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Multicenter Study
. 2023 May 22;18(1):84.
doi: 10.1186/s13014-023-02271-y.

Magnetic resonance guided SBRT reirradiation in locally recurrent prostate cancer: a multicentric retrospective analysis

Luca Boldrini  1   2 , Angela Romano  1 , Giuditta Chiloiro  1 , Stefanie Corradini  3 , Viola De Luca  1 , Valeria Verusio  4 , Andrea D'Aviero  5 , Alessandra Castelluccia  6   7 , Anna Rita Alitto  1 , Francesco Catucci  5 , Gianmarco Grimaldi  6 , Christian Trapp  3 , Juliane Hörner-Rieber  8 , Domenico Marchesano  6 , Vincenzo Frascino  1 , Gian Carlo Mattiucci  2   5 , Vincenzo Valentini  1   2 , Piercarlo Gentile  6 , Maria Antonietta Gambacorta  1   2
Affiliations
Multicenter Study

Magnetic resonance guided SBRT reirradiation in locally recurrent prostate cancer: a multicentric retrospective analysis

Luca Boldrini et al. Radiat Oncol. .

Abstract

Aims: Reirradiation of prostate cancer (PC) local recurrences represents an emerging challenge for current radiotherapy. In this context, stereotactic body radiation therapy (SBRT) allows the delivery of high doses, with curative intent. Magnetic Resonance guided Radiation Therapy (MRgRT) has shown promising results in terms of safety, feasibility and efficacy of delivering SBRT thanks to the enhanced soft tissue contrast and the online adaptive workflow. This multicentric retrospective analysis evaluates the feasibility and efficacy of PC reirradiation, using a 0.35 T hybrid MR delivery unit.

Methods: Patients affected by local recurrences of PC and treated in five institutions between 2019 and 2022 were retrospectively collected. All patients had undergone previous Radiation Therapy (RT) in definitive or adjuvant setting. Re-treatment MRgSBRT was delivered with a total dose ranging from 25 to 40 Gy in 5 fractions. Toxicity according to CTCAE v 5.0 and treatment response were assessed at the end of the treatment and at follow-up.

Results: Eighteen patients were included in this analysis. All patients had previously undergone external beam radiation therapy (EBRT) up to a total dose of 59.36 to 80 Gy. Median cumulative biologically effective dose (BED) of SBRT re-treatment was 213,3 Gy (103,1-560), considering an α/β of 1.5. Complete response was achieved in 4 patients (22.2%). No grade ≥ 2 acute genitourinary (GU) toxicity events were recorded, while gastrointestinal (GI) acute toxicity events occurred in 4 patients (22.2%).

Conclusion: The low rates of acute toxicity of this experience encourages considering MRgSBRT a feasibile therapeutic approach for the treatment of clinically relapsed PC. Accurate gating of target volumes, the online adaptive planning workflow and the high definition of MRI treatment images allow delivering high doses to the PTV while efficiently sparing organs at risk (OARs).

Keywords: MRgRT; Prostate cancer; Radiotherapy; Reirradiation; SBRT.

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Conflict of interest statement

Luca Boldrini has active research and consultation agreements with Varian Medical Systems, ViewRay Inc and IBA and received speaker honoraria for scientific presentations and travel reimbursements.Stefanie Corradini received research grants from Elekta, ViewRay and Brainlab and speaker fees/travel support from Elekta, ViewRay, C-RAD, Roche and Brainlab.Juliane Hörner-Rieber received speaker fees and travel reimbursement from ViewRay Inc. as well as travel reimbursement from IntraOP Medical and Elekta Instrument AB outside the submitted work. JHR further reports grants from IntraOP Medical and Varian Medical Systems outside the submitted work.Vincenzo Valentini has received departmental research grants from Varian Medical Systems, ViewRay Inc., Elekta, Merck-Serono, Roche.

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