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Fink C, Ristau J, Buchele C, Klüter S, Liermann J, Hoegen-Saßmannshausen P, Sandrini E, Lentz-Hommertgen A, Baumann L, Andratschke N, Baumgartl M, Li M, Reiner M, Corradini S, Hörner-Rieber J, Bonekamp D, Schlemmer HP, Belka C, Guckenberger M, Debus J, Koerber S. Stereotactic ultrahypofractionated MR-guided radiotherapy for localized prostate cancer - Acute toxicity and patient-reported outcomes in the prospective, multicenter SMILE phase II trial. Clin Transl Radiat Oncol 2024; 46:100771. [PMID: 38586081 PMCID: PMC10998039 DOI: 10.1016/j.ctro.2024.100771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/07/2024] [Accepted: 03/24/2024] [Indexed: 04/09/2024] Open
Abstract
Background Due to superior image quality and daily adaptive planning, MR-guided stereotactic body radiation therapy (MRgSBRT) has the potential to further widen the therapeutic window in radiotherapy of localized prostate cancer. This study reports on acute toxicity rates and patient-reported outcomes after MR-guided adaptive ultrahypofractionated radiotherapy for localized prostate cancer within the prospective, multicenter phase II SMILE trial. Materials and methods A total of 69 patients with localized prostate cancer underwent MRgSBRT with daily online plan adaptation. Inclusion criteria comprised a tumor stage ≤ T3a, serum PSA value ≤ 20 ng/ml, ISUP Grade group ≤ 4. A dose of 37.5 Gy was prescribed to the PTV in five fractions on alternating days with an optional simultaneous boost of 40 Gy to the dominant intraprostatic lesion defined by multiparametric MRI. Acute genitourinary (GU-) and gastrointestinal (GI-) toxicity, as defined by CTCAE v. 5.0 and RTOG as well as patient-reported outcomes according to EORTC QLQ-C30 and -PR25 scores were analyzed at completion of radiotherapy, 6 and 12 weeks after radiotherapy and compared to baseline symptoms. Results There were no toxicity-related treatment discontinuations. At the 12-week follow-up visit, no grade 3 + toxicities were reported according to CTCAE. Up until the 12-week visit, in total 16 patients (23 %) experienced a grade 2 GU or GI toxicity. Toxicity rates peaked at the end of radiation therapy and subsided within the 12-week follow-up period. At the 12-week follow-up visit, no residual grade 2 GU toxicities were reported and 1 patient (1 %) had residual grade 2 enteritic symptoms. With exception to a significant improvement in the emotional functioning score following MRgSBRT, no clinically meaningful changes in the global health status nor in relevant subscores were reported. Conclusion Daily online-adaptive MRgSBRT for localized prostate cancer resulted in an excellent overall toxicity profile without any major negative impact on quality of life.
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Affiliation(s)
- C.A. Fink
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - J. Ristau
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Department of Radiation Oncology, Maria Hilf Hospital Mönchengladbach, Mönchengladbach, Germany
| | - C. Buchele
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - S. Klüter
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - J. Liermann
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - E. Sandrini
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - A. Lentz-Hommertgen
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - L. Baumann
- Institute of Medical Biometry, Heidelberg University, Heidelberg, Germany
| | - N. Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - M. Baumgartl
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - M. Li
- Department of Radiation Oncology, LMU University Hospital Munich, Munich, Germany
| | - M. Reiner
- Department of Radiation Oncology, LMU University Hospital Munich, Munich, Germany
| | - S. Corradini
- Department of Radiation Oncology, LMU University Hospital Munich, Munich, Germany
| | - J. Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - D. Bonekamp
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - H.-P. Schlemmer
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - C. Belka
- Department of Radiation Oncology, LMU University Hospital Munich, Munich, Germany
| | - M. Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - J. Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - S.A. Koerber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Department of Radiation Oncology, Barmherzige Brueder Hospital Regensburg, Regensburg, Germany
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