MR-Guided Radiotherapy for Prostate Cancer

Tocco, Boris; Kishan, Amar U.; Martin, Ting; Kerkmeijer, Linda G.W.; Tree, A.

doi:10.3389/fonc.2020.616291

Cited by 66 publications

(61 citation statements)

References 77 publications

(93 reference statements)

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“…It is also doubtful if the costs of MR-Linac can be reduced considerably to improve cost-effectiveness. To illustrate, the implementation of MR-Linac deals with substantial investments and [14,23,31,32]. Potential efficiencies will emerge over time as MRI imaging is increasingly being used within radiotherapy [23].…”

Section: Discussionmentioning

confidence: 99%

“…To illustrate, the implementation of MR-Linac deals with substantial investments and [14,23,31,32]. Potential efficiencies will emerge over time as MRI imaging is increasingly being used within radiotherapy [23]. So beyond clinical challenges, also operational and technical aspects presently impede the cost-effectiveness of MR-Linac for localized PCa.…”

Section: Discussionmentioning

confidence: 99%

“…So beyond clinical challenges, also operational and technical aspects presently impede the cost-effectiveness of MR-Linac for localized PCa. Alongside the aforementioned obstacles, the ongoing technological development of MR-Linac and potential learning curves may improve cost-effective outcomes [14,23,31,33]. MR guidance with the potential of improved adaptive contour propagation and rapid dose reconstruction during radiation may allow smaller uncertainty margins around the prostate.…”

Section: Discussionmentioning

confidence: 99%

“…Over the course of the last 15-years urinary and bowel complications after EBRT have decreased substantially as uncertainty margins were reduced due to the introduction of 3D conformal MRI-guided radiotherapy and image-guidance by fiducial marker placement within the prostate [34]. Hence, improved accuracy of treatment delivery and further reduction in uncertainty margins may result in less toxicity as less healthy tissue (e.g., bladder and rectum) is exposed to radiation [12,23].…”

Section: Discussionmentioning

confidence: 99%

“…This study lacked comparisons with other standard radiotherapy regimens such as brachytherapy and 20-fractions EBRT [12,18,19]. Furthermore, the appraisal of adverse effects did not include sexual complications, which is an important outcome following radiotherapy [20][21][22][23].…”

mentioning

confidence: 99%

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Early health economic analysis of 1.5 T MRI-guided radiotherapy for localized prostate cancer: Decision analytic modelling

Zyp

Vanneste

Grutters

et al. 2021

Radiotherapy and Oncology

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Background and purpose: 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 fractionation schedules of external beam radiotherapy (EBRT) and low-dose-rate (LDR) brachytherapy. Materials and methods: A state transition model was developed for men with localized prostate cancer. Complication rates such as grade !2 urinary, grade !2 bowel and sexual complications, and utilities were based on systematic literature searches. Costs were estimated from a Dutch healthcare perspective. Threshold analyses were performed to identify the thresholds of complications and costs for MR-Linac to be cost-effective, while holding other outcomes such as biochemical progression and mortality constant. One-way sensitivity analyses were performed to outline uncertainty outcomes.Results: At €6460 per patient, no reductions in complications were needed to consider MR-Linac costeffective compared to EBRT 20 and 39 fractions. Compared to EBRT 5 fractions and LDR brachytherapy, MR-Linac was found to be cost-effective when complications are relatively reduced by 54% and 66% respectively. Results are highly sensitive to the utilities of urinary, bowel and sexual complications and the probability of biochemical progression. Conclusions: MR-Linac is found to be cost-effective compared to 20 and 39 fractions EBRT at baseline. For MR-Linac to become cost-effective over 5 fractions EBRT and LDR brachytherapy, it has to reduce complications substantially or be offered at lower costs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Early health economic analysis of 1.5 T MRI-guided radiotherapy for localized prostate cancer: Decision analytic modelling

Zyp

Vanneste

Grutters

et al. 2021

Radiotherapy and Oncology

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Magnetic Resonance Imaging–Guided vs Computed Tomography–Guided Stereotactic Body Radiotherapy for Prostate Cancer

et al. 2023

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ImportanceMagnetic resonance imaging (MRI) guidance offers multiple theoretical advantages in the context of stereotactic body radiotherapy (SBRT) for prostate cancer. However, to our knowledge, these advantages have yet to be demonstrated in a randomized clinical trial.ObjectiveTo determine whether aggressive margin reduction with MRI guidance significantly reduces acute grade 2 or greater genitourinary (GU) toxic effects after prostate SBRT compared with computed tomography (CT) guidance.Design, Setting, and ParticipantsThis phase 3 randomized clinical trial (MRI-Guided Stereotactic Body Radiotherapy for Prostate Cancer [MIRAGE]) enrolled men aged 18 years or older who were receiving SBRT for clinically localized prostate adenocarcinoma at a single center between May 5, 2020, and October 1, 2021. Data were analyzed from January 15, 2021, through May 15, 2022. All patients had 3 months or more of follow-up.InterventionsPatients were randomized 1:1 to SBRT with CT guidance (control arm) or MRI guidance. Planning margins of 4 mm (CT arm) and 2 mm (MRI arm) were used to deliver 40 Gy in 5 fractions.Main Outcomes and MeasuresThe primary end point was the incidence of acute (≤90 days after SBRT) grade 2 or greater GU toxic effects (using Common Terminology Criteria for Adverse Events, version 4.03 [CTCAE v4.03]). Secondary outcomes included CTCAE v4.03–based gastrointestinal toxic effects and International Prostate Symptom Score (IPSS)–based and Expanded Prostate Cancer Index Composite-26 (EPIC-26)–based outcomes.ResultsBetween May 2020 and October 2021, 156 patients were randomized: 77 to CT (median age, 71 years [IQR, 67-77 years]) and 79 to MRI (median age, 71 years [IQR, 68-75 years]). A prespecified interim futility analysis conducted after 100 patients reached 90 or more days after SBRT was performed October 1, 2021, with the sample size reestimated to 154 patients. Thus, the trial was closed to accrual early. The incidence of acute grade 2 or greater GU toxic effects was significantly lower with MRI vs CT guidance (24.4% [95% CI, 15.4%-35.4%] vs 43.4% [95% CI, 32.1%-55.3%]; P = .01), as was the incidence of acute grade 2 or greater gastrointestinal toxic effects (0.0% [95% CI, 0.0%-4.6%] vs 10.5% [95% CI, 4.7%-19.7%]; P = .003). Magnetic resonance imaging guidance was associated with a significantly smaller percentage of patients with a 15-point or greater increase in IPSS at 1 month (6.8% [5 of 72] vs 19.4% [14 of 74]; P = .01) and a significantly reduced percentage of patients with a clinically significant (≥12-point) decrease in EPIC-26 bowel scores (25.0% [17 of 68] vs 50.0% [34 of 68]; P = .001) at 1 month.Conclusions and RelevanceIn this randomized clinical trial, compared with CT-guidance, MRI-guided SBRT significantly reduced both moderate acute physician-scored toxic effects and decrements in patient-reported quality of life. Longer-term follow-up will confirm whether these notable benefits persist.Trial RegistrationClinicalTrials.gov Identifier: NCT04384770

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Dosimetric advantages of daily adaptive strategy in IMPT for high‐risk prostate cancer

Tamura

Kobashi

Nishioka

et al. 2022

J Applied Clin Med Phys

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Purpose To evaluate the dosimetric advantages of daily adaptive radiotherapy (DART) in intensity‐modulated proton therapy (IMPT) for high‐risk prostate cancer by comparing estimated doses of the conventional non‐adaptive radiotherapy (NART) that irradiates according to an original treatment plan through the entire treatment and the DART that uses an adaptive treatment plan generated by using daily CT images acquired before each treatment. Methods Twenty‐three patients with prostate cancer were included. A treatment plan with 63 Gy (relative biological effectiveness (RBE)) in 21 fractions was generated using treatment planning computed tomography (CT) images assuming that all patients had high‐risk prostate cancer for which the clinical target volume (CTV) needs to include prostate and the seminal vesicle (SV) in our treatment protocol. Twenty‐one adaptive treatment plans for each patient (total 483 data sets) were generated using daily CT images, and dose distributions were calculated. Using a 3 mm set‐up uncertainty in the robust optimization, the doses to the CTV, prostate, SV, rectum, and bladder were compared. Results Estimated accumulated doses of NART and DART in the 23 patients were 60.81 ± 3.47 Gy (RBE) and 63.24 ± 1.04 Gy (RBE) for CTV D99 (p < 0.01), 62.99 ± 1.28 Gy (RBE) and 63.43 ± 1.33 Gy (RBE) for the prostate D99 (p = 0.2529), and 59.07 ± 5.19 Gy (RBE) and 63.17 ± 1.04 Gy (RBE) for SV D99 (p < 0.001). No significant differences were observed between NART and DART in the estimated accumulated dose for the rectum and bladder. Conclusion Compared with the NART, DART was shown to be a useful approach that can maintain the dose coverage to the target without increasing the dose to the organs at risk (OAR) using the 3 mm set‐up uncertainty in the robust optimization in patients with high‐risk prostate cancer.

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MR-Guided Radiotherapy for Prostate Cancer

Cited by 66 publications

References 77 publications

Early health economic analysis of 1.5 T MRI-guided radiotherapy for localized prostate cancer: Decision analytic modelling

Early health economic analysis of 1.5 T MRI-guided radiotherapy for localized prostate cancer: Decision analytic modelling

Magnetic Resonance Imaging–Guided vs Computed Tomography–Guided Stereotactic Body Radiotherapy for Prostate Cancer

Dosimetric advantages of daily adaptive strategy in IMPT for high‐risk prostate cancer

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