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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

  • Radiotherapy
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Abstract

Objectives

To report preliminary data on feasibility and patient-reported outcomes following PSMA-PET/CT guided SBRT by means of 1.5 T MRI-Linac.

Methods and materials

Between October 2019 and April 2020, twenty consecutive castration sensitive oligorecurrent prostate cancer patients were enrolled in an ethical committee approved prospective observational study (Protocol n. XXXX) and treated with PSMA-PET/CT guided SBRT by means of 1.5 T MRI-Linac (Unity, Elekta AB, Stockholm, Sweden). The mean delivered dose was 35 Gy in 5 fractions. Clinicians reported toxicity was prospectively collected according to Common Terminology Criteria for Adverse Events v5.0. Quality of life (QoL) assessment was performed using EORTC-QLQ C30 questionnaires administered at baseline, end of treatment and at first follow-up.

Results

Twenty-five lesions in 20 castration sensitive oligorecurrent patients were treated: the most commonly treated anatomic sites were nodal (n = 16) and pelvic bone (n = 9). Median PSA-value preMRI guided SBRT was 1.16 ng/mL (range, 0.27–8.9), whereas median PSA value at first follow-up after SBRT was 0.44 ng/mL (range, 0.06–8.15). At first follow-up, for 16 patients showing detectable PSA, PSMA-PET/CT was performed detecting, respectively, in 6 cases partial response and in 10 cases complete response. In the remaining cases, PSA-value was undetectable after SBRT. Radiotherapy treatment was safe and well tolerated according to the PROMs. No acute G2 or higher toxicities were recorded.

Conclusions

The current series represent the largest one exploring the feasibility and patient-reported outcomes following PSMA-PET/CT guided SBRT by means of 1.5 T MRI-Linac. The preliminary findings here reported are encouraging in terms of effectiveness and tolerability.

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References

  1. Fossati N, Gandaglia G, Briganti A, Montorsi F (2019) The emerging role of PET-CT scan after radical prostatectomy: still a long way to go. Lancet Oncol 20(9):1193–1195. https://doi.org/10.1016/S1470-2045(19)30501-7

    Article  PubMed  Google Scholar 

  2. EAU Guidelines. Edn. presented at the EAU Annual Congress Barcelona 2019. ISBN 978-94-92671-04-2

  3. Interdisziplinäre Leitlinie der Qualität S3 zur Früherkennung, Diagnose und Therapie der verschiedenen Stadien des Prostatakarzinoms [Internet]. Available: https://www.leitlinienprogramm-onkologie.de/leitlinien/prostatakarzinom/. Accessed 9 May 2018

  4. Calais J, Ceci F, Eiber M, Hope TA, Hofman MS, Rischpler C et al (2019) (18)F-fluciclovine PET-CT and (68)Ga-PSMA-11 PET-CT in patients with early biochemical recurrence after prostatectomy: a prospective, single-centre, single-arm, comparative imaging trial. Lancet Oncol 20(9):1286–1294. https://doi.org/10.1016/S1470-2045(19)30415-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Mazzola R, Cuccia F, Figlia V, Giaj-Levra N, Nicosia L, Ricchetti F et al (2019) New metabolic tracers for detectable PSA levels in the post-prostatectomy setting: Is the era of melting glaciers upcoming? Transl Androl Urol 8(Suppl 5):S538–S541. https://doi.org/10.21037/tau.2019.12.34

    Article  PubMed  PubMed Central  Google Scholar 

  6. De Bari B, Mazzola R, Aiello D, Aloi D, Gatta R, Corradini S et al (2019) ((68)Ga)-PSMA-PET/CT for the detection of postoperative prostate cancer recurrence: Possible implications on treatment volumes for radiation therapy. Cancer Radiother 23(3):194–200. https://doi.org/10.1016/j.canrad.2018.09.003

    Article  PubMed  Google Scholar 

  7. Ost P, Jereczek-Fossa BA, Van As N, Zilli T, Tree A, Henderson D et al (2016) Pattern of progression after stereotactic body radiotherapy for oligometastatic prostate cancer nodal recurrences. Clin Oncol (R Coll Radiol) 28(9):e115–e120. https://doi.org/10.1016/j.clon.2016.04.040

    Article  CAS  Google Scholar 

  8. Triggiani L, Alongi F, Buglione M, Detti B, Santoni R, Bruni A et al (2017) Efficacy of stereotactic body radiotherapy in oligorecurrent and in oligoprogressive prostate cancer: new evidence from a multicentric study. Br J Cancer 116(12):1520–1525. https://doi.org/10.1038/bjc.2017.103

    Article  PubMed  PubMed Central  Google Scholar 

  9. Fersino S, Borghesi S, Jereczek-Fossa BA, Arcangeli S, Mortellaro G, Magrini SM, Alongi F; Uro-Oncology study group of Italian association of Radiotherapy and Clinical Oncology (AIRO) (2020) PROACTA: a survey on the actual attitude of the Italian radiation oncologists in the management and prescription of hormonal therapy in prostate cancer patients. Radiol Med. https://doi.org/10.1007/s11547-020-01264-1.

  10. Corradini S, Alongi F, Andratschke N, Belka C, Boldrini L, Cellini F et al (2019) MR-guidance in clinical reality: current treatment challenges and future perspectives. Radiat Oncol 14(1):92. https://doi.org/10.1186/s13014-019-1308-y

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Cuccia F, Mazzola R, Nicosia L, Figlia V, Giaj-Levra N, Ricchetti F et al (2020) Impact of hydrogel peri-rectal spacer insertion on prostate gland intra-fraction motion during 1.5 T MR-guided stereotactic body radiotherapy. Radiat Oncol 15(1):178. https://doi.org/10.1186/s13014-020-01622-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. De Bari B, Mazzola R, Aiello D, Fersino S, Gregucci F, Alongi P et al (2018) Could 68-Ga PSMA PET/CT become a new tool in the decision-making strategy of prostate cancer patients with biochemical recurrence of PSA after radical prostatectomy? A preliminary, monocentric series. Radiol Med 123(9):719–725. https://doi.org/10.1007/s11547-018-0890-7

    Article  PubMed  Google Scholar 

  13. Wahl RL, Jacene H, Kasamon Y, Lodge MA (2009) From RECIST to PERCIST: evolving considerations for PET response criteria in solid tumors. J Nucl Med 50(Suppl 1):122S-S150. https://doi.org/10.2967/jnumed.108.057307

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Ost P, Bossi A, Decaestecker K, De Meerleer G, Giannarini G, Karnes RJ et al (2015) Metastasis-directed therapy of regional and distant recurrences after curative treatment of prostate cancer: a systematic review of the literature. Eur Urol 67(5):852–863

    Article  Google Scholar 

  15. Ost P, Reynders D, Decaestecker K, Fonteyne V, Lumen N, De Bruycker A et al (2018) Surveillance or metastasis-directed therapy for oligometastatic prostate cancer recurrence: a prospective, randomized, multicenter phase II trial. J Clin Oncol 36(5):446–453

    Article  CAS  Google Scholar 

  16. Shankar Siva MB, Murphy DG, Shaw M, Chander S, Violet J, Tai KH et al (2018) Stereotactic ablative body radiotherapy (SABR) for oligometastatic prostate cancer: a prospective clinical trial. Eur Urol 74(4):455–462

    Article  Google Scholar 

  17. Nicosia L, Franzese C, Mazzola R, Franceschini D, Rigo M, Dagostino G et al (2020) Recurrence pattern of stereotactic body radiotherapy in oligometastatic prostate cancer: a multi-institutional analysis. Strahlenther Onkol. 196(3):213–221. https://doi.org/10.1007/s00066-019-01523-9

    Article  PubMed  Google Scholar 

  18. Mazzola R, Francolini G, Triggiani L, Napoli G, Cuccia F, Nicosia L et al (2020) Metastasis-directed therapy (SBRT) guided by PET-CT 18F-CHOLINE versus PET-CT 68Ga-PSMA in castration-sensitive oligorecurrent prostate cancer: a comparative analysis of effectiveness. Clin Genitourin Cancer S1558–7673(20):30191–30199. https://doi.org/10.1016/j.clgc.2020.08.002

    Article  Google Scholar 

  19. Phillips R, Shi WY, Deek M, Radwan N, Lim SJ, Antonarakis ES et al (2020) Outcomes of observation vs stereotactic ablative radiation for oligometastatic prostate cancer: the ORIOLE phase 2 randomized clinical trial. JAMA Oncol 6(5):650–659. https://doi.org/10.1001/jamaoncol.2020.014

    Article  PubMed  PubMed Central  Google Scholar 

  20. De Bruycker A, Tran PT, Achtman AH, Ost P; GAP6 consortium. Clinical perspectives from ongoing trials in oligometastatic or oligorecurrent prostate cancer: an analysis of clinical trials registries. World J Urol. 2020. https://doi.org/10.1007/s00345-019-03063-4.

  21. Jereczek-Fossa BA, Bortolato B, Gerardi MA, Dicuonzo S, Arienti VM, Berlinghieri S, Bracelli S, Buglione M, Caputo M, Catalano G, Cazzaniga LF, De Cicco L, Di Muzio N, Filippone FR, Fodor A, Franceschini D, Frata P, Gottardo S, Ivaldi GB, Laudati A, Magrini SM, Mantero E, Meaglia I, Morlino S, Palazzi M, Piccoli F, Romanelli P, Scorsetti M, Serafini F, Scandolaro L, Valdagni R, Orecchia R, Antognoni P; Lombardy Section of the Italian Society of Oncological Radiotherapy (Associazione Italiana di Radioterapia Oncologica-Lombardia, AIRO-L). Radiotherapy for oligometastatic cancer: a survey among radiation oncologists of Lombardy (AIRO-Lombardy), Italy. Radiol Med. 2019 Apr;124(4):315–322. https://doi.org/10.1007/s11547-018-0972-6

  22. Winkel D, Werensteijn-Honingh AM, Kroon PS, Eppinga WSC, Bol GH, Intven MPW et al (2019) Individual lymph nodes: “See it and Zap it.” Clin Transl Radiat Oncol 30(18):46–53. https://doi.org/10.1016/j.ctro.2019.03.004

    Article  Google Scholar 

  23. Winkel D, Bol GH, Werensteijn-Honingh AM, Intven MPW, Eppinga WSC, Hes J et al (2020) Target coverage and dose criteria based evaluation of the first clinical 1.5T MR-linac SBRT treatments of lymph node oligometastases compared with conventional CBCT-linac treatment. Radiother Oncol 146:118–125. https://doi.org/10.1016/j.radonc.2020.02.011

    Article  CAS  PubMed  Google Scholar 

  24. Chow E, Meyer RM, Ding K, Nabid A, Chabot P, Wong P et al (2015) Dexamethasone in the prophylaxis of radiation-induced pain flare after palliative radiotherapy for bone metastases: a double-blind, randomised placebo-controlled, phase 3 trial. Lancet Oncol 16(15):1463–1472. https://doi.org/10.1016/S1470-2045(15)00199-0

    Article  CAS  PubMed  Google Scholar 

  25. Dunlop A, Mitchell A, Tree A, Barnes H, Bower L, Chick J et al (2020) Daily adaptive radiotherapy for patients with prostate cancer using a high field MR-linac: initial clinical experiences and assessment of delivered doses compared to a C-arm linac. Clin Transl Radiat Oncol 29(23):35–42. https://doi.org/10.1016/j.ctro.2020.04.011

    Article  Google Scholar 

  26. Mazzola R, Figlia V, Rigo M, Cuccia F, Ricchetti F, Giaj-Levra N et al (2020) Feasibility and safety of 1.5 T MR-guided and daily adapted abdominal-pelvic SBRT for elderly cancer patients: geriatric assessment tools and preliminary patient-reported outcomes. J Cancer Res Clin Oncol. 146(9):2379–2397. https://doi.org/10.1007/s00432-020-03230-w

    Article  PubMed  Google Scholar 

  27. Alongi F, Rigo M, Figlia V, Cuccia F, Giaj-Levra N, Nicosia L et al (2020) 1.5 T MR-guided and daily adapted SBRT for prostate cancer: feasibility, preliminary clinical tolerability, quality of life and patient-reported outcomes during treatment. Radiat Oncol. 15(1):69. https://doi.org/10.1186/s13014-020-01510-w

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Cuccia F, Mortellaro G, Mazzola R, Donofrio A, Valenti V, Tripoli A, Matranga D, Lo Casto A, Failla G, Di Miceli G, Ferrera G (2020) Prognostic value of two geriatric screening tools in a cohort of older patients with early stage Non-Small Cell Lung Cancer treated with hypofractionated stereotactic radiotherapy. J Geriatr Oncol 11(3):475–481. https://doi.org/10.1016/j.jgo.2019.05.002

    Article  PubMed  Google Scholar 

  29. Cuccia F, Fiorentino A, Corrao S, Mortellaro G, Valenti V, Tripoli A, De Gregorio G, Serretta V, Verderame F, Ognibene L, Lo Casto A, Ferrera G (2020) Moderate hypofractionated helical tomotherapy for prostate cancer in a cohort of older patients: a mono-institutional report of toxicity and clinical outcomes. Aging Clin Exp Res 32(4):747–753. https://doi.org/10.1007/s40520-019-01243-1

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Advanced Radiation Oncology, IRCCS Sacro Cuore Don Calabria Hospital, Via Don A. Sempreboni 5, 37024, Negrar di Valpolicella, VR, Italy

    Rosario Mazzola, Francesco Cuccia, Vanessa Figlia, Michele Rigo, Luca Nicosia, Niccolò Giaj-Levra, Francesco Ricchetti, Claudio Vitale, Beatrice Mantoan, Antonio De Simone, Davide Gurrera, Gianluisa Sicignano, Stefania Naccarato, Ruggero Ruggieri & Filippo Alongi

  2. Faculty of Statistics, University of Palermo, Palermo, Italy

    Gioacchino Di Paola

  3. University of Brescia, Brescia, Italy

    Filippo Alongi

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  1. Rosario Mazzola
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Corresponding author

Correspondence to Francesco Cuccia.

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Conflict of interest

Filippo Alongi is a speaker and consultant for Elekta; Ruggero Ruggieri is a consultant for Elekta. All the other authors have no conflict of interests.

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All procedures have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Mazzola, R., Cuccia, F., Figlia, V. et al. Stereotactic body radiotherapy for oligometastatic castration sensitive prostate cancer using 1.5 T MRI-Linac: preliminary data on feasibility and acute patient-reported outcomes. Radiol med 126, 989–997 (2021). https://doi.org/10.1007/s11547-021-01352-w

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