Cargando…

Non-Adaptive MR-Guided Radiotherapy for Prostate SBRT: Less Time, Equal Results

Background: The use of stereotactic body radiation therapy (SBRT) is widely utilized for treatment of localized prostate cancer. Magnetic-resonance-guided radiotherapy (MRgRT) was introduced in 2014 and has recently been implemented in SBRT for prostate cancer as it provides an opportunity for small...

Descripción completa

Detalles Bibliográficos
Autores principales: Sandoval, Maria L., Youssef, Irini, Latifi, Kujtim, Grass, G. Daniel, Torres-Roca, Javier, Rosenberg, Stephen, Yamoah, Kosj, Johnstone, Peter A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8347281/
https://www.ncbi.nlm.nih.gov/pubmed/34362179
http://dx.doi.org/10.3390/jcm10153396
_version_ 1783735049246474240
author Sandoval, Maria L.
Youssef, Irini
Latifi, Kujtim
Grass, G. Daniel
Torres-Roca, Javier
Rosenberg, Stephen
Yamoah, Kosj
Johnstone, Peter A.
author_facet Sandoval, Maria L.
Youssef, Irini
Latifi, Kujtim
Grass, G. Daniel
Torres-Roca, Javier
Rosenberg, Stephen
Yamoah, Kosj
Johnstone, Peter A.
author_sort Sandoval, Maria L.
collection PubMed
description Background: The use of stereotactic body radiation therapy (SBRT) is widely utilized for treatment of localized prostate cancer. Magnetic-resonance-guided radiotherapy (MRgRT) was introduced in 2014 and has recently been implemented in SBRT for prostate cancer as it provides an opportunity for smaller margins and adaptive daily planning. Currently, the only publications of MRgRT for prostate SBRT describe European clinical experiences which utilized adaptive planning. However, adaptive planning adds significantly to the time required for daily treatment. Objectives: Since prostate SBRT has demonstrated acceptable toxicity for several years, we did not consider daily adaptation critical to the process of prostate SBRT. After Institutional Review Board approval, we analyzed and now report our experience using MRgRT without adaptation. Methods: Between 25 September 2019 and 21 December 2020, 35 consecutive patients were treated with MRgRT prostate SBRT at our center. Patients treated with MRgRT included favorable intermediate risk (43%) and unfavorable intermediate risk (54%), and only one patient had low-risk prostate cancer. Nine patients (25%) received adjuvant leuprolide for a median of 4.5 months (range 4–6 m). Our clinical pathway allows for a maximum prostate gland volume of 60 cc; median prostate volume of this cohort was 35.0 cc (range 17–58.4 cc). Median pre-treatment PSA was 6.30 (range 2.55–16.77). Each patient was treated with 36.25 Gy delivered in five fractions over 2 weeks with urethral sparing to a maximal dose of 35 Gy. Target volumes included the prostate gland and proximal seminal vesicles with a 3 mm margin. Results: Median follow-up as of 26 May 2021 was 11.97 months (range 4.37–19.80). First follow-up data are available for all patients, with a median of 1.10 month from completion of treatment (0.63–3.40). The median PSA at first visit was 2.75 (range 0.02–9.00) with a median AUA symptom score of 9 (range 1–24). Second follow-up data are available for 34 patients at a median of 4.45 months (range 2.57–8.90). At second follow-up, the median PSA was 1.60 (range 0.02–5.40) with a median AUA symptom score of 6 (range 1–33). Seventeen patients had third follow-up data with a median of 9.77 months (range 4.70–12.33) after SBRT. The median PSA was 1.13 (range 0.02–4.73) with an AUA score of 9 (2–22) at the third follow-up. We observed a statistically significant decrease in PSA between pre-treatment and at first follow-up (p < 0.005). The most common toxicity was grade 2 urethritis, managed in all cases by tamsulosin. One patient developed grade 2 tenesmus relieved by topical steroids. No cases of grade ≥ 3 toxicity were seen in our patient population. Conclusions: By avoiding the extra time required for plan adaptation, MRgRT without daily adaptation allows for successful prostate SBRT with manageable toxicity. We continue to reserve our limited adaptive treatment slots for preoperative pancreatic and ultra-central lung SBRT patients, which require time-intensive respiratory gating and adaptive planning.
format Online
Article
Text
id pubmed-8347281
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-83472812021-08-08 Non-Adaptive MR-Guided Radiotherapy for Prostate SBRT: Less Time, Equal Results Sandoval, Maria L. Youssef, Irini Latifi, Kujtim Grass, G. Daniel Torres-Roca, Javier Rosenberg, Stephen Yamoah, Kosj Johnstone, Peter A. J Clin Med Article Background: The use of stereotactic body radiation therapy (SBRT) is widely utilized for treatment of localized prostate cancer. Magnetic-resonance-guided radiotherapy (MRgRT) was introduced in 2014 and has recently been implemented in SBRT for prostate cancer as it provides an opportunity for smaller margins and adaptive daily planning. Currently, the only publications of MRgRT for prostate SBRT describe European clinical experiences which utilized adaptive planning. However, adaptive planning adds significantly to the time required for daily treatment. Objectives: Since prostate SBRT has demonstrated acceptable toxicity for several years, we did not consider daily adaptation critical to the process of prostate SBRT. After Institutional Review Board approval, we analyzed and now report our experience using MRgRT without adaptation. Methods: Between 25 September 2019 and 21 December 2020, 35 consecutive patients were treated with MRgRT prostate SBRT at our center. Patients treated with MRgRT included favorable intermediate risk (43%) and unfavorable intermediate risk (54%), and only one patient had low-risk prostate cancer. Nine patients (25%) received adjuvant leuprolide for a median of 4.5 months (range 4–6 m). Our clinical pathway allows for a maximum prostate gland volume of 60 cc; median prostate volume of this cohort was 35.0 cc (range 17–58.4 cc). Median pre-treatment PSA was 6.30 (range 2.55–16.77). Each patient was treated with 36.25 Gy delivered in five fractions over 2 weeks with urethral sparing to a maximal dose of 35 Gy. Target volumes included the prostate gland and proximal seminal vesicles with a 3 mm margin. Results: Median follow-up as of 26 May 2021 was 11.97 months (range 4.37–19.80). First follow-up data are available for all patients, with a median of 1.10 month from completion of treatment (0.63–3.40). The median PSA at first visit was 2.75 (range 0.02–9.00) with a median AUA symptom score of 9 (range 1–24). Second follow-up data are available for 34 patients at a median of 4.45 months (range 2.57–8.90). At second follow-up, the median PSA was 1.60 (range 0.02–5.40) with a median AUA symptom score of 6 (range 1–33). Seventeen patients had third follow-up data with a median of 9.77 months (range 4.70–12.33) after SBRT. The median PSA was 1.13 (range 0.02–4.73) with an AUA score of 9 (2–22) at the third follow-up. We observed a statistically significant decrease in PSA between pre-treatment and at first follow-up (p < 0.005). The most common toxicity was grade 2 urethritis, managed in all cases by tamsulosin. One patient developed grade 2 tenesmus relieved by topical steroids. No cases of grade ≥ 3 toxicity were seen in our patient population. Conclusions: By avoiding the extra time required for plan adaptation, MRgRT without daily adaptation allows for successful prostate SBRT with manageable toxicity. We continue to reserve our limited adaptive treatment slots for preoperative pancreatic and ultra-central lung SBRT patients, which require time-intensive respiratory gating and adaptive planning. MDPI 2021-07-30 /pmc/articles/PMC8347281/ /pubmed/34362179 http://dx.doi.org/10.3390/jcm10153396 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Sandoval, Maria L.
Youssef, Irini
Latifi, Kujtim
Grass, G. Daniel
Torres-Roca, Javier
Rosenberg, Stephen
Yamoah, Kosj
Johnstone, Peter A.
Non-Adaptive MR-Guided Radiotherapy for Prostate SBRT: Less Time, Equal Results
title Non-Adaptive MR-Guided Radiotherapy for Prostate SBRT: Less Time, Equal Results
title_full Non-Adaptive MR-Guided Radiotherapy for Prostate SBRT: Less Time, Equal Results
title_fullStr Non-Adaptive MR-Guided Radiotherapy for Prostate SBRT: Less Time, Equal Results
title_full_unstemmed Non-Adaptive MR-Guided Radiotherapy for Prostate SBRT: Less Time, Equal Results
title_short Non-Adaptive MR-Guided Radiotherapy for Prostate SBRT: Less Time, Equal Results
title_sort non-adaptive mr-guided radiotherapy for prostate sbrt: less time, equal results
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8347281/
https://www.ncbi.nlm.nih.gov/pubmed/34362179
http://dx.doi.org/10.3390/jcm10153396
work_keys_str_mv AT sandovalmarial nonadaptivemrguidedradiotherapyforprostatesbrtlesstimeequalresults
AT youssefirini nonadaptivemrguidedradiotherapyforprostatesbrtlesstimeequalresults
AT latifikujtim nonadaptivemrguidedradiotherapyforprostatesbrtlesstimeequalresults
AT grassgdaniel nonadaptivemrguidedradiotherapyforprostatesbrtlesstimeequalresults
AT torresrocajavier nonadaptivemrguidedradiotherapyforprostatesbrtlesstimeequalresults
AT rosenbergstephen nonadaptivemrguidedradiotherapyforprostatesbrtlesstimeequalresults
AT yamoahkosj nonadaptivemrguidedradiotherapyforprostatesbrtlesstimeequalresults
AT johnstonepetera nonadaptivemrguidedradiotherapyforprostatesbrtlesstimeequalresults