MR-guided prostate SBRT in prostate cancer patients with low-volume metastatic disease.
MR-Linac
Oligo-metastatic
Prostate cancer
Stereotactic body radiation therapy (SBRT)
Journal
World journal of urology
ISSN: 1433-8726
Titre abrégé: World J Urol
Pays: Germany
ID NLM: 8307716
Informations de publication
Date de publication:
Dec 2023
Dec 2023
Historique:
received:
03
08
2023
accepted:
26
09
2023
medline:
4
12
2023
pubmed:
4
11
2023
entrez:
4
11
2023
Statut:
ppublish
Résumé
Recent data have found an overall survival benefit from prostate-directed radiotherapy in patients with low-volume metastatic prostate cancer. Prostate SBRT is an attractive treatment in this setting and may be optimised with MR-guided adaptive treatment. Here, we share our institutional experience delivering stereotactic MR-guided adaptive prostate SBRT (SMART) for patients with low-volume metastatic disease. We reviewed patients with low-volume metastatic disease who received prostate SMART from October 2019 to December 2021 on a 0.35T MR-Linac. The cohort included 14 patients. Genitourinary (GU) and gastrointestinal (GI) toxicities were assessed using CTCAE v 5.0. Progression was defined as a change in systemic or hormonal therapy regimen as a result of PSA rise or disease progression. The median follow-up time was 29 months. Seven patients had hormone sensitive prostate cancer and 7 had castrate resistant prostate cancer (CRPC). 13 patients received 36.25 Gy in 5 fractions and one patient received 33 Gy in 5 fractions. At the time of last follow-up, 11 patients had not experienced progression and three patients, all with CRPC, had experienced progression. No patients developed local progression in the prostate after SMART. One patient experienced acute grade 2 urinary toxicity (7%) and no patients experienced acute grade 2 GI toxicity (0%). No grade 3 + acute toxicities were observed. Prostate SMART was found to be well tolerated and all patients had local control of disease within the prostate at the time of last follow-up. Prostate SMART may represent a low-risk and well-tolerated approach for delivering prostate-directed radiotherapy for patients with limited metastatic disease.
Sections du résumé
BACKGROUND
BACKGROUND
Recent data have found an overall survival benefit from prostate-directed radiotherapy in patients with low-volume metastatic prostate cancer. Prostate SBRT is an attractive treatment in this setting and may be optimised with MR-guided adaptive treatment. Here, we share our institutional experience delivering stereotactic MR-guided adaptive prostate SBRT (SMART) for patients with low-volume metastatic disease.
METHODS
METHODS
We reviewed patients with low-volume metastatic disease who received prostate SMART from October 2019 to December 2021 on a 0.35T MR-Linac. The cohort included 14 patients. Genitourinary (GU) and gastrointestinal (GI) toxicities were assessed using CTCAE v 5.0. Progression was defined as a change in systemic or hormonal therapy regimen as a result of PSA rise or disease progression.
RESULTS
RESULTS
The median follow-up time was 29 months. Seven patients had hormone sensitive prostate cancer and 7 had castrate resistant prostate cancer (CRPC). 13 patients received 36.25 Gy in 5 fractions and one patient received 33 Gy in 5 fractions. At the time of last follow-up, 11 patients had not experienced progression and three patients, all with CRPC, had experienced progression. No patients developed local progression in the prostate after SMART. One patient experienced acute grade 2 urinary toxicity (7%) and no patients experienced acute grade 2 GI toxicity (0%). No grade 3 + acute toxicities were observed.
CONCLUSIONS
CONCLUSIONS
Prostate SMART was found to be well tolerated and all patients had local control of disease within the prostate at the time of last follow-up. Prostate SMART may represent a low-risk and well-tolerated approach for delivering prostate-directed radiotherapy for patients with limited metastatic disease.
Identifiants
pubmed: 37924333
doi: 10.1007/s00345-023-04675-7
pii: 10.1007/s00345-023-04675-7
doi:
Substances chimiques
Prostate-Specific Antigen
EC 3.4.21.77
Types de publication
Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3889-3894Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Surveillance, Epidemiology, and End Results Program Cancer stat facts: prostate cancer. https://seer.cancer.gov/statfacts/html/prost.html . Accessed 28 Jan 2020
Parikh RR, Byun J, Goyal S, Kim IY (2017) Local therapy improves overall survival in patients with newly diagnosed metastatic prostate cancer. Prostate 77:559–572
doi: 10.1002/pros.23294
pubmed: 28093791
Boevé LMS, Hulshof MCCM, Vis AN, Zwinderman AH, Twisk JWR, Witjes WPJ, Delaere KPJ, Moorselaar RJAV, Verhagen PCMS, van Andel G (2019) Effect on survival of androgen deprivation therapy alone compared to androgen deprivation therapy combined with concurrent radiation therapy to the prostate in patients with primary bone metastatic prostate cancer in a prospective randomised clinical trial: data from the HORRAD trial. Eur Urol 75(3):410–418. https://doi.org/10.1016/j.eururo.2018.09.008
doi: 10.1016/j.eururo.2018.09.008
pubmed: 30266309
Parker CC, James ND, Brawley CD, Clarke NW, Hoyle AP, Ali A, Ritchie AWS, Attard G, Chowdhury S, Cross W, Dearnaley DP, Gillessen S, Gilson C, Jones RJ, Langley RE, Malik ZI, Mason MD, Matheson D, Millman R, Russell JM, Thalmann GN, Amos CL, Alonzi R, Bahl A, Birtle A, Din O, Douis H, Eswar C, Gale J, Gannon MR, Jonnada S, Khaksar S, Lester JF, O’Sullivan JM, Parikh OA, Pedley ID, Pudney DM, Sheehan DJ, Srihari NN, Tran ATH, Parmar MKB, Sydes MR, Systemic Therapy for Advanced or Metastatic Prostate cancer: Evaluation of Drug Efficacy (STAMPEDE) Investigators (2018) Radiotherapy to the primary tumour for newly diagnosed, metastatic prostate cancer (STAMPEDE): a randomised controlled phase 3 trial. Lancet 392(10162):2353–2366. https://doi.org/10.1016/S0140-6736(18)32486-3
doi: 10.1016/S0140-6736(18)32486-3
pubmed: 30355464
pmcid: 6269599
Leeman JE, Cagney DN, Mak RH, Huynh MA, Tanguturi SK, Singer L, Catalano P, Martin NE, D’Amico AV, Mouw KW, Nguyen PL, King MT, Han Z, Williams C, Huynh E (2022) Magnetic resonance-guided prostate stereotactic body radiation therapy with daily online plan adaptation: results of a prospective phase 1 trial and supplemental cohort. Adv Radiat Oncol 7(5):100934. https://doi.org/10.1016/j.adro.2022.100934
doi: 10.1016/j.adro.2022.100934
pubmed: 35847547
pmcid: 9280019
Kishan AU, Ma TM, Lamb JM et al (2023) Magnetic resonance imaging-guided vs computed tomography-guided stereotactic body radiotherapy for prostate cancer: the MIRAGE randomized clinical trial. JAMA Oncol 9(3):365–373. https://doi.org/10.1001/jamaoncol.2022.6558
doi: 10.1001/jamaoncol.2022.6558
pubmed: 36633877
pmcid: 9857817
Leeman JE, Shin KY, Chen YH, Mak RH, Nguyen PL, D’Amico AV, Martin NE (2023) Acute toxicity comparison of magnetic resonance-guided adaptive versus fiducial or computed tomography-guided non-adaptive prostate stereotactic body radiotherapy: A systematic review and meta-analysis. Cancer. https://doi.org/10.1002/cncr.34836
doi: 10.1002/cncr.34836
pubmed: 37485697
Kyriakopoulos CE, Chen YH, Carducci MA, Liu G, Jarrard DF, Hahn NM, Shevrin DH, Dreicer R, Hussain M, Eisenberger M, Kohli M, Plimack ER, Vogelzang NJ, Picus J, Cooney MM, Garcia JA, DiPaola RS, Sweeney CJ (2018) Chemohormonal therapy in metastatic hormone-sensitive prostate cancer: long-term survival analysis of the randomized Phase III E3805 CHAARTED trial. J Clin Oncol 36(11):1080–1087. https://doi.org/10.1200/JCO.2017.75.3657
doi: 10.1200/JCO.2017.75.3657
pubmed: 29384722
pmcid: 5891129
Burdett S, Boevé LM, Ingleby FC, Fisher DJ, Rydzewska LH, Vale CL, van Andel G, Clarke NW, Hulshof MC, James ND, Parker CC, Parmar MK, Sweeney CJ, Sydes MR, Tombal B, Verhagen PC, Tierney JF (2019) Prostate radiotherapy for metastatic hormone-sensitive prostate cancer: a STOPCAP systematic review and meta-analysis. Eur Urol 76(1):115–124. https://doi.org/10.1016/j.eururo.2019.02.003
doi: 10.1016/j.eururo.2019.02.003
pubmed: 30826218
pmcid: 6575150
Alberto B, Stéphanie F, Xavier M, Paul S, Raymond SM, Aude F, Bertrand FT, Stephane S, Dominik RB, Philippe R, Gabriel K, Naji S, Fabio C, Jean FB, Ali H, Marlon S, Jihane B, Hélène R, Karim F (2023) Prostate irradiation in men with de novo, low-volume, metastatic, castration-sensitive prostate cancer (mCSPC): results of PEACE-1, a phase 3 randomized trial with a 2x2 design. J Clin Oncol 41:17
Widmark A, Gunnlaugsson A, Beckman L, Thellenberg-Karlsson C, Hoyer M, Lagerlund M, Kindblom J, Ginman C, Johansson B, Björnlinger K, Seke M, Agrup M, Fransson P, Tavelin B, Norman D, Zackrisson B, Anderson H, Kjellén E, Franzén L, Nilsson P (2019) Ultra-hypofractionated versus conventionally fractionated radiotherapy for prostate cancer: 5-year outcomes of the HYPO-RT-PC randomised, non-inferiority, phase 3 trial. Lancet 394(10196):385–395. https://doi.org/10.1016/S0140-6736(19)31131-6
doi: 10.1016/S0140-6736(19)31131-6
pubmed: 31227373
Lukka HR, Pugh SL, Bruner DW, Bahary JP, Lawton CAF, Efstathiou JA, Kudchadker RJ, Ponsky LE, Seaward SA, Dayes IS, Gopaul DD, Michalski JM, Delouya G, Kaplan ID, Horwitz EM, Roach M 3rd, Pinover WH, Beyer DC, Amanie JO, Sandler HM, Kachnic LA (2018) Patient reported outcomes in NRG oncology RTOG 0938, evaluating two ultra-hypofractionated regimens for prostate cancer. Int J Radiat Oncol Biol Phys 102(2):287–295. https://doi.org/10.1016/j.ijrobp.2018.06.008
doi: 10.1016/j.ijrobp.2018.06.008
pubmed: 29913254
pmcid: 6248906