Standard and Hypofractionated Dose Escalation to Intraprostatic Tumor Nodules in Localized Prostate Cancer: 5-Year Efficacy and Toxicity in the DELINEATE Trial

Tree, A.; Satchwell, Laura; Alexander, E.; Blasiak-Wal, I.; deSouza, Nandita M.; Gao, Annie; Robinson, Emily; McNair, H.; Parker, Chris; Talbot, James; Dearnaley, David P.; Murray, Julia

doi:10.1016/j.ijrobp.2022.09.058

Cited by 24 publications

(20 citation statements)

References 41 publications

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“…Two studies utilized MR with endorectal coil [ 7 , 8 ]. Four studies required use of multiparametric MR [ 10 , 12 , 14 – 16 ]. All studies except for 2SMART described the sequences used to delineate IPLs; they utilized at least T 2 -weighted imaging (T2W).…”

Section: Resultsmentioning

confidence: 99%

“…All studies except for 2SMART described the sequences used to delineate IPLs; they utilized at least T 2 -weighted imaging (T2W). Three studies utilized at least T2W and DWI [ 10 , 12 , 14 , 17 ]. DWI generally includes generation of ADC maps, where specifically cited in one study [ 17 ] and are the primary images for most lesions according to PI-RADS radiologist guidelines [ 9 ].…”

Section: Resultsmentioning

confidence: 99%

“…Maas et al utilized the following sequences: T2W, DWI, and ADC. Diagnostic MRs were usually fused (registered) with planning CTs to aid in contouring but one study displayed them side-by-side [ 12 ]. Many studies did not explicitly characterize IPL criteria for focal boost eligibility.…”

Section: Resultsmentioning

confidence: 99%

“…All studies used CT simulation. Most studies did not clarify the temporal relationship between CT simulation and planning MR; the lone exception, DELINEATE, performed CT and MR on the same day [ 12 ]. All but one study described techniques used for verification of patient setup [ 8 ].…”

Section: Resultsmentioning

confidence: 99%

“…The synthesized bDFS was 92.4% (95% CI 84.5–97.7%) for studies with follow-up greater than 5 years. Since then, there have been increasingly mature results published as well as ongoing clinical trials about focal boosts in a variety of radiation therapy schedules, including hypofractionation [ 12 ] and ultra-hypofractionation (also called stereotactic body radiation therapy, or SBRT, and stereotactic ablative body radiotherapy, or SABR) [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Focal radiotherapy boost to MR-visible tumor for prostate cancer: a systematic review

Dornisch,

Zhong,

Poon

et al. 2024

World J Urol

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Purpose The FLAME trial provides strong evidence that MR-guided external beam radiation therapy (EBRT) focal boost for localized prostate cancer increases biochemical disease-free survival (bDFS) without increasing toxicity. Yet, there are many barriers to implementation of focal boost. Our objectives are to systemically review clinical outcomes for MR-guided EBRT focal boost and to consider approaches to increase implementation of this technique. Methods We conducted literature searches in four databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline. We included prospective phase II/III trials of patients with localized prostate cancer underdoing definitive EBRT with MR-guided focal boost. The outcomes of interest were bDFS and acute/late gastrointestinal and genitourinary toxicity. Results Seven studies were included. All studies had a median follow-up of greater than 4 years. There were heterogeneities in fractionation, treatment planning, and delivery. Studies demonstrated effectiveness, feasibility, and tolerability of focal boost. Based on the Phoenix criteria for biochemical recurrence, the reported 5-year biochemical recurrence-free survival rates ranged 69.7–100% across included studies. All studies reported good safety profiles. The reported ranges of acute/late grade 3 + gastrointestinal toxicities were 0%/1–10%. The reported ranges of acute/late grade 3 + genitourinary toxicities were 0–13%/0–5.6%. Conclusions There is strong evidence that it is possible to improve oncologic outcomes without substantially increasing toxicity through MR-guided focal boost, at least in the setting of a 35-fraction radiotherapy regimen. Barriers to clinical practice implementation are addressable through additional investigation and new technologies.

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