Refining prognostic stratification in salvage radiotherapy for prostate cancer: a retrospective multicenter cohort study using PSMA-PET and machine learning.

Background: 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.

Methods: In this retrospective multicenter study, 255 patients treated with SRT across 11 centers were selected from a database of 1,201 cases.

oDigital pathology biomarkers for guiding radiotherapy-based treatment concepts in prostate cancer - a systematic review and expert consensus.

Current risk-stratification systems for prostate cancer (PCa) do not sufficiently reflect the disease heterogeneity, and digital pathology (DP) combined with artificial intelligence (AI) tools (DP-AI) may offer a solution to this challenge. The aim of this work is to summarize the role of DP-AI for PCa patients treated with radiotherapy (RT), and to point out future areas of research. We conducted (1) a systematic review on the evidence of DP-AI for patients treated with RT and (2) a survey of experts using a modified Delphi method, addressing the current role of DP-AI in clinical and research practice to identify relevant fields of future development.

Salvage brachytherapy for recurrent prostate cancer after radiotherapy: An expert-endorsed review by uroGEC.

Radiorecurrent prostate cancer remains a challenging clinical scenario. Salvage brachytherapy, either low-dose-rate (LDR) or high-dose-rate (HDR), offers a promising organ-preserving option in carefully selected patients. This narrative review, endorsed by the uroGEC (Urology - Groupe Européen de Curiethérapie), summarizes current evidence, indications, techniques, outcomes, and limitations of SBT in men with local recurrence after primary radiotherapy.

Combined Hypofractionated Radiation Therapy and Brachytherapy for Managing Prostate-Specific Membrane Antigen Positron Emission Tomography-Staged Organ-Confined Prostate Cancer: Primary Endpoint Analysis of a Prospective Study.

Purpose: This study aims to evaluate the primary endpoint of a phase 2 prospective trial, which included a patient cohort staged with 18F-prostate-specific membrane antigen positron emission tomography/computed tomography (CT), treated with a combination of prostate high dose-rate brachytherapy and prostate/seminal vesicles external beam radiation therapy for intermediate and high-risk prostate cancer.

Methods And Materials: Forty-one patients with unfavorable intermediate, high risk (HR), and very HR prostate cancer were recruited to receive a combination of hypofractionated external beam radiation therapy to the prostate ± seminal vesicles of 36 Gy (12 fractions of 3 Gy each) delivered in consecutive days, followed by single-fraction real-time high-dose-rate brachytherapy of 14 Gy. Patients also received risk-adjusted androgen deprivation therapy (ADT).

The role of antimicrobial prophylaxis in brachytherapy for prostate, breast and gynaecological cancer: a narrative review.

Proper antimicrobial prophylaxis is critical for reducing the risk of infection during interventional procedures. Brachytherapy, a highly effective radiation therapy for various malignancies, allows for precise radiation delivery; however, the use of foreign material as instrumentation for brachytherapy potentially increases the risk of infection. Understanding infectious complications and proper antimicrobial use in this case is essential for successful outcomes and patient safety.

Tumor Asphericity in FDG PET Is an Independent Prognostic Parameter Improving Risk Stratification in Patients with Head and Neck Squamous Cell Carcinoma.

Tumor asphericity in F-FDG PET is a prognostic marker that has been investigated in small pilot studies of patients with head and neck squamous cell carcinoma (HNSCC). Here, we investigated the prognostic role of asphericity in a large multicenter database of patients with HNSCC treated with primary radiotherapy or chemoradiation and assessed its independent prognostic value. In total, 1,104 patients were included in this analysis.

Total lesion glycolysis of primary tumor and lymphnodes is a strong predictor for development of distant metastases in oropharyngeal carcinoma patients with independent validation in automatically delineated lesions.

Background: Oropharyngeal carcinomas are characterized by an increasing incidence and a relatively good prognosis. Nonetheless, a considerable number of patients develops metachronous distant metastases; identification of these patients is an urgent medical need.

Methods: This is a retrospective multicenter evaluation of 431 patients.

Dosimetric comparison of Acuros BV and AAPM TG-43 formalism for interstitial iridium-192 high-dose-rate brachytherapy.

Purpose: The aim of this study was a retrospective dosimetric comparison of iridium-192 (Ir) high-dose-rate (HDR) interstitial brachytherapy plans using model-based dose calculation algorithm (MBDCA) following TG-186 recommendations and TG-43 dosimetry protocol for breast, head-and-neck, and lung patient cohorts, with various treatment concepts and prescriptions.

Material And Methods: In this study, 59 interstitial Ir HDR brachytherapy cases treated in our center (22 breast, 22 head and neck, and 15 lung) were retrospectively selected and re-calculated with TG-43 dosimetry protocol as well as with Acuros BV dose calculation algorithm, with dose to medium option based on computed tomography images. Treatment planning dose volume parameter differences were determined and their significance was assessed.

Better Oncological Outcomes After Prostate-specific Membrane Antigen Positron Emission Tomography-guided Salvage Radiotherapy Following Prostatectomy.

Background And Objective: Up to 50% of patients with prostate cancer experience prostate-specific antigen (PSA) relapse following primary radical prostatectomy (RP). Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) is increasingly being used for staging after RP owing to its high detection rate. Our aim was to compare outcomes for patients who received salvage radiotherapy (sRT) with versus without PSMA PET guidance.

Personalised biomechanical modelling towards the optimisation of high dose-rate brachytherapy planning and treatment against prostate cancer.

High dose-rate brachytherapy presents a promising therapeutic avenue for prostate cancer management, involving the temporary implantation of catheters which deliver radioactive sources to the cancerous site. However, as catheters puncture and penetrate the prostate, tissue deformation is evident which may affect the accuracy and efficiency of the treatment. In this work, a data-driven modelling procedure is proposed to simulate brachytherapy while accounting for prostate biomechanics.

A convolutional attention model for predicting response to chemo-immunotherapy from ultrasound elastography in mouse tumor models.

Background: In the era of personalized cancer treatment, understanding the intrinsic heterogeneity of tumors is crucial. Despite some patients responding favorably to a particular treatment, others may not benefit, leading to the varied efficacy observed in standard therapies. This study focuses on the prediction of tumor response to chemo-immunotherapy, exploring the potential of tumor mechanics and medical imaging as predictive biomarkers.

Case Report: Post-traumatic splenosis and potential pitfall for PSMA-PET.

Background: 18F-prostate specific membrane antigen (PSMA) PET is fast becoming the gold-standard in prostate cancer, both in staging of intermediate-/high-risk patients and in re-staging patients with biochemical failure. Several pitfalls of 18F-PSMA PET have been reported, and we report, to our best of knowledge, for the first time, a case which could have been falsely diagnosed as peritoneal spread.

Case Presentation: A 67-year-old patient with high-risk prostate cancer underwent staging with 18F-PSMA-1007 PET/CT (PSMA-PET/CT).

Feature-Based vs. Deep-Learning Fusion Methods for the In Vivo Detection of Radiation Dermatitis Using Optical Coherence Tomography, a Feasibility Study.

Acute radiation dermatitis (ARD) is a common and distressing issue for cancer patients undergoing radiation therapy, leading to significant morbidity. Despite available treatments, ARD remains a distressing issue, necessitating further research to improve prevention and management strategies. Moreover, the lack of biomarkers for early quantitative assessment of ARD impedes progress in this area.

Whole pelvis vs. hemi pelvis elective nodal radiotherapy in patients with PSMA-positive nodal recurrence after radical prostatectomy - a retrospective multi-institutional propensity score analysis.

Purpose: Despite growing evidence for bilateral pelvic radiotherapy (whole pelvis RT, WPRT) there is almost no data on unilateral RT (hemi pelvis RT, HPRT) in patients with nodal recurrent prostate cancer after prostatectomy. Nevertheless, in clinical practice HPRT is sometimes used with the intention to reduce side effects compared to WPRT. Prostate-specific membrane antigen positron emission tomography / computed tomography (PSMA-PET/CT) is currently the best imaging modality in this clinical situation.

European association of urology risk stratification predicts outcome in patients receiving PSMA-PET-planned salvage radiotherapy for biochemical recurrence following radical prostatectomy.

Purpose: The European Association of Urology (EAU) proposed a risk stratification (high vs. low risk) for patients with biochemical recurrence (BR) following radical prostatectomy (RP). Here we investigated whether this stratification accurately predicts outcome, particularly in patients staged with PSMA-PET.

A clinical evaluation of the performance of five commercial artificial intelligence contouring systems for radiotherapy.

Purpose/objectives: Auto-segmentation with artificial intelligence (AI) offers an opportunity to reduce inter- and intra-observer variability in contouring, to improve the quality of contours, as well as to reduce the time taken to conduct this manual task. In this work we benchmark the AI auto-segmentation contours produced by five commercial vendors against a common dataset.

Methods And Materials: The organ at risk (OAR) contours generated by five commercial AI auto-segmentation solutions (Mirada (Mir), MVision (MV), Radformation (Rad), RayStation (Ray) and TheraPanacea (Ther)) were compared to manually-drawn expert contours from 20 breast, 20 head and neck, 20 lung and 20 prostate patients.

Development and Validation of a Multi-institutional Nomogram of Outcomes for PSMA-PET-Based Salvage Radiotherapy for Recurrent Prostate Cancer.

Importance: Prostate-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.

Objective: To develop and validate a nomogram for prediction of freedom from biochemical failure (FFBF) after PSMA-PET-based sRT.

Design, Setting, And Participants: 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.

Salvage radiotherapy is effective in patients with PSMA-PET-negative biochemical recurrence- results of a retrospective study.

Background/purpose: The present study aimed to assess whether SRT to the prostatic fossa should be initiated in a timely manner after detecting biochemical recurrence (BR) in patients with prostate cancer, when no correlate was identified with prostate-specific membrane antigen positron emission tomography (PSMA-PET).

Materials And Methods: This retrospective, multicenter analysis included 1222 patients referred for PSMA-PET after a radical prostatectomy due to BR. Exclusion criteria were: pathological lymph node metastases, prostate-specific antigen (PSA) persistence, distant or lymph node metastases, nodal irradiation, and androgen deprivation therapy (ADT).

A convolutional neural network with self-attention for fully automated metabolic tumor volume delineation of head and neck cancer in F]FDG PET/CT.

Purpose: PET-derived metabolic tumor volume (MTV) and total lesion glycolysis of the primary tumor are known to be prognostic of clinical outcome in head and neck cancer (HNC). Including evaluation of lymph node metastases can further increase the prognostic value of PET but accurate manual delineation and classification of all lesions is time-consuming and prone to interobserver variability. Our goal, therefore, was development and evaluation of an automated tool for MTV delineation/classification of primary tumor and lymph node metastases in PET/CT investigations of HNC patients.

PSMA-PET/CT-guided salvage radiotherapy in recurrent or persistent prostate cancer and PSA < 0.2 ng/ml.

Purpose: The purpose of this retrospective, multicenter study was to assess efficacy of PSMA-PET/CT-guided salvage radiotherapy (sRT) in patients with recurrent or persistent PSA after primary surgery and PSA levels < 0.2 ng/ml.

Methods: The study included patients from a pooled cohort (n = 1223) of 11 centers from 6 countries.

18F-Fluorodeoxyglucose Positron Emission Tomography of Head and Neck Cancer: Location and HPV Specific Parameters for Potential Treatment Individualization.

Purpose: 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) is utilized for staging and treatment planning of head and neck squamous cell carcinomas (HNSCC). Some older publications on the prognostic relevance showed inconclusive results, most probably due to small study sizes. This study evaluates the prognostic and potentially predictive value of FDG-PET in a large multi-center analysis.

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 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.