Clinical and translational radiation oncology · 2026
MRI-guided adaptive stereotactic body radiotherapy for the prostate bed: a prospective study of safety, tolerability, and patient-reported quality-of-life outcomes.
СтатьяНазвание и аннотация: Перевод в очереди
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Pieretti Daniela Gonsalves, López-Campos Fernando, Ocanto Abrahams, González Maria, Torres Lisselott, Fernandez Castalia, Sanchez Gloria, Guardia Gloria, Flores Alvaro, Andreescu Jon, Viduera Laura, Urias Dulce, Cabanes Ofelia, Rogriguez Julia, Romero Zoghbi Sigfredo Elias, González Jose Antonio, Gaztañaga Miren, Glaria Luis, Dzhugashvili Maia, Arcangeli Stefano, Ferrario Federica, Salamanca Juan Ignacio Martinez, Francolini Giulio, Couñago Felipe
Аннотация
BACKGROUND AND OBJECTIVES: Magnetic resonance-guided radiotherapy (MRgRT) applied as stereotactic body radiotherapy to the prostate bed represents an emerging post-prostatectomy treatment approach, offering superior soft-tissue visualization and the potential for daily online adaptive planning. This study reports a prospective experience with MR-guided adaptive SBRT to the prostate bed, with a primary focus on treatment-related adverse events and patient-reported quality-of-life (QoL) outcomes.
MATERIALS AND METHODS: A prospective cohort of 31 patients with biochemical recurrence following radical prostatectomy was treated with MR-guided adaptive SBRT (32.5 Gy in 5 fractions) using a 0.35 T MR-LINAC (MRIdian®, ViewRay). Elective pelvic nodal irradiation was delivered in 42% of patients (25 Gy in 5 fractions), and a simultaneous integrated boost (SIB) to macroscopic disease (35 Gy in 5 fractions) was administered in 9.7% of cases. Concomitant androgen deprivation therapy (ADT) was administered in 77.4% of patients. Adverse events were graded according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0, and patient-reported outcomes were assessed using the Expanded Prostate Cancer Index Composite-26 (EPIC-26) and the International Prostate Symptom Score (IPSS).
RESULTS: With a median follow-up of 8.8 months (IQR: 6.1-16.8), no grade ≥ 3 adverse events were observed at any time point. Acute grade ≥ 2 genitourinary (GU) adverse events were 3.3% at treatment completion (1/30) and 4.3% at 6 months (1/23), with low-grade urinary incontinence as the predominant event. "No grade ≥ 2 gastrointestinal (GI) adverse events were observed throughout the follow-up period.EPIC-26 urinary domain scores were preserved over time (baseline: 79.6; 6 months: 81.5), while bowel domain scores remained consistently at ceiling levels (median 100 points at all time points). Median prostate-specific antigen (PSA) declined from 0.31 ng/mL pre-treatment to 0.02 ng/mL at 6 months, with continued suppression at 12 months (0.04 ng/mL, n = 11). Biochemical response was 100% (31/31), although interpretation is limited by the short follow-up.
CONCLUSIONS: MRgRT to the prostate bed demonstrates a favorable early safety and tolerability profile, with no grade ≥ 3 adverse events, low rates of grade ≥ 2 GU adverse events (4.3% at 6 months, 1/23), and absence of late grade ≥ 3 GI adverse events, while maintaining patient-reported QoL outcomes.
MATERIALS AND METHODS: A prospective cohort of 31 patients with biochemical recurrence following radical prostatectomy was treated with MR-guided adaptive SBRT (32.5 Gy in 5 fractions) using a 0.35 T MR-LINAC (MRIdian®, ViewRay). Elective pelvic nodal irradiation was delivered in 42% of patients (25 Gy in 5 fractions), and a simultaneous integrated boost (SIB) to macroscopic disease (35 Gy in 5 fractions) was administered in 9.7% of cases. Concomitant androgen deprivation therapy (ADT) was administered in 77.4% of patients. Adverse events were graded according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0, and patient-reported outcomes were assessed using the Expanded Prostate Cancer Index Composite-26 (EPIC-26) and the International Prostate Symptom Score (IPSS).
RESULTS: With a median follow-up of 8.8 months (IQR: 6.1-16.8), no grade ≥ 3 adverse events were observed at any time point. Acute grade ≥ 2 genitourinary (GU) adverse events were 3.3% at treatment completion (1/30) and 4.3% at 6 months (1/23), with low-grade urinary incontinence as the predominant event. "No grade ≥ 2 gastrointestinal (GI) adverse events were observed throughout the follow-up period.EPIC-26 urinary domain scores were preserved over time (baseline: 79.6; 6 months: 81.5), while bowel domain scores remained consistently at ceiling levels (median 100 points at all time points). Median prostate-specific antigen (PSA) declined from 0.31 ng/mL pre-treatment to 0.02 ng/mL at 6 months, with continued suppression at 12 months (0.04 ng/mL, n = 11). Biochemical response was 100% (31/31), although interpretation is limited by the short follow-up.
CONCLUSIONS: MRgRT to the prostate bed demonstrates a favorable early safety and tolerability profile, with no grade ≥ 3 adverse events, low rates of grade ≥ 2 GU adverse events (4.3% at 6 months, 1/23), and absence of late grade ≥ 3 GI adverse events, while maintaining patient-reported QoL outcomes.