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. 2022 Aug 10:12:921465.
doi: 10.3389/fonc.2022.921465. eCollection 2022.

Long-term outcomes of prostate intensity-modulated radiation therapy incorporating a simultaneous intra-prostatic MRI-directed boost

Brady S Laughlin  1 , Alvin C Silva  2 , Sujay A Vora  1 , Sameer R Keole  1 , William W Wong  1 , Michael H Schild  3 , Steven E Schild  1
Affiliations

Long-term outcomes of prostate intensity-modulated radiation therapy incorporating a simultaneous intra-prostatic MRI-directed boost

Brady S Laughlin et al. Front Oncol. .

Abstract

Purpose/objectives: This retrospective study demonstrates the long-term outcomes of treating prostate cancer using intensity modulated (IMRT) with incorporation of MRI-directed boost.

Materials/methods: From February 2009 to February 2013, 78 men received image-guided IMRT delivering 77.4 Gy in 44 fractions with simultaneously integrated boost to 81-83 Gy to an MRI-identified lesion. Patients with intermediate-risk or high-risk prostate cancer were recommended to receive 6 and 24-36 months of adjuvant hormonal therapy, respectively.

Results: Median follow-up was 113 months (11-147). There were 18 low-risk, 43 intermediate-risk, and 17 high-risk patients per NCCN risk stratification included in this study. Adjuvant hormonal therapy was utilized in 32 patients (41%). The 10-year biochemical control rate for all patients was 77%. The 10-year biochemical control rates for low-risk, intermediate-risk, and high-risk diseases were 94%, 81%, and 88%, respectively (p = 0.35). The 10-year rates of local control, distant control, and survival were 99%, 88%, and 66%, respectively. Of 25 patients who died, only four (5%) died of prostate cancer. On univariate analysis, T-category and pretreatment PSA level were associated with distant failure rate (p = 0.02). There was no grade =3 genitourinary and gastrointestinal toxicities that persisted at the last follow-up.

Conclusions: This study demonstrated the long-term efficacy of using MRI to define an intra-prostatic lesion for SIB to 81-83Gy while treating the entire prostate gland to 77.4 Gy with IMRT. Our study confirms that modern MRI can be used to locally intensify dose to prostate tumors providing high long-term disease control while maintaining favorable long-term toxicity.

Keywords: IMRT (intensity modulated radiation therapy); MRI; SIB; prostate cancer; radiation therapy.

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Conflict of interest statement

SS is a writer and editor for UptoDate. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Biochemical control according to NCCN risk stratification.
Figure 2
Figure 2
Overall survival in patients receiving MRI-directed boost.
Figure 3
Figure 3
Distant control in patients receiving MRI-directed boost.
Figure 4
Figure 4
Biochemical control in patients receiving MRI-directed boost.
Figure 5
Figure 5
Local control in patients receiving MRI-directed boost.
See this image and copyright information in PMC

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