补救性立体定向磁共振引导自适应放疗(SMART)再照射治疗局部复发前列腺癌:临床和剂量学结果

IF 2.7 3区 医学 Q3 ONCOLOGY
Elena Moreno-Olmedo, Dan Murray, Ben George, Daniel Ford, Nicola Dallas, Prantik Das, Ami Sabharwal, Yoodhvir Nagar, Jamie Mills, Carla Perna, Yae-eun Suh, Alex Martin, Philip Camilleri
{"title":"补救性立体定向磁共振引导自适应放疗(SMART)再照射治疗局部复发前列腺癌:临床和剂量学结果","authors":"Elena Moreno-Olmedo,&nbsp;Dan Murray,&nbsp;Ben George,&nbsp;Daniel Ford,&nbsp;Nicola Dallas,&nbsp;Prantik Das,&nbsp;Ami Sabharwal,&nbsp;Yoodhvir Nagar,&nbsp;Jamie Mills,&nbsp;Carla Perna,&nbsp;Yae-eun Suh,&nbsp;Alex Martin,&nbsp;Philip Camilleri","doi":"10.1016/j.ctro.2025.101037","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>Stereotactic ablative radiotherapy (SABR) is a salvage option for locally recurrent prostate cancer (LRPC); however, challenges remain. Stereotactic MRguided Adaptive Radiotherapy (SMART) permits daily adaptation, real-time tracking and automated beam gating, allowing critical organ sparing while potentially improving target coverage. Equivalent Dose in 2 Gy fraction (EQD2) calculation allows accurate organs-at-risk (OAR) dose accumulation in re-irradiation.</div><div>We report safety and efficacy of daily SMART re-irradiation for LRPC, alongside an EQD2-based OAR tolerance calculation method.</div></div><div><h3>Methods</h3><div>Salvage SMART to histologically proven non-metastatic hormone-sensitive LRPC was retrospectively analysed. Inclusion criteria included: ≥18 months post-RT, prostate-specific antigen (PSA) ≤ 30 ng/mL, PSA doubling-time &gt; 6 months, International Prostate Symptom Score (IPSS) ≤ 19, prostate ≤ 80 cc and cT1–T3a/b.Reirradiation regimens were 30–35 Gy/5 fractions. Dose-boost and hormone therapy were allowed. Rectal spacer was recommended.</div><div>Outcomes included toxicity, local control (LC), biochemical relapse-free survival (bRFS), progression free survival (PFS) and overall survival (OS). EQD2-based workflow to estimate OAR cumulative constraints was reported.</div></div><div><h3>Results</h3><div>Between 2019 and 2023, nineteen patients underwent salvage-SMART to whole-gland (n = 12), hemi-gland (n = 5) or seminal vesicle (n = 2) at a median 87 months (range 35–587) from first radiotherapy. All 95 delivered fractions underwent online adaptation, meeting all estimated OAR.</div><div>With 21 months follow-up, acute grade 2 genitourinary (GU) toxicity was 21 % with no acute ≥ grade 3 GU or ≥ grade 2 gastrointestinal (GI) toxicity observed. Late GU grade 3 toxicity occurred in 3 patients (15.7 %).</div><div>OS was 100%; bRFS 73.7%; LC 84.2%; and median-PFS was not reached. One and two-year PFS were 94.7% and 89.4%. One and two-year LC was 100%. Two contralateral intraprostatic failures followed hemi-gland treatment were observed.</div></div><div><h3>Conclusion</h3><div>Daily adaptive SMART re-irradiation is a feasible, non-invasive salvage option for LRPC, combining high LC with low toxicity. Our experience supports integrating MR- guidance with an individualized EQD2-informed planning.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101037"},"PeriodicalIF":2.7000,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Salvage stereotactic MR-Guided adaptive radiotherapy (SMART) re-irradiation for locally recurrent prostate Cancer: Clinical and dosimetric outcomes\",\"authors\":\"Elena Moreno-Olmedo,&nbsp;Dan Murray,&nbsp;Ben George,&nbsp;Daniel Ford,&nbsp;Nicola Dallas,&nbsp;Prantik Das,&nbsp;Ami Sabharwal,&nbsp;Yoodhvir Nagar,&nbsp;Jamie Mills,&nbsp;Carla Perna,&nbsp;Yae-eun Suh,&nbsp;Alex Martin,&nbsp;Philip Camilleri\",\"doi\":\"10.1016/j.ctro.2025.101037\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><div>Stereotactic ablative radiotherapy (SABR) is a salvage option for locally recurrent prostate cancer (LRPC); however, challenges remain. Stereotactic MRguided Adaptive Radiotherapy (SMART) permits daily adaptation, real-time tracking and automated beam gating, allowing critical organ sparing while potentially improving target coverage. Equivalent Dose in 2 Gy fraction (EQD2) calculation allows accurate organs-at-risk (OAR) dose accumulation in re-irradiation.</div><div>We report safety and efficacy of daily SMART re-irradiation for LRPC, alongside an EQD2-based OAR tolerance calculation method.</div></div><div><h3>Methods</h3><div>Salvage SMART to histologically proven non-metastatic hormone-sensitive LRPC was retrospectively analysed. Inclusion criteria included: ≥18 months post-RT, prostate-specific antigen (PSA) ≤ 30 ng/mL, PSA doubling-time &gt; 6 months, International Prostate Symptom Score (IPSS) ≤ 19, prostate ≤ 80 cc and cT1–T3a/b.Reirradiation regimens were 30–35 Gy/5 fractions. Dose-boost and hormone therapy were allowed. Rectal spacer was recommended.</div><div>Outcomes included toxicity, local control (LC), biochemical relapse-free survival (bRFS), progression free survival (PFS) and overall survival (OS). EQD2-based workflow to estimate OAR cumulative constraints was reported.</div></div><div><h3>Results</h3><div>Between 2019 and 2023, nineteen patients underwent salvage-SMART to whole-gland (n = 12), hemi-gland (n = 5) or seminal vesicle (n = 2) at a median 87 months (range 35–587) from first radiotherapy. All 95 delivered fractions underwent online adaptation, meeting all estimated OAR.</div><div>With 21 months follow-up, acute grade 2 genitourinary (GU) toxicity was 21 % with no acute ≥ grade 3 GU or ≥ grade 2 gastrointestinal (GI) toxicity observed. Late GU grade 3 toxicity occurred in 3 patients (15.7 %).</div><div>OS was 100%; bRFS 73.7%; LC 84.2%; and median-PFS was not reached. One and two-year PFS were 94.7% and 89.4%. One and two-year LC was 100%. Two contralateral intraprostatic failures followed hemi-gland treatment were observed.</div></div><div><h3>Conclusion</h3><div>Daily adaptive SMART re-irradiation is a feasible, non-invasive salvage option for LRPC, combining high LC with low toxicity. Our experience supports integrating MR- guidance with an individualized EQD2-informed planning.</div></div>\",\"PeriodicalId\":10342,\"journal\":{\"name\":\"Clinical and Translational Radiation Oncology\",\"volume\":\"56 \",\"pages\":\"Article 101037\"},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2025-08-26\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical and Translational Radiation Oncology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2405630825001296\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical and Translational Radiation Oncology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2405630825001296","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0

摘要

立体定向消融放疗(SABR)是局部复发性前列腺癌(LRPC)的一种挽救选择;然而,挑战依然存在。立体定向磁共振引导自适应放疗(SMART)允许日常适应、实时跟踪和自动光束门控,在潜在地提高目标覆盖范围的同时允许关键器官保留。2 Gy当量剂量(EQD2)计算允许再辐照中器官危险(OAR)剂量的准确累积。我们报告了每日SMART再照射LRPC的安全性和有效性,以及基于eqd2的OAR耐受计算方法。方法对经组织学证实的非转移性激素敏感性LRPC进行回顾性分析。纳入标准为:放疗后≥18个月,前列腺特异性抗原(PSA)≤30 ng/mL, PSA倍增时间≤6个月,国际前列腺症状评分(IPSS)≤19,前列腺≤80 cc, cT1-T3a /b。再照射方案为30-35 Gy/5次。剂量增强和激素治疗是允许的。建议使用直肠垫片。结果包括毒性、局部控制(LC)、生化无复发生存(bRFS)、无进展生存(PFS)和总生存(OS)。报告了基于eqd2的OAR累积约束估计工作流程。结果2019年至2023年期间,19例患者在首次放疗后中位87个月(范围35-587个月)接受了全腺(n = 12)、半腺(n = 5)或精囊(n = 2)的抢救- smart治疗。所有95个交付的分数都进行了在线适应,满足了所有估计的OAR。经过21个月的随访,急性2级泌尿生殖系统(GU)毒性为21%,未观察到急性≥3级GU或≥2级胃肠道(GI)毒性。3例(15.7%)出现晚期GU 3级毒性。OS为100%;bRFS 73.7%;LC 84.2%;未达到中位pfs。1年和2年PFS分别为94.7%和89.4%。一年期和两年的信用证是100%。在半腺体治疗后观察到2例对侧前列腺内衰竭。结论每日自适应SMART再照射治疗LRPC是可行的、无创的、高LC和低毒性相结合的治疗方法。我们的经验支持将MR指导与个性化的eqd2知情规划相结合。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Salvage stereotactic MR-Guided adaptive radiotherapy (SMART) re-irradiation for locally recurrent prostate Cancer: Clinical and dosimetric outcomes

Introduction

Stereotactic ablative radiotherapy (SABR) is a salvage option for locally recurrent prostate cancer (LRPC); however, challenges remain. Stereotactic MRguided Adaptive Radiotherapy (SMART) permits daily adaptation, real-time tracking and automated beam gating, allowing critical organ sparing while potentially improving target coverage. Equivalent Dose in 2 Gy fraction (EQD2) calculation allows accurate organs-at-risk (OAR) dose accumulation in re-irradiation.
We report safety and efficacy of daily SMART re-irradiation for LRPC, alongside an EQD2-based OAR tolerance calculation method.

Methods

Salvage SMART to histologically proven non-metastatic hormone-sensitive LRPC was retrospectively analysed. Inclusion criteria included: ≥18 months post-RT, prostate-specific antigen (PSA) ≤ 30 ng/mL, PSA doubling-time > 6 months, International Prostate Symptom Score (IPSS) ≤ 19, prostate ≤ 80 cc and cT1–T3a/b.Reirradiation regimens were 30–35 Gy/5 fractions. Dose-boost and hormone therapy were allowed. Rectal spacer was recommended.
Outcomes included toxicity, local control (LC), biochemical relapse-free survival (bRFS), progression free survival (PFS) and overall survival (OS). EQD2-based workflow to estimate OAR cumulative constraints was reported.

Results

Between 2019 and 2023, nineteen patients underwent salvage-SMART to whole-gland (n = 12), hemi-gland (n = 5) or seminal vesicle (n = 2) at a median 87 months (range 35–587) from first radiotherapy. All 95 delivered fractions underwent online adaptation, meeting all estimated OAR.
With 21 months follow-up, acute grade 2 genitourinary (GU) toxicity was 21 % with no acute ≥ grade 3 GU or ≥ grade 2 gastrointestinal (GI) toxicity observed. Late GU grade 3 toxicity occurred in 3 patients (15.7 %).
OS was 100%; bRFS 73.7%; LC 84.2%; and median-PFS was not reached. One and two-year PFS were 94.7% and 89.4%. One and two-year LC was 100%. Two contralateral intraprostatic failures followed hemi-gland treatment were observed.

Conclusion

Daily adaptive SMART re-irradiation is a feasible, non-invasive salvage option for LRPC, combining high LC with low toxicity. Our experience supports integrating MR- guidance with an individualized EQD2-informed planning.
求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Clinical and Translational Radiation Oncology
Clinical and Translational Radiation Oncology Medicine-Radiology, Nuclear Medicine and Imaging
CiteScore
5.30
自引率
3.20%
发文量
114
审稿时长
40 days
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信