2-/4-year MFS after sRT were 93%/81%. In multivariate analysis, the presence of PLN-PET was a strong predictor for MFS (hazard ratio, 2.39; P < .001). After sRT, DM were detected by PSMA-PET in 128/198 (65%) patients, and 2 metastatic patterns were observed: 43% had DM in sub-diaphragmatic para-aortic LNs (abdominal-lymphatic), 45% in bones, 9% in supra-diaphragmatic LNs, and 6% in visceral organs (distant). Two distinct signatures with risk factors for each pattern were identified. CONCLUSIONS: MFS in our study is lower compared with previous studies, obviously due to the higher detection rate of DM in PSMA-PET after sRT. Thus, it remains unclear whether MFS is a surrogate endpoint for overall survival in PSMA PET-staged patients in the post-sRT setting. PLN-PET may be proposed as a new surrogate parameter predictive of MFS. Analysis of recurrence patterns in PET after sRT revealed risk factor signatures for 2 metastatic patterns (abdominal-lymphatic and distant), which may allow individualized sRT concepts in the future.
Journal title abbreviation:: Int J Radiat Oncol Biol Phys
Year:: 2022
Journal volume:: 113
Journal issue:: 5
Pages contribution:: 1015-1024
Fulltext / DOI:: doi:10.1016/j.ijrobp.2022.04.048
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/35659629
Print-ISSN:: 0360-3016
TUM Institution:: 1413; Klinik und Poliklinik für Nuklearmedizin; Klinik und Poliklinik für RadioOnkologie und Strahlentherapie
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