Adaptive magnetic resonance image guided radiation for intact localized prostate cancer how to optimally test a rapidly emerging technology.
Date
2022-09-05ICR Author
Author
Hall, WA
Kishan, AU
Hall, E
Nagar, H
Vesprini, D
Paulson, E
Van der Heide, UA
Lawton, CAF
Kerkmeijer, LGW
Tree, AC
Type
Journal Article
Metadata
Show full item recordAbstract
INTRODUCTION: Prostate cancer is a common malignancy for which radiation therapy (RT) provides an excellent management option with high rates of control and low toxicity. Historically RT has been given with CT based image guidance. Recently, magnetic resonance (MR) imaging capabilities have been successfully integrated with RT delivery platforms, presenting an appealing, yet complex, expensive, and time-consuming method of adapting and guiding RT. The precise benefits of MR guidance for localized prostate cancer are unclear. We sought to summarize optimal strategies to test the benefits of MR guidance specifically in localized prostate cancer. METHODS: A group of radiation oncologists, physicists, and statisticians were identified to collectively address this topic. Participants had a history of treating prostate cancer patients with the two commercially available MRI-guided RT devices. Participants also had a clinical focus on randomized trials in localized prostate cancer. The goal was to review both ongoing trials and present a conceptual focus on MRI-guided RT specifically in the definitive treatment of prostate cancer, along with developing and proposing novel trials for future consideration. Trial hypotheses, endpoints, and areas for improvement in localized prostate cancer that specifically leverage MR guided technology are presented. RESULTS: Multiple prospective trials were found that explored the potential of adaptive MRI-guided radiotherapy in the definitive treatment of prostate cancer. Different primary areas of improvement that MR guidance may offer in prostate cancer were summarized. Eight clinical trial design strategies are presented that summarize options for clinical trials testing the potential benefits of MRI-guided RT. CONCLUSIONS: The number and scope of trials evaluating MRI-guided RT for localized prostate cancer is limited. Yet multiple promising opportunities to test this technology and potentially improve outcomes for men with prostate cancer undergoing definitive RT exist. Attention, in the form of multi-institutional randomized trials, is needed.
Collections
Subject
FLAME prostate
MIRAGE trial
MR guided radiation prostate cancer
MR guided radiation therapy
adaptive radiation therapy
adaptive radiation therapy prostate cancer
prostate cancer
Research team
Clin Trials & Stats Unit
Language
eng
Date accepted
2022-07-04
License start date
2022-01-01
Citation
Frontiers in Oncology, 2022, 12 pp. 962897 -
Publisher
FRONTIERS MEDIA SA
Except where otherwise noted, this item's license is described
as
http://creativecommons.org/licenses/by/4.0/
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