Magnetic resonance imaging-guided radiotherapy for prostate cancer: A systematic review of the literature.

This systematic literature review explores the potential clinical benefits of magnetic resonance imaging-guided linear accelerator for radiotherapy of prostate cancer, across multiple indications: primary treatment, salvage therapy following radical prostatectomy, reirradiation, and focal boosting of the dominant intraprostatic lesion. Technical considerations related to magnetic resonance imaging-guided radiotherapy are also addressed. Most of the available studies are single-centre or prospective non-randomized trials, with notable methodological heterogeneity regarding irradiation protocols and outcome measures. To date, the MIRAGE trial remains the only published phase III randomized study comparing magnetic resonance imaging-guided radiotherapy to standard stereotactic body radiotherapy. Significant reduction in both acute and late urinary and gastrointestinal toxicity has been demonstrated, attributed to the enhanced precision of imaging-guidance and the reduction in planning target volume margins. However, long-term oncological efficacy remains to be established. Further phase III trials and health economic evaluations are clearly needed to establish the clinical value of this technology. As of today, the implementation of magnetic resonance imaging-guided linear accelerators in routine clinical practice remains limited by technical, organizational, and financial challenges, with accessibility restricted to a limited number of centres and reimbursement strategies yet to be adequately defined.