MRI-guided radiotherapy in twenty fractions for localised prostate cancer; results from the MOMENTUM study
Background and purpose: MRI-guided radiotherapy (MRIgRT) offers multiple potential advantages over CT-guidance. This study examines the potential clinical benefits of MRIgRT for men with localised prostate cancer, in the setting of moderately hypofractionated radiotherapy. We evaluate two-year toxic...
| Main Authors: | , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-05-01
|
| Series: | Clinical and Translational Radiation Oncology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405630824000193 |
| _version_ | 1797291758342635520 |
|---|---|
| author | Kobika Sritharan Lois Daamen Angela Pathmanathan Tine Schytte Floris Pos Ananya Choudhury Jochem R.N. van der Voort van Zyp Linda G.W. Kerkmeijer William Hall Emma Hall Helena M. Verkooijen Trina Herbert Shaista Hafeez Adam Mitchell Alison C. Tree |
| author_facet | Kobika Sritharan Lois Daamen Angela Pathmanathan Tine Schytte Floris Pos Ananya Choudhury Jochem R.N. van der Voort van Zyp Linda G.W. Kerkmeijer William Hall Emma Hall Helena M. Verkooijen Trina Herbert Shaista Hafeez Adam Mitchell Alison C. Tree |
| author_sort | Kobika Sritharan |
| collection | DOAJ |
| description | Background and purpose: MRI-guided radiotherapy (MRIgRT) offers multiple potential advantages over CT-guidance. This study examines the potential clinical benefits of MRIgRT for men with localised prostate cancer, in the setting of moderately hypofractionated radiotherapy. We evaluate two-year toxicity outcomes, early biochemical response and patient-reported outcomes (PRO), using data obtained from a multicentre international registry study, for the first group of patients with prostate cancer who underwent treatment on a 1.5 T MR-Linac. Materials and methods: Patients who were enrolled within the MOMENTUM study and received radical treatment with 60 Gy in 20 fractions were identified. PSA levels and CTCAE version 5.0 toxicity data were measured at follow-up visits. Those patients who consented to PRO data collection also completed EQ-5D-5L, EORTC QLQ-C30 and EORTC QLQ-PR25 questionnaires. Results: Between November 2018 and June 2022, 146 patients who had MRIgRT for localised prostate cancer on the 1.5 T MR-Linac were eligible for this study. Grade 2 and worse gastro-intestinal (GI) toxicity was reported in 3 % of patients at three months whilst grade 2 and worse genitourinary (GU) toxicity was 7 % at three months. There was a significant decrease in the median PSA at 12 months. The results from both the EQ-5D-5L data and EORTC global health status scale indicate a decline in the quality of life (QoL) during the first six months. The mean change in score for the EORTC scale showed a decrease of 11.4 points, which is considered clinically important. QoL improved back to baseline by 24 months. Worsening of hormonal symptoms in the first six months was reported with a return to baseline by 24 months and sexual activity in all men worsened in the first three months and returned to baseline at 12 months. Conclusion: This study establishes the feasibility of online-MRIgRT for localised prostate on a 1.5 T MR-Linac with low rates of toxicity, similar to that published in the literature. However, the clinical benefits of MRIgRT over conventional radiotherapy in the setting of moderate hypofractionation is not evident. Further research will focus on the delivery of ultrahypofractionated regimens, where the potential advantages of MRIgRT for prostate cancer may become more discernible. |
| first_indexed | 2024-03-07T19:41:24Z |
| format | Article |
| id | doaj.art-38d9afe672b042ba8f9278a02acf4e0c |
| institution | Directory Open Access Journal |
| issn | 2405-6308 |
| language | English |
| last_indexed | 2024-03-07T19:41:24Z |
| publishDate | 2024-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Clinical and Translational Radiation Oncology |
| spelling | doaj.art-38d9afe672b042ba8f9278a02acf4e0c2024-02-29T05:19:43ZengElsevierClinical and Translational Radiation Oncology2405-63082024-05-0146100742MRI-guided radiotherapy in twenty fractions for localised prostate cancer; results from the MOMENTUM studyKobika Sritharan0Lois Daamen1Angela Pathmanathan2Tine Schytte3Floris Pos4Ananya Choudhury5Jochem R.N. van der Voort van Zyp6Linda G.W. Kerkmeijer7William Hall8Emma Hall9Helena M. Verkooijen10Trina Herbert11Shaista Hafeez12Adam Mitchell13Alison C. Tree14The Royal Marsden NHS Foundation Trust, UK; The Institute of Cancer Research, UK; Corresponding author at: Department of Radiotherapy, Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK.Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, the NetherlandsThe Royal Marsden NHS Foundation Trust, UKOdense University Hospital, DenmarkThe Netherlands Cancer Institute, The NetherlandsDivision of Cancer Sciences, University of Manchester and The Christie NHS Foundation Trust, UKDivision of Imaging and Oncology, University Medical Center Utrecht, Utrecht, the NetherlandsRadboud University Medical Center, The NetherlandsMedical College of Wisconsin, USAThe Institute of Cancer Research, UKDivision of Imaging and Oncology, University Medical Center Utrecht, Utrecht, the NetherlandsThe Royal Marsden NHS Foundation Trust, UKThe Royal Marsden NHS Foundation Trust, UKThe Royal Marsden NHS Foundation Trust, UK; The Institute of Cancer Research, UKThe Royal Marsden NHS Foundation Trust, UK; The Institute of Cancer Research, UKBackground and purpose: MRI-guided radiotherapy (MRIgRT) offers multiple potential advantages over CT-guidance. This study examines the potential clinical benefits of MRIgRT for men with localised prostate cancer, in the setting of moderately hypofractionated radiotherapy. We evaluate two-year toxicity outcomes, early biochemical response and patient-reported outcomes (PRO), using data obtained from a multicentre international registry study, for the first group of patients with prostate cancer who underwent treatment on a 1.5 T MR-Linac. Materials and methods: Patients who were enrolled within the MOMENTUM study and received radical treatment with 60 Gy in 20 fractions were identified. PSA levels and CTCAE version 5.0 toxicity data were measured at follow-up visits. Those patients who consented to PRO data collection also completed EQ-5D-5L, EORTC QLQ-C30 and EORTC QLQ-PR25 questionnaires. Results: Between November 2018 and June 2022, 146 patients who had MRIgRT for localised prostate cancer on the 1.5 T MR-Linac were eligible for this study. Grade 2 and worse gastro-intestinal (GI) toxicity was reported in 3 % of patients at three months whilst grade 2 and worse genitourinary (GU) toxicity was 7 % at three months. There was a significant decrease in the median PSA at 12 months. The results from both the EQ-5D-5L data and EORTC global health status scale indicate a decline in the quality of life (QoL) during the first six months. The mean change in score for the EORTC scale showed a decrease of 11.4 points, which is considered clinically important. QoL improved back to baseline by 24 months. Worsening of hormonal symptoms in the first six months was reported with a return to baseline by 24 months and sexual activity in all men worsened in the first three months and returned to baseline at 12 months. Conclusion: This study establishes the feasibility of online-MRIgRT for localised prostate on a 1.5 T MR-Linac with low rates of toxicity, similar to that published in the literature. However, the clinical benefits of MRIgRT over conventional radiotherapy in the setting of moderate hypofractionation is not evident. Further research will focus on the delivery of ultrahypofractionated regimens, where the potential advantages of MRIgRT for prostate cancer may become more discernible.http://www.sciencedirect.com/science/article/pii/S2405630824000193MR-LinacProstate cancerMRIgRTMOMENTUMAdaptive radiotherapyPatient-reported outcomes |
| spellingShingle | Kobika Sritharan Lois Daamen Angela Pathmanathan Tine Schytte Floris Pos Ananya Choudhury Jochem R.N. van der Voort van Zyp Linda G.W. Kerkmeijer William Hall Emma Hall Helena M. Verkooijen Trina Herbert Shaista Hafeez Adam Mitchell Alison C. Tree MRI-guided radiotherapy in twenty fractions for localised prostate cancer; results from the MOMENTUM study Clinical and Translational Radiation Oncology MR-Linac Prostate cancer MRIgRT MOMENTUM Adaptive radiotherapy Patient-reported outcomes |
| title | MRI-guided radiotherapy in twenty fractions for localised prostate cancer; results from the MOMENTUM study |
| title_full | MRI-guided radiotherapy in twenty fractions for localised prostate cancer; results from the MOMENTUM study |
| title_fullStr | MRI-guided radiotherapy in twenty fractions for localised prostate cancer; results from the MOMENTUM study |
| title_full_unstemmed | MRI-guided radiotherapy in twenty fractions for localised prostate cancer; results from the MOMENTUM study |
| title_short | MRI-guided radiotherapy in twenty fractions for localised prostate cancer; results from the MOMENTUM study |
| title_sort | mri guided radiotherapy in twenty fractions for localised prostate cancer results from the momentum study |
| topic | MR-Linac Prostate cancer MRIgRT MOMENTUM Adaptive radiotherapy Patient-reported outcomes |
| url | http://www.sciencedirect.com/science/article/pii/S2405630824000193 |
| work_keys_str_mv | AT kobikasritharan mriguidedradiotherapyintwentyfractionsforlocalisedprostatecancerresultsfromthemomentumstudy AT loisdaamen mriguidedradiotherapyintwentyfractionsforlocalisedprostatecancerresultsfromthemomentumstudy AT angelapathmanathan mriguidedradiotherapyintwentyfractionsforlocalisedprostatecancerresultsfromthemomentumstudy AT tineschytte mriguidedradiotherapyintwentyfractionsforlocalisedprostatecancerresultsfromthemomentumstudy AT florispos mriguidedradiotherapyintwentyfractionsforlocalisedprostatecancerresultsfromthemomentumstudy AT ananyachoudhury mriguidedradiotherapyintwentyfractionsforlocalisedprostatecancerresultsfromthemomentumstudy AT jochemrnvandervoortvanzyp mriguidedradiotherapyintwentyfractionsforlocalisedprostatecancerresultsfromthemomentumstudy AT lindagwkerkmeijer mriguidedradiotherapyintwentyfractionsforlocalisedprostatecancerresultsfromthemomentumstudy AT williamhall mriguidedradiotherapyintwentyfractionsforlocalisedprostatecancerresultsfromthemomentumstudy AT emmahall mriguidedradiotherapyintwentyfractionsforlocalisedprostatecancerresultsfromthemomentumstudy AT helenamverkooijen mriguidedradiotherapyintwentyfractionsforlocalisedprostatecancerresultsfromthemomentumstudy AT trinaherbert mriguidedradiotherapyintwentyfractionsforlocalisedprostatecancerresultsfromthemomentumstudy AT shaistahafeez mriguidedradiotherapyintwentyfractionsforlocalisedprostatecancerresultsfromthemomentumstudy AT adammitchell mriguidedradiotherapyintwentyfractionsforlocalisedprostatecancerresultsfromthemomentumstudy AT alisonctree mriguidedradiotherapyintwentyfractionsforlocalisedprostatecancerresultsfromthemomentumstudy |