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MR-guided prostate SBRT in prostate cancer patients with low-volume metastatic disease

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Abstract

Background

Recent data have found an overall survival benefit from prostate-directed radiotherapy in patients with low-volume metastatic prostate cancer. Prostate SBRT is an attractive treatment in this setting and may be optimised with MR-guided adaptive treatment. Here, we share our institutional experience delivering stereotactic MR-guided adaptive prostate SBRT (SMART) for patients with low-volume metastatic disease.

Methods

We reviewed patients with low-volume metastatic disease who received prostate SMART from October 2019 to December 2021 on a 0.35T MR-Linac. The cohort included 14 patients. Genitourinary (GU) and gastrointestinal (GI) toxicities were assessed using CTCAE v 5.0. Progression was defined as a change in systemic or hormonal therapy regimen as a result of PSA rise or disease progression.

Results

The median follow-up time was 29 months. Seven patients had hormone sensitive prostate cancer and 7 had castrate resistant prostate cancer (CRPC). 13 patients received 36.25 Gy in 5 fractions and one patient received 33 Gy in 5 fractions. At the time of last follow-up, 11 patients had not experienced progression and three patients, all with CRPC, had experienced progression. No patients developed local progression in the prostate after SMART. One patient experienced acute grade 2 urinary toxicity (7%) and no patients experienced acute grade 2 GI toxicity (0%). No grade 3 + acute toxicities were observed.

Conclusions

Prostate SMART was found to be well tolerated and all patients had local control of disease within the prostate at the time of last follow-up. Prostate SMART may represent a low-risk and well-tolerated approach for delivering prostate-directed radiotherapy for patients with limited metastatic disease.

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Data availability

Data that support the findings of this study are avialable upon reasonable request.

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Authors and Affiliations

  1. Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Shalini Moningi, Neil E. Martin, Paul L. Nguyen, Anthony V. D’Amico, Daniel N. Cagney & Jonathan E. Leeman

  2. Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA

    Atish D. Choudhury

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  1. Shalini Moningi
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  2. Atish D. Choudhury
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  3. Neil E. Martin
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  4. Paul L. Nguyen
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  5. Anthony V. D’Amico
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  6. Daniel N. Cagney
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  7. Jonathan E. Leeman
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Contributions

SM: Project development, data collection, data analysis, manuscript writing/editing. ADC: Data analysis, manuscript writing/editing. NEM: Data analysis, manuscript writing/editing. PLN: Data analysis, manuscript writing/editing. AVDA: Data analysis, manuscript writing/editing. DNC: Project development, data analysis, manuscript writing/editing. JEL: Project development, data collection, data analysis, manuscript writing/editing.

Corresponding author

Correspondence to Jonathan E. Leeman.

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Conflict of interest

ADC: Honoraria: OncLive, Bayer, Targeted Oncology, Aptitude Health, Journal of Clinical Pathways, Cancer Network, Clinical Care Options, Great Debates & Updates, Pfizer, Springer Healthcare; Consulting: Blackstone; Advisory Board: Clovis, Dendreon, Bayer, Eli Lilly, AstraZeneca, Astellas, Blue Earth, Janssen, Tolmar; Research Funding: Bayer, PLN: grants and/or personal fees from Astellas Pharma, Bayer, Boston Scientific, Janssen Pharmaceuticals, Myovant, Nanocan, Dendreon, Ferring, COTA, Blue Earth Diagnostics, Augmenix, and Novartis Pharma; and stock options with Nanocan. JEL: Research funding from Viewray, NH Theraguix and Varian.

Research involving human participants and/or animals

This study was approved by our institutional IRB committee.

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All prospective study participants, or their legal guardian, provided informed written consent prior to study enrollment.

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Moningi, S., Choudhury, A.D., Martin, N.E. et al. MR-guided prostate SBRT in prostate cancer patients with low-volume metastatic disease. World J Urol 41, 3889–3894 (2023). https://doi.org/10.1007/s00345-023-04675-7

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  • DOI: https://doi.org/10.1007/s00345-023-04675-7

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