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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

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 relapse/persistence after prostatectomy. This work examined (1) metastasis-free survival (MFS) after PSM...

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Main Authors: Zamboglou, Constantinos (Author) , Strouthos, Iosif (Author) , Sahlmann, Joerg (Author) , Farolfi, Andrea (Author) , Serani, Francesca (Author) , Medici, Federica (Author) , Cavallini, Letizia (Author) , Morganti, Alessio Guiseppe (Author) , Trapp, Christian (Author) , Körber, Stefan A. (Author) , Peeken, Jan C. (Author) , Vogel, Marco M. E. (Author) , Schiller, Kilian (Author) , Combs, Stephanie E. (Author) , Eiber, Matthias (Author) , Vrachimis, Alexis (Author) , Ferentinos, Konstantinos (Author) , Spohn, Simon K. B. (Author) , Kirste, Simon (Author) , Gratzke, Christian (Author) , Ruf, Juri (Author) , Grosu, Anca-Ligia (Author) , Ceci, Francesco (Author) , Fendler, Wolfgang P. (Author) , Miksch, Jonathan (Author) , Kroeze, Stephanie (Author) , Guckenberger, Matthias (Author) , Lanzafame, Helena (Author) , Fanti, Stefano (Author) , Hruby, George (Author) , Wiegel, Thomas (Author) , Emmett, Louise (Author) , Schmidt-Hegemann, Nina Sophie (Author) , Henkenberens, Christoph (Author)
Format: Article (Journal)
Language:English
Published: [1 August 2022]
In: International journal of radiation oncology, biology, physics
Year: 2022, Volume: 113, Issue: 5, Pages: 1015-1024
ISSN:1879-355X
DOI:10.1016/j.ijrobp.2022.04.048
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/j.ijrobp.2022.04.048
Verlag, lizenzpflichtig, Volltext: https://www.sciencedirect.com/science/article/pii/S0360301622004096
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Author Notes:Constantinos Zamboglou, Iosif Strouthos, Joerg Sahlmann, Andrea Farolfi, Francesca Serani, Federica Medici, Letizia Cavallini, Alessio Guiseppe Morganti, Christian Trapp, Stefan A. Koerber, Jan C. Peeken, Marco M. E. Vogel, Kilian Schiller, Stephanie E. Combs, Matthias Eiber, Alexis Vrachimis, Konstantinos Ferentinos, Simon K. B. Spohn, Simon Kirste, Christian Gratzke, Juri Ruf, Anca-Ligia Grosu, Francesco Ceci, Wolfgang P. Fendler, Jonathan Miksch, Stephanie Kroeze, Matthias Guckenberger, Helena Lanzafame, Stefano Fanti, George Hruby, Thomas Wiegel, Louise Emmett, Nina Sophie Schmidt-Hegemann, and Christoph Henkenberens
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Summary: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 relapse/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.
Item Description:Gesehen am 16.10.2022
Physical Description:Online Resource
ISSN:1879-355X
DOI:10.1016/j.ijrobp.2022.04.048

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