Clinical and translational radiation oncology · 2026
Daily adaptive 1.5 T MR-Linac image-guided re-irradiation for prostate cancer: an international retrospective experience.
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Cooper Sian, Brennan Victoria Sarah, Alongi Filippo, Chick Joan, Gorovets Daniel, Herbert Trina, Kollmeier Marisa, McBride Sean, Nagar Himanshu, Nicosia Luca, Romei Andrea, Tree Alison, Tyagi Neelam, van der Voort van Zyp Jochem, Pathmanathan Angela
Аннотация
BACKGROUND: Local recurrence in prostate cancer (PCa) after radical radiotherapy has become increasingly prevalent in the era of next-generation imaging. Meta-analyses suggest a favourable adverse event (AE) profile for stereotactic body radiotherapy (SBRT). This study aimed to evaluate the safety and efficacy of high-precision daily adaptive 1.5 T MR-Linac re-irradiation (re-EBRT).
METHODS: This international retrospective study evaluated outcomes in patients with locally radio-recurrent PCa treated with adaptive SBRT re-EBRT on a 1.5 T MR-Linac platform. Eligible patients had biochemically or histologically confirmed radiological local recurrence within the previously irradiated prostate or prostate bed. Clinical characteristics, treatment, AE, and follow-up data were summarised using descriptive statistics and Kaplan-Meier methods.
RESULTS: Seventy five patients were included across four centres. The median interval from primary radical therapy to recurrence was 79.0 months (IQR 56.2-126.5). Median PSA at initial presentation was 8.1 ng/mL (IQR 6.0-11.8), with a median PSA at recurrence of 2.2 ng/mL (IQR 1.0-3.6). Median age at re-EBRT was 73.3 years (IQR 68.5-77.7). MRI-guided adaptive radiotherapy (MRIgART) was delivered with hypofractionated regimens, most commonly 30 Gy in 5 fractions, with 46.7% receiving focal (GTV-only) and 53.3% whole-gland treatment. At 3 months, genitourinary AE were Grade 0-1 in 85.3% (64/75) of patients, Grade 2 in 13.3% (10/75) and Grade 3 AE in 1.3% (1/75). By 12 months, Grade 3 AE had risen to 12.5% (6/48), with no Grade ≥ 4 events. Gastrointestinal AE were mild, with no Grade 2 or higher events observed at any timepoint. Median post-re-EBRT follow-up was 11.9 months (IQR 3.5-21.1 months). Failure-free survival was 96.6% (95% CI 92.0-100.0) at 12 months and 76.5% (95% CI 62.8-93.2) at 24 months. The failures observed occurred within 24 months and were confined to intraprostatic/prostate bed or seminal vesicle sites.
CONCLUSIONS: MRIgART re-EBRT is feasible for locally recurrent PCa, with acceptable gastrointestinal but non-negligible short to medium-term genitourinary toxicity.Data sharing statement: Research data are not available at this time. All centres subscribe to the MOMENTUM registry, from which data access requests can be made by participating centres.
METHODS: This international retrospective study evaluated outcomes in patients with locally radio-recurrent PCa treated with adaptive SBRT re-EBRT on a 1.5 T MR-Linac platform. Eligible patients had biochemically or histologically confirmed radiological local recurrence within the previously irradiated prostate or prostate bed. Clinical characteristics, treatment, AE, and follow-up data were summarised using descriptive statistics and Kaplan-Meier methods.
RESULTS: Seventy five patients were included across four centres. The median interval from primary radical therapy to recurrence was 79.0 months (IQR 56.2-126.5). Median PSA at initial presentation was 8.1 ng/mL (IQR 6.0-11.8), with a median PSA at recurrence of 2.2 ng/mL (IQR 1.0-3.6). Median age at re-EBRT was 73.3 years (IQR 68.5-77.7). MRI-guided adaptive radiotherapy (MRIgART) was delivered with hypofractionated regimens, most commonly 30 Gy in 5 fractions, with 46.7% receiving focal (GTV-only) and 53.3% whole-gland treatment. At 3 months, genitourinary AE were Grade 0-1 in 85.3% (64/75) of patients, Grade 2 in 13.3% (10/75) and Grade 3 AE in 1.3% (1/75). By 12 months, Grade 3 AE had risen to 12.5% (6/48), with no Grade ≥ 4 events. Gastrointestinal AE were mild, with no Grade 2 or higher events observed at any timepoint. Median post-re-EBRT follow-up was 11.9 months (IQR 3.5-21.1 months). Failure-free survival was 96.6% (95% CI 92.0-100.0) at 12 months and 76.5% (95% CI 62.8-93.2) at 24 months. The failures observed occurred within 24 months and were confined to intraprostatic/prostate bed or seminal vesicle sites.
CONCLUSIONS: MRIgART re-EBRT is feasible for locally recurrent PCa, with acceptable gastrointestinal but non-negligible short to medium-term genitourinary toxicity.Data sharing statement: Research data are not available at this time. All centres subscribe to the MOMENTUM registry, from which data access requests can be made by participating centres.