Magnetic Resonance Imaging Versus Computed Tomography Guidance for Stereotactic Body Radiotherapy in Prostate Cancer: 2-year Outcomes from the MIRAGE Randomized Clinical Trial.

Autor: Kishan AU; Department of Radiation Oncology, University of California-Los Angeles, Los Angeles, CA, USA; Department of Urology, University of California-Los Angeles, Los Angeles, CA, USA. Electronic address: aukishan@mednet.ucla.edu., Lamb JM; Department of Radiation Oncology, University of California-Los Angeles, Los Angeles, CA, USA., Wilhalme H; Statistics Core, Department of Medicine, University of California-Los Angeles, Los Angeles, CA, USA., Casado M; Department of Radiation Oncology, University of California-Los Angeles, Los Angeles, CA, USA., Chong N; Department of Radiation Oncology, University of California-Los Angeles, Los Angeles, CA, USA., Zello L; Department of Radiation Oncology, University of California-Los Angeles, Los Angeles, CA, USA., Juarez JE; Department of Radiation Oncology, University of California-Los Angeles, Los Angeles, CA, USA., Jiang T; Department of Radiation Oncology, University of California-Los Angeles, Los Angeles, CA, USA., Neilsen BK; Department of Radiation Oncology, University of California-Los Angeles, Los Angeles, CA, USA., Low DA; Department of Radiation Oncology, University of California-Los Angeles, Los Angeles, CA, USA., Yang Y; Department of Radiation Oncology, University of California-Los Angeles, Los Angeles, CA, USA., Neylon J; Department of Radiation Oncology, University of California-Los Angeles, Los Angeles, CA, USA., Basehart V; Department of Radiation Oncology, University of California-Los Angeles, Los Angeles, CA, USA., Martin Ma T; Department of Radiation Oncology, University of Washington, Seattle, WA, USA., Valle LF; Department of Radiation Oncology, University of California-Los Angeles, Los Angeles, CA, USA; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA., Cao M; Department of Radiation Oncology, University of California-Los Angeles, Los Angeles, CA, USA., Steinberg ML; Department of Radiation Oncology, University of California-Los Angeles, Los Angeles, CA, USA.
Jazyk: angličtina
Zdroj: European urology [Eur Urol] 2024 Nov 12. Date of Electronic Publication: 2024 Nov 12.
DOI: 10.1016/j.eururo.2024.10.026
Abstrakt: It has been shown that magnetic resonance imaging (MRI) guidance versus computed tomography (CT) guidance for aggressive margin-reduction (AMR) for stereotactic body radiotherapy (SBRT) in prostate cancer reduces acute toxicity, but the longer-term benefits are unknown. We performed a secondary analysis of MIRAGE, a phase 3 randomized clinical trial of MRI-guided SBRT for prostate cancer, to determine whether AMR with MRI guidance significantly reduced 2-yr physician-scored or patient-reported toxic effects in comparison to CT guidance. The cumulative incidence of 2-yr physician-scored toxicity, defined as grade ≥2 genitourinary (GU) and gastrointestinal (GI) toxic effects according to Common Terminology Criteria for Adverse Events v4.03, were lower with MRI guidance. Cumulative incidence rates of late grade ≥2 toxicity at 2 yr with MRI-guided versus CT-guided SBRT were 27% (95% confidence interval [CI] 19-39%)] versus 51% (95% CI 41-63%) for GU toxicity (p = 0.004), and 1.4% (95% CI 0.2-9.6) versus 9.5% (95% CI 4.6-19) for GI toxicity (p = 0.025). Cumulative logistic regression revealed that MRI-guided SBRT was associated with significantly lower odds of a clinically relevant deterioration in bowel function according to the Expanded Prostate Cancer Index Composite-26 score (odds ratio 0.444, 95% CI 0.209-0.942; p = 0.035) and in the Sexual Health Inventory in Men score (odds ratio 0.366, 95% CI 0.148-0.906; p = 0.03). There were no significant differences in the odds of a deterioration for other quality-of-life metrics. These findings support the hypothesis that aggressive planning for margin reduction for prostate SBRT using MRI leads to continued reductions in toxic effects over 2-yr follow-up. This trial is registered on ClinicalTrials.gov Identifier as NCT04384770.
(Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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