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, 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","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 > 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, 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\",\"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 > 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}
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.