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This study evaluates the safety and outcome of PSMA-RLT in metastatic castration-resistant prostate cancer (mCRPC) patients with ECOG performance status 3.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this analysis, a cohort of 18 mCRPC patients with ECOG performance status 3 who received PSMA-RLT was examined. The median number of treatment cycles was 2 (range: 1\u201310), with a mean cumulative administered activity of 21.5\u2009\u00b1\u200915.0 GBq (range: 2.7\u201362.6 GBq) of [\n                      <jats:sup>177<\/jats:sup>\n                      Lu]Lu-PSMA-617. Outcome and adverse events including hematologic and renal toxicities, fatigue, and xerostomia were analyzed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>50% of patients achieved either stable disease or a partial biochemical response. Median progression-free survival and overall survival were 1.3 months and 2.8 months, respectively. Severe adverse events were uncommon, occurring in three patients: one developed grade 3 leukopenia, another experienced grade 3 thrombocytopenia, and one patient had pancytopenia of grade 3\/4. No higher RLT-induced grade of renal toxicity and xerostomia were observed, whilst symptoms of fatigue improved in the cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study indicates that PSMA-RLT is a feasible and overall well-tolerated treatment for mCRPC ECOG 3 patients with manageable toxicity profile. Despite limited survival outcomes, ECOG 3 status may be considered not to be a categorical exclusion criterion for RLT. Future prospective studies should further investigate the role of PSMA-RLT in this challenging subgroup.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00259-025-07346-4","type":"journal-article","created":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T02:54:43Z","timestamp":1748228083000},"page":"4893-4901","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Expanding the scope of PSMA-RLT: evaluating treatment in challenging mCRPC patients with poor performance status (ECOG 3)"],"prefix":"10.1007","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-2106-9548","authenticated-orcid":false,"given":"Moritz B.","family":"Bastian","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedikt","family":"W\u00f6rl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arne","family":"Blickle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Burgard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tilman","family":"Speicher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Bartholom\u00e4","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Schaefer-Schuler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Maus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samer","family":"Ezziddin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Rosar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,26]]},"reference":[{"key":"7346_CR1","doi-asserted-by":"publisher","first-page":"1995","DOI":"10.1056\/NEJMoa1014618","volume":"364","author":"JS de Bono","year":"2011","unstructured":"de Bono JS, Logothetis CJ, Molina A, Fizazi K, North S, Chu L, et al. 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The study was approved by the local Institutional Review Board (ethics committee permission number 140\/17).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"\u00a0Ethical approval"}},{"value":"All patients who participated in this study gave their written consent after being informed about risks and potential side effects of this therapy. All patients agreed to publication of their data in accordance with the declaration of Helsinki.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate and consent to publish"}},{"value":"This study was in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the local Institutional Review Board (ethics committee permission number 140\/17).","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate and consent to publish"}},{"value":"The authors have no relevant financial or non-financial interests to disclose.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}