Magnetic Resonance Imaging-Directed Stereotactic Body Radiation Therapy Microboost in Concert With Pelvic Nodal Irradiation for Prostate Cancer in the Higher-Risk Spectrum: Toxicity

IF 2.9 Q3 ONCOLOGY

Advances in Radiation Oncology Pub Date : 2026-04-01 Epub Date: 2026-02-13 DOI:10.1016/j.adro.2026.101997

Mina Musthafa AB , Markus Wells MD , Timothy Kearney MD , Brianna Vizcaino BA , Vianca F. Santos MPH , Astrid Sanchez MS , Christopher Mendez MA , Aaron Katz MD , Keith Kowalcyzk MD , Ryan Hankins MD , Mohit Gupta MD , Herbert Lepor MD , Jonathan A. Haas MD , Jonathan W. Lischalk MD

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引用次数: 0

Abstract

Purpose

Recent publications have renewed interest in prophylactic pelvic radiation therapy for higher-risk prostate cancer, as well as dose escalation for magnetic resonance imaging (MRI)-defined intraprostatic lesions. Here, we explore the use of pelvic nodal irradiation with a 3-fraction stereotactic body radiation therapy (SBRT) boost to the prostate and seminal vesicles, with a simultaneous MRI-directed focal intraprostatic lesion-ablative microboost (MIB).

Methods and Materials

We evaluated an institutional registry of patients undergoing pelvic nodal radiation followed by an SBRT boost to the prostate and seminal vesicles from April 2021 to March 2023. The study was approved by the local institutional review board (study #00001269). All patients were treated with pelvic nodal irradiation followed by a 3-fraction SBRT boost. The prostate SBRT boost dose was primarily 2100 cGy in 3 fractions (an accommodated range of 1800-2100 cGy). A subgroup of 15 patients received an MIB to an additional dose of 2300 cGy in 3 fractions (range, 2100-2400 cGy). The distribution of adverse event grades for acute and late gastrointestinal (GI) and genitourinary (GU) toxicity was assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events, version 5.0.

Results

Fifty-eight patients underwent pelvic nodal irradiation followed by an SBRT boost to the prostate, with the distribution of risk groups as follows: patients were either in the high (36.2%, n = 21) or very high (34.5% n = 20) risk groups, whereas those with known nodal disease (19.0%, n = 11) or intermediate risk (10.3%, n = 6) comprised the rest of the study population. Most patients received androgen-deprivation therapy. The prostate SBRT boost dose was primarily 2100 cGy in 3 fractions. Fifteen patients received an MIB to an additional dose of 2300 cGy in 3 fractions. A median follow-up of 8.7 months was used to document the incidence of GU and GI toxicity. The distribution of GI and GU toxicity showed no significant difference between the MIB and non-MIB subcohorts at either the acute (<90 days) or late (>90 days) time points. Two grade 3 toxicities were observed, both in the non-MIB cohort. Grade 2+ GI and GU toxicities were not significantly different between the 2 groups, as assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events, version 5.0.

Conclusions

In the early follow-up period, we observed no significant difference in GI or GU toxicity between those who underwent MIB and those who did not. These results suggest that MRI-directed SBRT MIB did not increase GI toxicity and may even reduce GU toxicity compared with standard treatment. Future research should explore long-term side effects, with attention to the Expanded Prostate Cancer Index Composite (EPIC) scores and oncologic outcomes of this novel method of dose escalation.

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磁共振成像定向立体定向放射治疗微增强联合盆腔淋巴结放射治疗前列腺癌的高危谱：毒性

目的：最近的出版物重新燃起了对高危前列腺癌的预防性盆腔放射治疗的兴趣，以及对磁共振成像（MRI）定义的前列腺内病变的剂量增加。在本研究中，我们探讨了盆腔淋巴结放射治疗的使用，并对前列腺和精囊进行三分位立体定向体放射治疗（SBRT）增强，同时进行mri定向局灶前列腺内病变消融微增强（MIB）。方法和材料：我们评估了2021年4月至2023年3月期间接受盆腔淋巴结放疗后前列腺和精囊SBRT增强的机构登记患者。该研究得到了当地机构审查委员会的批准（研究#00001269）。所有患者均接受盆腔淋巴结照射，随后进行3分次SBRT增强。前列腺SBRT增强剂量主要为2100 cGy，分为三个部分（可调节范围为1800-2100 cGy）。15名患者的亚组接受了3次额外剂量2300 cGy的MIB（范围，2100-2400 cGy）。使用美国国家癌症研究所不良事件通用术语标准5.0版对急性和晚期胃肠道（GI）和泌尿生殖系统（GU）毒性的不良事件等级分布进行评估。结果58例患者接受盆腔淋巴结照射后进行前列腺SBRT增强，风险组分布如下：高危组（36.2%,n = 21）或高危组（34.5%,n = 20），其余研究人群为已知淋巴结疾病（19.0%,n = 11）或中危组（10.3%,n = 6）。大多数患者接受雄激素剥夺治疗。前列腺SBRT增强剂量主要为2100 cGy，分3次。15名患者接受了三次额外剂量2300 cGy的MIB。中位随访时间为8.7个月，用于记录GU和GI毒性的发生率。GI和GU毒性的分布在急性（90天）或晚期（90天）时间点上在MIB和非MIB亚组之间没有显着差异。在非mib队列中观察到两个3级毒性。根据美国国家癌症研究所不良事件通用术语标准5.0版评估，2+级GI和GU毒性在两组之间没有显著差异。结论在早期随访中，我们观察到接受MIB治疗的患者和未接受MIB治疗的患者在GI或GU毒性方面没有显著差异。这些结果表明，与标准治疗相比，mri定向SBRT MIB不会增加胃肠道毒性，甚至可能降低胃肠道毒性。未来的研究应该探索长期的副作用，并关注这种新型剂量递增方法的扩展前列腺癌指数综合（EPIC）评分和肿瘤学结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Advances in Radiation Oncology Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

4.60

自引率

4.30%

发文量

208

审稿时长

98 days

期刊介绍： The purpose of Advances is to provide information for clinicians who use radiation therapy by publishing: Clinical trial reports and reanalyses. Basic science original reports. Manuscripts examining health services research, comparative and cost effectiveness research, and systematic reviews. Case reports documenting unusual problems and solutions. High quality multi and single institutional series, as well as other novel retrospective hypothesis generating series. Timely critical reviews on important topics in radiation oncology, such as side effects. Articles reporting the natural history of disease and patterns of failure, particularly as they relate to treatment volume delineation. Articles on safety and quality in radiation therapy. Essays on clinical experience. Articles on practice transformation in radiation oncology, in particular: Aspects of health policy that may impact the future practice of radiation oncology. How information technology, such as data analytics and systems innovations, will change radiation oncology practice. Articles on imaging as they relate to radiation therapy treatment.