An unusual case of oedematous prostate volumetric changes observed over the course of radiotherapy on the MR linear accelerator

Clough, Abigael; Bridge, Pete; Hales, Rosie; McDaid, Lisa; Choudhury, Ananya; Eccles, C.

doi:10.1016/j.jmir.2020.11.019

Cited by 2 publications

(3 citation statements)

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“…One, single patient case study was found to assess prostate volume changes during a moderately hypofractionated regimen as per our 20#MRIgRT group [23]. A maximum prostate volume increase of 27% relative to planning MRI was noted at fraction 9 (24 Gy); by fraction 20 this had reduced to 3% [23]. Although such a marked volume increase was not shown in our 20#MRIgRT cohort, fluctuation in prostate volume and a final prostate volume greater than baseline occurred in both studies.…”

Section: Discussionmentioning

confidence: 76%

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Prostate Volume Changes during Extreme and Moderately Hypofractionated Magnetic Resonance Image-guided Radiotherapy

Alexander¹,

McNair²,

Oelfke³

et al. 2022

Clinical Oncology

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Prostate Volume Changes during Extreme and Moderately Hypofractionated Magnetic Resonance Image-guided Radiotherapy

Alexander¹,

McNair²,

Oelfke³

et al. 2022

Clinical Oncology

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“…Small target volume changes associated with prostate hypofractionation have previously been described with MR-Linac extreme hypofractionation ( 16 , 17 ). In contrast, our patient had almost a 50% reduction in target volume, potentially due to the longer span in overall treatment time.…”

Section: Discussionmentioning

confidence: 89%

Case Report: MR-Guided Adaptive Radiotherapy, Some Room to Maneuver

Winter

Padayachee

et al. 2022

Front. Oncol.

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BackgroundA magnetic resonance linear accelerator (MR-Linac) provides superior soft tissue contrast to evaluate inter- and intra-fraction motion and facilitate online adaptive radiation therapy (ART). We present here an unusual case of locally advanced castrate-resistant prostate cancer treated with high-dose palliative ultra-hypofractionated radiation therapy on the MR-Linac with significant inter-fraction tumor regression.Case PresentationThe patient was a 65-year-old man diagnosed with metastatic prostate cancer to bone and pelvic lymph nodes 7 years prior. At diagnosis, he presented with a PSA of 23 ng/ml and was commenced on a luteinizing hormone-releasing hormone agonist, achieving a PSA nadir of 4.68 ng/ml at 12 months. The patient subsequently had progressive lower urinary tract symptoms, his PSA increased to 47 ng/ml, and there was a markedly enlarged pelvic mass involving the prostate with gross extra-capsular disease and invasion into the posterior bladder wall. The patient was referred for palliative radiation to the pelvic mass due to urinary symptoms, pain, and lower limb paraesthesia. Treatment was planned to be delivered on the MR-Linac with a schedule of 36 Gy over 6 weekly factions allowing for maximal target dose delivery while minimizing surrounding organs at risk (OARs) radiation exposure. Unexpectedly, the target volume had a marked 49% (453 cc to 233 cc) reduction that was accounted for in the online adaptive process. A new reference plan was generated after 3 fractions to add sacral plexus as an OAR, previously not visible due to mass encroachment. The patient reported ongoing reduction in urinary symptoms, pelvic pain, and lower limb paresthesia by the end of treatment.ConclusionUsing daily MR-guided ART, improved visualization of the changing target and OARs ensured safe dose escalation. The unexpected positive response of the target and improved patient outcomes demonstrated the added value of the MR-Linac for online adaptive radiotherapy in this setting.

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An unusual case of oedematous prostate volumetric changes observed over the course of radiotherapy on the MR linear accelerator

Cited by 2 publications

References 5 publications

Prostate Volume Changes during Extreme and Moderately Hypofractionated Magnetic Resonance Image-guided Radiotherapy

Prostate Volume Changes during Extreme and Moderately Hypofractionated Magnetic Resonance Image-guided Radiotherapy

Case Report: MR-Guided Adaptive Radiotherapy, Some Room to Maneuver

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