Brachytherapy · 2025
Feasibility of combining high-dose-rate prostate brachytherapy with dose intensification to the MRI dominant lesion followed by real-time adaptive MR-guided pelvic radiotherapy for high-risk prostate cancer.
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Cohen Gil'ad N, Gurewitz Jason, Johnson Jennifer, Cooney Jeffrey, Shi Yuhao, Adler Harry, Long Matthew, Byun David J, Zelefsky Michael J
Аннотация
PURPOSE: Optimizing radiotherapy delivery for higher-risk prostate cancer often requires dose escalation while minimizing dose to surrounding normal tissues. We report on the feasibility of combining high-dose-rate (HDR) brachytherapy with dose intensification to the dominant intra-prostatic lesion (DIL) followed by magnetic resonance-guided stereotactic body radiotherapy (MRgSBRT).
METHODS AND MATERIALS: Eighty-eight patients were treated with a single fraction of 15-Gy HDR brachytherapy boost followed by MRgSBRT to prostate, or prostate and pelvic lymph nodes, to a dose of 25 Gy in five fractions. The DIL noted on multi-parametric MR imaging was defined as a PIRADS-4/-5 lesion with an associated diffusion-weighted abnormality(s), and was intraoperatively boosted during brachytherapy to 120% of the prescription dose. Dosimetric objectives included D99% >120% to the DIL, D1% <120% for the urethra and D1cc <80% for the rectum. Real-time adaptive SBRT was delivered with a 1.5-T Unity MR Linac.
RESULTS: For the HDR procedure, the mean prostate and DIL D90% were 108.3% ± 2.7% and 135.9% ± 12.2%, respectively. Mean urethra Dmax and D20% were 116.5% ± 4.5% and 108.2% ± 3.8%, respectively. Mean rectal V100 and D1cc were 0.0 ± 0.0cc and 73.6% ± 7.0%, respectively. DIL objective was not met in two lesions owing to proximity of the urethra and bladder neck. At a median follow-up of 6.8 months, Grade 2 genitourinary acute toxicity was observed in 33% of patients and Grade 2 acute gastrointestinal toxicity was observed in 1%.
CONCLUSIONS: HDR boost with dose escalation to the DIL in combination with MRgSBRT is a feasible and effective treatment protocol. No significant genitourinary or gastrointestinal acute toxicity was observed.
METHODS AND MATERIALS: Eighty-eight patients were treated with a single fraction of 15-Gy HDR brachytherapy boost followed by MRgSBRT to prostate, or prostate and pelvic lymph nodes, to a dose of 25 Gy in five fractions. The DIL noted on multi-parametric MR imaging was defined as a PIRADS-4/-5 lesion with an associated diffusion-weighted abnormality(s), and was intraoperatively boosted during brachytherapy to 120% of the prescription dose. Dosimetric objectives included D99% >120% to the DIL, D1% <120% for the urethra and D1cc <80% for the rectum. Real-time adaptive SBRT was delivered with a 1.5-T Unity MR Linac.
RESULTS: For the HDR procedure, the mean prostate and DIL D90% were 108.3% ± 2.7% and 135.9% ± 12.2%, respectively. Mean urethra Dmax and D20% were 116.5% ± 4.5% and 108.2% ± 3.8%, respectively. Mean rectal V100 and D1cc were 0.0 ± 0.0cc and 73.6% ± 7.0%, respectively. DIL objective was not met in two lesions owing to proximity of the urethra and bladder neck. At a median follow-up of 6.8 months, Grade 2 genitourinary acute toxicity was observed in 33% of patients and Grade 2 acute gastrointestinal toxicity was observed in 1%.
CONCLUSIONS: HDR boost with dose escalation to the DIL in combination with MRgSBRT is a feasible and effective treatment protocol. No significant genitourinary or gastrointestinal acute toxicity was observed.