Magnetic Resonance-Guided Adaptive Radiation therapy for Prostate Cancer: The First Results from the MOMENTUM study—An International Registry for the Evidence-Based Introduction of Magnetic Resonance-Guided Adaptive Radiation Therapy

Frederik R. Teunissen, Thomas Willigenburg, Alison C. Tree, William A. Hall, Seungtaek L. Choi, Ananya Choudhury, John P. Christodouleas, Johannes C.J. de Boer, Eline N. de Groot-van Breugel, Linda G.W. Kerkmeijer, Floris J. Pos, Tine Schytte, Danny Vesprini, Helena M. Verkooijen, Jochem R.N. van der Voort van Zyp*

*Corresponding author for this work

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Abstract

Purpose: Magnetic resonance (MR)-guided radiation therapy (MRgRT) is a new technique for treatment of localized prostate cancer (PCa). We report the 12-month outcomes for the first PCa patients treated within an international consortium (the MOMENTUM study) on a 1.5T MR-Linac system with ultrahypofractionated radiation therapy. Methods and Materials: Patients treated with 5 × 7.25 Gy were identified. Prostate specific antigen-level, physician-reported toxicity (Common Terminology Criteria for Adverse Events [CTCAE]), and patient-reported outcomes (Quality of Life Questionnaire PR25 and Quality of Life Questionnaire C30 questionnaires) were recorded at baseline and at 3, 6, and 12 months of follow-up (FU). Pairwise comparative statistics were conducted to compare outcomes between baseline and FU. Results: The study included 425 patients with localized PCa (11.4% low, 82.0% intermediate, and 6.6% high-risk), and 365, 313, and 186 patients reached 3-, 6-, and 12-months FU, respectively. Median prostate specific antigen level declined significantly to 1.2 ng/mL and 0.1 ng/mL at 12 months FU for the nonandrogen deprivation therapy (ADT) and ADT group, respectively. The peak of genitourinary and gastrointestinal CTCAE toxicity was reported at 3 months FU, with 18.7% and 1.7% grade ≥2, respectively. The QLQ-PR25 questionnaire outcomes showed significant deterioration in urinary domain score at all FU moments, from 8.3 (interquartile range [IQR], 4.1-16.6) at baseline to 12.4 (IQR, 8.3-24.8; P = .005) at 3 months, 12.4 (IQR, 8.3-20.8; P = .018;) at 6 months, and 12.4 (IQR, 8.3-20.8; P = .001) at 12 months. For the non-ADT group, physician- and patient-reported erectile function worsened significantly between baseline and 12 months FU. Conclusions: Ultrahypofractionated MR-guided radiation therapy for localized PCa using a 1.5T MR-Linac is effective and safe. The peak of CTCAE genitourinary and gastrointestinal toxicity was reported at 3 months FU. Furthermore, for patients without ADT, a significant increase in CTCAE erectile dysfunction was reported at 12 months FU. These data are useful for educating patients on expected outcomes and informing study design of future comparative-effectiveness studies.

Original languageEnglish
JournalPractical Radiation Oncology
Volume13
Issue number3
Pages (from-to)e261-e269
ISSN1879-8500
DOIs
Publication statusPublished - 1. May 2023

Keywords

  • Humans
  • Magnetic Resonance Spectroscopy
  • Male
  • Prostate-Specific Antigen
  • Prostatic Neoplasms/radiotherapy
  • Quality of Life
  • Radiotherapy Planning, Computer-Assisted
  • Radiotherapy, Image-Guided/adverse effects
  • Registries

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