Adaptive ultra-hypofractionated whole-pelvic radiotherapy in high-risk and very high-risk prostate cancer on 1.5-Tesla MR-Linac: Estimated delivered dose and early toxicity results

Q1 Medicine

Chronic Diseases and Translational Medicine Pub Date : 2024-01-21 DOI:10.1002/cdt3.114

Linrui Gao, Ran Wei, Shirui Qin, Yuan Tian, Wenlong Xia, Yongwen Song, Shulian Wang, Hui Fang, Yu Tang, Hao Jing, Yueping Liu, Yuan Tang, Shunan Qi, Bo Chen, Yexiong Li, Nianzeng Xing, Ningning Lu

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引用次数: 0

Abstract

Background

Magnetic resonance (MR)-guided ultra-hypofractionated radiotherapy with whole-pelvic irradiation (UHF-WPRT) is a novel approach to radiotherapy for patients with high-risk (HR) and very high-risk (VHR) prostate cancer (PCa). However, the inherent complexity of adaptive UHF-WPRT might inevitably result in longer on-couch time. We aimed to estimate the delivered dose, study the feasibility and safety of adaptive UHF-WPRT on a 1.5-Tesla MR-Linac.

Methods

Ten patients with clinical stage T3a-4N0-1M0-1c PCa, who consecutively received UHF-WPRT, were enrolled prospectively. The contours of the target and organ-at-risks on the position verification-MR (PV-MR), beam-on 3D-MR(Bn-MR), and post-MR (after radiotherapy delivery) were derived from the pre-MR data by deformable image registration. The physician then manually adjusted them, and dose recalculation was performed accordingly. GraphPad Prism 9 (GraphPad Prism Software Inc.) was utilized for conducting statistical analyses.

Results

In total, we collected 188 MR scans (50 pre-MR, 50 PV-MR, 44 Bn-MR, and 44 post-MR scans). With median 59 min, the mean prostate clinical target volume (CTV)-V_100% was 98.59% ± 2.74%, and the mean pelvic CTVp-V_100% relative percentages of all scans was 99.60% ± 1.18%. The median V_{29 Gy} change in the rectal wall was −2% (−18% to 20%). With a median follow-up of 9 months, no patient had acute Common Terminology Criteria for Adverse Events (CTCAE) grade 2 or more severe genitourinary (GU) or gastrointestinal (GI) toxicities (0%).

Conclusion

UHF-RT to the prostate and the whole pelvis with concomitant boost to positive nodes using an Adapt-To-Shape (ATS) workflow was technically feasible for patients with HR and VHR PCa, presenting only mild GU and GI toxicities. The estimated target dose during the beam-on phase was clinically acceptable based on the 3D-MR–based dosimetry analysis.

Clinical trial registration

Chinese Clinical Trial Registry ChiCTR2000033382.

Abstract Image

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在 1.5 特斯拉 MR-Linac 上对高危和极高危前列腺癌进行自适应超高分次全盆腔放疗：估计放射剂量和早期毒性结果

磁共振（MR）引导的全盆腔照射超高频分次放疗（UHF-WPRT）是治疗高危（HR）和极高危（VHR）前列腺癌（PCa）患者的一种新型放疗方法。然而，自适应超高频前列腺腔内放射治疗固有的复杂性可能会不可避免地导致放疗时间延长。我们的目的是在 1.5 特斯拉 MR-Linac 上估算超高频前列腺放射治疗的放射剂量，并研究其可行性和安全性。10 名临床分期为 T3a-4N0-1M0-1c 的前列腺癌患者连续接受了超高频前列腺放射治疗。通过可变形图像配准，从MR前数据推导出位置验证-MR（PV-MR）、束上3D-MR（Bn-MR）和后MR（放疗后）上的目标和危险器官轮廓。然后，医生对其进行手动调整，并相应地重新计算剂量。我们总共收集了 188 次 MR 扫描（50 次 MR 前扫描、50 次 PV-MR、44 次 Bn-MR 和 44 次 MR 后扫描）。中位59分钟，前列腺临床靶体积（CTV）-V100%的平均值为98.59% ± 2.74%，所有扫描的盆腔CTVp-V100%相对百分比的平均值为99.60% ± 1.18%。直肠壁V29 Gy变化的中位数为-2%（-18%至20%）。在中位随访9个月期间，没有患者出现急性不良事件通用术语标准（CTCAE）2级或更严重的泌尿生殖系统（GU）或胃肠道（GI）毒性反应（0%）。对前列腺和整个骨盆进行超高频前列腺放射治疗，同时使用适应形状（ATS）工作流程对阳性结节进行增强，这对HR和VHR PCa患者来说在技术上是可行的，仅出现轻微的泌尿生殖系统和胃肠道毒性反应。根据基于3D-MR的剂量学分析，射束开启阶段的估计目标剂量在临床上是可接受的。

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来源期刊

Chronic Diseases and Translational Medicine Medicine-General Medicine

CiteScore

6.70

自引率

0.00%

发文量

195

审稿时长

35 weeks

期刊介绍： This journal aims to promote progress from basic research to clinical practice and to provide a forum for communication among basic, translational, and clinical research practitioners and physicians from all relevant disciplines. Chronic diseases such as cardiovascular diseases, cancer, diabetes, stroke, chronic respiratory diseases (such as asthma and COPD), chronic kidney diseases, and related translational research. Topics of interest for Chronic Diseases and Translational Medicine include Research and commentary on models of chronic diseases with significant implications for disease diagnosis and treatment Investigative studies of human biology with an emphasis on disease Perspectives and reviews on research topics that discuss the implications of findings from the viewpoints of basic science and clinical practic.