MR-Guided Radiotherapy for Prostate Cancer.

Published on Dec 9, 2020in Frontiers in Oncology6.244
· DOI :10.3389/FONC.2020.616291
Boris R. Tocco2
Estimated H-index: 2
(The Royal Marsden NHS Foundation Trust),
Amar U. Kishan22
Estimated H-index: 22
(UCLA: University of California, Los Angeles)
+ 2 AuthorsAlison Tree22
Estimated H-index: 22
(The Royal Marsden NHS Foundation Trust)
External beam radiotherapy remains the primary treatment modality for localized prostate cancer. The radiobiology of prostate carcinoma lends itself to hypofractionation, with recent studies showing good outcomes with shorter treatment schedules. However, the ability to accurately deliver hypofractionated treatment is limited by current image-guided techniques. Magnetic resonance imaging is the main diagnostic tool for localized prostate cancer and its use in the therapeutic setting offers anatomical information to improve organ delineation. MR-guided radiotherapy, with daily re-planning, has shown early promise in the accurate delivery of radiotherapy. In this article, we discuss the shortcomings of current image-guidance strategies and the potential benefits and limitations of MR-guided treatment for prostate cancer. We also recount present experiences of MR-linac workflow and the opportunities afforded by this technology.
#1Chris ParkerH-Index: 88
#2Noel W. Clarke (University of Salford)H-Index: 72
Last. Matthew R. SydesH-Index: 72
view all 48 authors...
Summary Background The optimal timing of radiotherapy after radical prostatectomy for prostate cancer is uncertain. We aimed to compare the efficacy and safety of adjuvant radiotherapy versus an observation policy with salvage radiotherapy for prostate-specific antigen (PSA) biochemical progression. Methods We did a randomised controlled trial enrolling patients with at least one risk factor (pathological T-stage 3 or 4, Gleason score of 7–10, positive margins, or preoperative PSA ≥10 ng/mL) for...
#1Sophie R. de Mol van Otterloo (UU: Utrecht University)H-Index: 2
Last. Helena M. Verkooijen (UU: Utrecht University)H-Index: 34
view all 34 authors...
Purpose: MR-guided Radiation Therapy (MRgRT) allows for high-precision radiotherapy under real-time MR visualization. This enables margin reduction and subsequent dose escalation which may lead to higher tumor control and less toxicity. The Unity MR-linac (Elekta AB, Stockholm, Sweden) integrates a linear accelerator with a 1.5T diagnostic quality MRI and an online adaptive workflow. A prospective international registry was established to facilitate the evidence-based implementation of the Unity...
#1Alex Dunlop (ICR: Institute of Cancer Research)H-Index: 12
#2A. Mitchell (ICR: Institute of Cancer Research)H-Index: 4
Last. Uwe Oelfke (ICR: Institute of Cancer Research)H-Index: 52
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Abstract Introduction MR-guided adapted radiotherapy (MRgART) using a high field MR-linac has recently become available. We report the estimated delivered fractional dose of the first five prostate cancer patients treated at our centre using MRgART and compare this to C-Arm linac daily Image Guided Radiotherapy (IGRT). Methods Patients were treated using adapted treatment plans shaped to their daily anatomy. The treatments were recalculated on an MR image acquired immediately prior to treatment ...
#1Rebecca Levin-Epstein (UCLA: University of California, Los Angeles)H-Index: 6
#2G. Qiao-Guan (Case Western Reserve University)H-Index: 1
Last. Amar U. Kishan (UCLA: University of California, Los Angeles)H-Index: 22
view all 12 authors...
Purpose: To assess the optimal planning target volume (PTV) margins for stereotactic body radiotherapy (SBRT) of prostate cancer based on inter- and intra-fractional prostate motion determined from daily image guidance. Methods and Materials: 205 patients who were enrolled on two prospective studies of SBRT (8 Gy x 5 fractions) for localized prostate cancer treated at a single institution between 2012 and 2017 had complete inter- and intra-fractional shift data available. All patients had schedu...
#1Cédric Draulans (Katholieke Universiteit Leuven)H-Index: 6
#2Uulke A. van der Heide (NKI-AVL: Netherlands Cancer Institute)H-Index: 23
Last. Linda G.W. Kerkmeijer (Radboud University Nijmegen)H-Index: 21
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BACKGROUND AND PURPOSE: Local recurrences after radiotherapy for prostate cancer (PCa) often originate at the location of the macroscopic tumour(s). Since PCa cells are known to be sensitive to high fraction doses, hypofractionated whole gland stereotactic body radiotherapy (SBRT) in conjunction with a simultaneous ablative microboost to the macroscopic tumour(s) within the prostate could be a way to reduce the risk of local failure. We investigated the safety of this treatment strategy. MATERIA...
#1Filippo Alongi (University of Brescia)H-Index: 32
#2M. RigoH-Index: 12
Last. Rosario MazzolaH-Index: 21
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BACKGROUND: Unity Elekta is a unique magnetic resonance (MR)-linac that conjugates a 1.5 Tesla MR unit with a 7 MV flattening filter free accelerator.A prospective observational study for the clinical use of Elekta Unity is currently ongoing in our department. Herein, we present our preliminary report on the feasibility, quality of life, and patient-reported outcomes measures (PROMs) for localized prostate cancer (PC) treated with stereotactic body radiotherapy (SBRT). METHODS: The SBRT protocol...
#1Julia Murray (ICR: Institute of Cancer Research)H-Index: 8
#2Alison Tree (ICR: Institute of Cancer Research)H-Index: 22
Last. David P. Dearnaley (ICR: Institute of Cancer Research)H-Index: 110
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Abstract Purpose To report a planned analysis of the efficacy and toxicity of dose escalation to the intraprostatic dominant nodule identified on multiparametric MRI (mp-MRI) using standard and hypofractionated external beam radiotherapy. Methods and Materials XXX is a single centre prospective phase 2 multi-cohort study including standard (Cohort A: 74Gy/37F) and moderately hypofractionated (Cohort B: 60Gy/20F) prostate image-guided IMRT in patients with NCCN intermediate and high-risk disease....
#1Gerard Morton (U of T: University of Toronto)H-Index: 38
#2Merrylee McGuffin (U of T: University of Toronto)H-Index: 8
Last. Andrew Loblaw (U of T: University of Toronto)H-Index: 37
view all 13 authors...
BACKGROUND AND PURPOSE: High dose-rate (HDR) brachytherapy as monotherapy is a treatment option for localized prostate cancer, but optimal dose and fractionation is unknown. We report efficacy results of a randomized phase II trial of HDR monotherapy delivered as either one or two fractions. MATERIALS AND METHODS: Eligible patients had low or intermediate risk prostate cancer, prostate volume <60 cc, and no androgen deprivation use. 170 patients were randomized to receive HDR as either a single ...
#1David P. Dearnaley (The Royal Marsden NHS Foundation Trust)H-Index: 110
#2Clare Griffin (ICR: Institute of Cancer Research)H-Index: 15
Last. Emma Hall (ICR: Institute of Cancer Research)H-Index: 60
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325Background: CHHiP is a non-inferiority trial to determine efficacy and safety of hypofractionated radiotherapy for localised prostate cancer (PCa). Five year results indicated that moderate hypo...
#1Marcel A van Schie (NKI-AVL: Netherlands Cancer Institute)H-Index: 5
#2Petra J. van Houdt (NKI-AVL: Netherlands Cancer Institute)H-Index: 13
Last. Uulke A. van der Heide (NKI-AVL: Netherlands Cancer Institute)H-Index: 23
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Purpose: Quantitative MRI reflects tissue characteristics. As possible changes during radiotherapy may lead to treatment adaptation based on response, we here assessed if such changes during treatment can be detected. Methods and Materials: In the hypoFLAME trial patients received ultra-hypofractionated prostate radiotherapy with an integrated boost to the tumor in 5 weekly fractions. We analyzed T2 and ADC maps of 47 patients that were acquired in MRI exams prior to and during radiotherapy, and...
Cited By8
#1Jörg Tamihardja (University of Würzburg)H-Index: 3
#2Sinan Cirsi (University of Würzburg)
Last. Michael Flentje (University of Würzburg)H-Index: 69
view all 8 authors...
BACKGROUND Evaluation of delivered dose to the dominant intraprostatic lesion (DIL) for moderately hypofractionated radiotherapy of prostate cancer by cone beam computed tomography (CBCT)-based dose accumulation and target coverage analysis. METHODS Twenty-three patients with localized prostate cancer treated with moderately hypofractionated prostate radiotherapy with simultaneous integrated boost (SIB) between December 2016 and February 2020 were retrospectively analyzed. Included patients were...
#1Hania A. Al-Hallaq (U of C: University of Chicago)H-Index: 21
#2V. Batista (University Hospital Heidelberg)H-Index: 4
Last. Juergen Meyer (University of Washington Medical Center)H-Index: 22
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Abstract null null Emerging data indicates SGRT could improve safety and quality by preventing errors in its capacity as an independent system in the treatment room. The aim of this work is to investigate the utility of SGRT in the context of safety and quality. Three incident learning systems (ILS) were reviewed to categorize and quantify errors that could have been prevented with SGRT: SAFRON (International Atomic Energy Agency), UW-ILS (University of Washington) and AvIC (Skane University Hos...
#4Anna Rita AlittoH-Index: 6
#6Luca BoldriniH-Index: 18
Radiotherapy is highly involved in the management of prostate cancer. Its features and potential applications experienced a radical evolution over last decades, as they are associated to the continuous evolution of available technology and current oncological innovations. Some application of radiotherapy like brachytherapy have been recently enriched by innovative features and multidisciplinary dedications. In this report we aim to put some questions regarding the following issues regarding mult...
#1Mei Li (Sichuan University)H-Index: 1
#2Qin Zhang (Sichuan University)
Last. Kaixuan Yang (Sichuan University)H-Index: 2
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Advances in radiation technology, such as intensity-modulated radiation therapy (IMRT), have largely enabled a biological dose escalation of the target volume (TV) while reducing the dose to adjacent tissues or organs at risk (OARs). However, the risk of radiation-induced injury increases with increasing radiation dose and area during radiotherapy (RT), which predominantly limits further increases in TV dose distribution and reduces the local control rate. In this regard, the accurate target del...
#2Irini Youssef (SUNY Downstate Medical Center)H-Index: 8
Last. Peter A.S. JohnstoneH-Index: 57
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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 ...
#1D. Wegener (University of Tübingen)H-Index: 3
#2Daniel Zips (University of Tübingen)H-Index: 43
Last. Arndt-Christian MüllerH-Index: 17
view all 9 authors...
Der potenzielle Nutzen des verbesserten Weichteilkontrastes von MR-Sequenzen gegenuber der Computertomographie (CT) fur die Radiotherapie des Prostatakarzinoms ist bekannt und fuhrt zu konsistenteren und kleineren Zielvolumina sowie verbesserter Risikoorganschonung. Hybridgerate aus Magnetresonanztomographie (MRT) und Linearbeschleuniger (MR-Linac) stellen eine neue vielversprechende Erweiterung der radioonkologischen Therapieoptionen dar. Dieser Artikel gibt eine Ubersicht uber bisherige Erfahr...
#1Sophie R. de Mol van Otterloo (UU: Utrecht University)H-Index: 2
Last. Corinne Faivre-Finn (University of Manchester)H-Index: 53
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Purpose null High-field magnetic resonance-linear accelerators (MR-Linacs), linear accelerators combined with a diagnostic magnetic resonance imaging (MRI) scanner and online adaptive workflow, potentially give rise to novel online anatomic and response adaptive radiation therapy paradigms. The first high-field (1.5T) MR-Linac received regulatory approval in late 2018, and little is known about clinical use, patient tolerability of daily high-field MRI, and toxicity of treatments. Herein we repo...
Abstract null null Background and purpose null 1.5 Tesla magnetic resonance imaging radiotherapy linear accelerator (MR-Linac) is gaining interest for treatment of localized prostate cancer. Clinical evidence is lacking and it therefore remains uncertain whether MR-Linac is cost-effective. An early health economic analysis was performed to calculate the necessary relative reduction in complications and the maximum price of MR-Linac (5 fractions) to be cost-effective compared to 5, 20 and 39 frac...
#1Jim Zhong (University of Leeds)H-Index: 2
#2F. Slevin (University of Leeds)H-Index: 4
Last. Ann HenryH-Index: 34
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