Stereotactic body radiotherapy for oligometastatic castration sensitive prostate cancer using 1.5 T MRI-Linac: preliminary data on feasibility and acute patient-reported outcomes

Mazzola, Rosario; Cuccia, Francesco; Figlia, Vanessa; Rigo, Michele; Nicosia, Luca; Giaj-Levra, Niccolò; Ricchetti, F.; Vitale, Claudio; Mantoan, Beatrice; Paola, Gioacchino Di; Simone, Antonio De; Gurrera, Davide; Sicignano, G.; Naccarato, S.; Ruggieri, R.; Alongi, Filippo

doi:10.1007/s11547-021-01352-w

Cited by 19 publications

(16 citation statements)

References 27 publications

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“…During the first follow up, detectable PSA was found in 16 out of 20 patients. In post treatment PSMA PET/CT PR in 6 cases and CR in 10 cases [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Radiotherapy treatment modification for prostate cancer patients based on PSMA-PET/CT

et al. 2022

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Background Prostate cancer is the most common cancer among men, and its diagnosis and treatment are improving. Our study evaluated how PSMA-PET/CT prior to treatment planning might improve the optimal management of prostate cancer radiotherapy. Methods This retrospective pilot study included 43 prostate cancer (PCa) patients referred to our radiation oncologist department, from the urology department, for radiation therapy. 18F-PSMA-PET/CT was ordered by the radiation oncologists mainly due to the lack of resent image staging. The patients were divided into three different groups according to their initially planned treatments: radical radiation therapy (RT) (newly diagnosed PCa patients), salvage RT (patients with biochemical recurrence after radical prostatectomy), or oligometastatic RT (oligometastatic PCa patients with good response after systemic treatment). Results Following PSMA-PET/CT, the initially planned RT was changed for 60.5% of the patients due to new findings (metastases and/or recurrent disease). The final treatment choice was effected by PSMA-PET/CT outcome in 60.5% (26/43) of the patients, and in 50% (16/32) of patients, the radiation treatment plan changed following PSMA-PET/CT. Only 39.5% (17/43) of the patients who underwent PSMA-PET/CT were treated according to their initial treatment plans. Conclusions Our results indicate that PSMA-PET/CT impacts treatment decisions and the selection of RT as well as adjuvant treatment protocols in the management of prostate cancer.

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“…During the first follow up, detectable PSA was found in 16 out of 20 patients. In post treatment PSMA PET/CT PR in 6 cases and CR in 10 cases [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Radiotherapy treatment modification for prostate cancer patients based on PSMA-PET/CT

et al. 2022

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“…In support of this train of thought, pilot studies using PSMA-PET have shown efficacy in image-guided radiotherapy of metastases for the treatment of oligorecurrent PCa (52). In another study, 1.5T MRI guided stereotactic body RT by LINAC guided by PSMA-PET produced encouraging oncological and tolerability results in the management of oligometastatic castration sensitive prostate cancer (53). Recently, FAP-targeted PET has demonstrated fair to good interobserver agreement rates in the detection of organ and lymph node metastases across a variety of tumour types (54).…”

Section: Discussionmentioning

confidence: 99%

Nanoparticles targeted to fibroblast activation protein outperform PSMA for MRI delineation of primary prostate tumours

Dmochowska¹,

Milanova²,

Mukkamala

et al. 2022

Preprint

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Accurate and precise delineation of gross tumour volumes remains a barrier to radiotherapy dose escalation and boost dosing in the treatment of solid tumours, such as prostate cancer. Magnetic resonance imaging of tumour molecular targets has the power to enable focal dose boosting, particularly when combined with technological advances such as MRI-LINAC. Fibroblast activation protein (FAP) is a transmembrane protein overexpressed in stromal components of >90% of epithelial carcinomas. Herein we compare targeted MRI of gold standard PSMA with FAP in the delineation of orthotopic tumours in a mouse model of prostate cancer. Control (no ligand), FAP and PSMA-targeting iron oxide nanoparticles were prepared with modification of an MRI agent (FerroTrace). Mice with orthotopic LNCaP tumours underwent T2-weighted 3D MRI 24 hours after intravenous injection of contrast agents. FAP and PSMA nanoparticles produced contrast enhancement on MRI when compared to control nanoparticles, which was most pronounced on the tumour periphery. FAP-targeted MRI increased tumour contrast enhancement by ~15% when compared to PSMA. This study demonstrates preclinical feasibility of PSMA and FAP-targeted MRI which be used to enable targeted image-guided focal therapy of localized prostate cancer.

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“…However, they did not report the results of follow-up outcomes [23]. The researchers from the same group also reported the preliminary outcome results of 1.5T MRgSBRT for oligometastatic castration-sensitive prostate cancer [24,25].…”

Section: Discussionmentioning

confidence: 99%

1.5T Magnetic Resonance-Guided Stereotactic Body Radiotherapy for Localized Prostate Cancer: Preliminary Clinical Results of Clinician- and Patient-Reported Outcomes

Poon

Yuan

Wong

et al. 2021

Cancers

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Background: Magnetic resonance-guided stereotactic body radiotherapy (MRgSBRT) offers the potential for achieving better prostate cancer (PC) treatment outcomes. This study reports the preliminary clinical results of 1.5T MRgSBRT in localized PC, based on both clinician-reported outcome measurement (CROM) and patient-reported outcome measurement (PROM). Methods: Fifty-one consecutive localized PC patients were prospectively enrolled with a median follow-up of 199 days. MRgSBRT was delivered in five fractions of 7.25–8 Gy with daily online adaptation. Clinician-reported gastrointestinal (GI) and genitourinary (GU) adverse events based on the Common Terminology Criteria for Adverse Events (CTCAE) Scale v. 5.0 were assessed. The Expanded Prostate Cancer Index Composite Questionnaire was collected at baseline, 1 month, and every 3 months thereafter. Serial prostate-specific antigen measurements were longitudinally recorded. Results: The maximum cumulative clinician-reported grade ≥2 acute GU and GI toxicities were 11.8% (6/51) and 2.0% (1/51), respectively, while grade ≥2 subacute GU and GI toxicities were 2.3% (1/43) each. Patient-reported urinary, bowel, and hormonal domain summary scores were reduced at 1 month, then gradually returned to baseline levels, with the exception of the sexual domain. Domain-specific subscale scores showed similar longitudinal changes. All patients had early post-MRgSBRT biochemical responses. Conclusions: The finding of low toxicity supports the accumulation of clinical evidence for 1.5T MRgSBRT in localized PC.

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Stereotactic body radiotherapy for oligometastatic castration sensitive prostate cancer using 1.5 T MRI-Linac: preliminary data on feasibility and acute patient-reported outcomes

Cited by 19 publications

References 27 publications

Radiotherapy treatment modification for prostate cancer patients based on PSMA-PET/CT

Radiotherapy treatment modification for prostate cancer patients based on PSMA-PET/CT

Nanoparticles targeted to fibroblast activation protein outperform PSMA for MRI delineation of primary prostate tumours

1.5T Magnetic Resonance-Guided Stereotactic Body Radiotherapy for Localized Prostate Cancer: Preliminary Clinical Results of Clinician- and Patient-Reported Outcomes

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