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Keilholz, M.* ; Moar, E.F.* ; Brose, F.* ; Maier, S.H.* ; Belka, C.* ; Rogowski, P.* ; Zähringer, M.* ; Peeken, J.C. ; Combs, S.E. ; Schönecker, S.* ; Putz, F.* ; Süß, C.* ; Treutwein, M.* ; Angnostatou, V.* ; Schmidt-Hegemann, N.*

Multicenter ProKnow-based plan evaluation of postprostatectomy salvage radiotherapy patients using SPPORT and RADICALS-HD trial-defined dose constraints.

Strahlenther. Onkol., DOI: 10.1007/s00066-026-02584-3 (2026)
DOI PMC
Open Access Green as soon as Postprint is submitted to ZB.
PURPOSE: Salvage radiotherapy (sRT) after radical prostatectomy is the only curative treatment for patients with biochemical recurrence. Sparing organs at risk (OAR) is essential to minimize long-term toxicity. This multicenter study analyzed radiotherapy plans from Bavarian university centers within the Bavarian Cancer Research Center (BZKF) using dose-volume constraints from the SPPORT and RADICALS-HD trials. METHODS: In this retrospective multicenter analysis, 117 patients treated with prostate bed sRT were included. Radiotherapy plans were anonymized and evaluated using ProKnow (Elekta, Stockholm, Sweden). Scorecards based on SPPORT and RADICALS-HD dose-volume constraints were used to assess plan quality. Planning metrics, including planning target volume (PTV), D95, conformality index, and V66, were recorded, and their correlations with OAR dose were analyzed. RESULTS: The median PTV was 213.9 cm3 (interquartile range [IQR] 154.4-267.8 cm3), with a median D95 of 64.5 Gy (IQR 63.7-67.1 Gy). The median volume receiving 66 Gy (V66) was 192.62 cm3 (IQR 146.59-244.49 cm3). Bladder dose constraints were met in 92-100% of plans according to RADICALS-HD and in 89-97% according to SPPORT. Rectal constraints were fulfilled in 98-100% and 95-100% of plans, respectively. All femoral head plans met the SPPORT V50 constraint. Correlation analyses showed weak associations with bladder dose and weak-to-moderate associations with rectal dose. CONCLUSION: This multicenter analysis demonstrates that dose-volume objectives in the postoperative salvage setting can be reliably assessed across centers and are met in the majority of cases. ProKnow enables structured and objective plan evaluation and serves as a useful tool for standardized quality assurance.
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Publication type Article: Journal article
Document type Scientific Article
Keywords Dose–volume Constraints ; Organ-sparing Procedures ; Organs At Risk ; Prostate Cancer ; Radiotherapy Plan Quality; Prostate-cancer; Therapy; Radiation; Toxicity; Risk
ISSN (print) / ISBN 0179-7158
e-ISSN 1439-099X
Journal Strahlentherapie und Onkologie : Journal of Radiation Oncology, Biology, Physics
Publisher Springer
Publishing Place Europaplatz 3, Heidelberg, Germany
Reviewing status Peer reviewed
Institute(s) Institute of Radiation Medicine (IRM)
Grants Bayerisches Zentrum fr Krebsforschung (BZKF)