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Sritharan K, Daamen L, Pathmanathan A, Schytte T, Pos F, Choudhury A, van der Voort van Zyp JR, Kerkmeijer LG, Hall W, Hall E, Verkooijen HM, Herbert T, Hafeez S, Mitchell A, Tree AC. MRI-guided radiotherapy in twenty fractions for localised prostate cancer; results from the MOMENTUM study. Clin Transl Radiat Oncol 2024; 46:100742. [PMID: 38440792 PMCID: PMC10909700 DOI: 10.1016/j.ctro.2024.100742] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/30/2024] [Accepted: 02/03/2024] [Indexed: 03/06/2024] Open
Abstract
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.
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Affiliation(s)
- Kobika Sritharan
- The Royal Marsden NHS Foundation Trust, UK
- The Institute of Cancer Research, UK
| | - Lois Daamen
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | - Floris Pos
- The Netherlands Cancer Institute, The Netherlands
| | - Ananya Choudhury
- Division of Cancer Sciences, University of Manchester and The Christie NHS Foundation Trust, UK
| | | | | | | | - Emma Hall
- The Institute of Cancer Research, UK
| | - Helena M. Verkooijen
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | - Adam Mitchell
- The Royal Marsden NHS Foundation Trust, UK
- The Institute of Cancer Research, UK
| | - Alison C. Tree
- The Royal Marsden NHS Foundation Trust, UK
- The Institute of Cancer Research, UK
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Westerhoff J, de Mol van Otterloo S, Leer T, Daamen L, Rutgers R, Meijers L, Intven M, Verkooijen H. OC-0133 Patient Experience of MR-guided Radiotherapy using a 1.5T MR-Linac. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02509-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Westerhoff J, Daamen L, Christodouleas J, Blezer E, Choudhury A, Westley R, Erickson B, Fuller C, Hafeez S, van der Heide U, Intven M, Kirby A, Lalondrelle S, Minsky B, Mook S, Nowee M, Marijnen C, Orrling K, Sahgal A, Schultz C, Tersteeg R, Tree A, Tseng C, van der Voort van Zyp J, Verkooijen H, Hall W. OC-0419 Patterns of Care and Safety in 1800 patients treated on a high-field MR-Linac platform registry. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02555-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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van Goor I, Nagelhout A, Besselink M, Bonsing B, Bosscha K, Brosens L, Busch O, Cirkel G, van Dam R, Festen S, Groot Koerkamp B, van der Harst E, de Hingh I, Kazemier G, Meijer G, de Meijer V, Nieuwenhuijs V, Roos D, Schreinemakers J, Stommel M, Verdonk R, van Santvoort H, Molenaar Q, Daamen L, Intven M. OC-0111 Prognostic factors for isolated local recurrence after resection of pancreatic ductal adenocarcinoma. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02487-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Eijkelenkamp H, Grimbergen G, Heerkens H, Meijer G, Daamen L, Molenaar Q, van Santvoort H, Erickson B, Hall W, Intven M. MO-0221 Short-term toxicity outcomes after MR-guided SBRT for (peri-)pancreatic tumors on a 1.5T MR-linac. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02323-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Halle-Smith J, Hall L, Daamen L, Hodson J, Pande R, Young A, Jamieson N, Lamarca A, van Santvoort H, Molenaar IQ, Valle J, Roberts K. P-P48 Clinical Benefit of Surveillance after Resection of Pancreatic Ductal Adenocarcinoma: A Systematic Review and Meta-Analysis. Br J Surg 2021. [DOI: 10.1093/bjs/znab430.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
The clinical benefit and acceptability to patients of routine surveillance after resection of pancreatic ductal adenocarcinoma (PDAC) remains unclear. Furthermore, expert guidelines around the world offer conflicting recommendations. This study is a systematic review of evidence for surveillance programs.
Methods
A systematic review of studies evaluating different surveillance methods was undertaken. Meta-analyses were performed for those studies reporting rates of asymptomatic recurrence, treatment of recurrence and overall survival, according to different surveillance methods.
Results
There were ten studies included in the literature review. Five studies were appropriate for meta-analysis (1,596 patients). If enrolled in an active surveillance program, patients were more likely to have recurrence detected at an asymptomatic stage (Pooled Rate: 49.3% vs. 19.1%, p = 0.043). In terms of clinical outcomes, patients with asymptomatic recurrence were more likely to receive treatment for recurrence (Odds Ratio 3.49; 95% CI: 1.73-7.07; p < 0.001) and had longer overall survival (Mean Difference: 9.5 months; 95% CI: 4.1-14.8; p < 0.001) than those with symptoms at time of recurrence.
Conclusions
From this systematic review and meta-analysis of early data it appears that routine surveillance after surgery for PDAC detects more patients at the asymptomatic stage. Data from these non-randomised trials also suggest that treatment rates and survival may be superior in patients were recurrence is detected when asymptomatic. As such, these data suggest that routine surveillance may improve patient outcomes, however an appropriately conducted trial would be required to address concerns that various sources of bias may be affecting these results.
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Affiliation(s)
- James Halle-Smith
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Lewis Hall
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Lois Daamen
- Department of Surgery, UMC Utrecht Cancer Center, Utrecht University, Utrecht, Netherlands
| | - James Hodson
- Medical Statistics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Rupaly Pande
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Alastair Young
- Department of Pancreaticobiliary Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Nigel Jamieson
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Angela Lamarca
- Medical Oncology Department, The Christie NHS Foundation Trust / University of Manchester, Manchester, United Kingdom
| | - Hjalmar van Santvoort
- Department of Surgery, Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, Utrecht, Netherlands
| | - Izaak Quintus Molenaar
- Department of Surgery, Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, Utrecht, Netherlands
| | - Juan Valle
- Medical Oncology Department, The Christie NHS Foundation Trust / University of Manchester, Manchester, United Kingdom
| | - Keith Roberts
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
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Daamen L, de Mol van Otterloo S, van Goor I, Eijkelenkamp H, Erickson B, Hall W, Heerkens H, Meijer G, Molenaar Q, van Santvoort H, Verkooijen L, Intven M. PO-1218 Online adaptive MR-guided SBRT for unresectable upper abdominal malignancies using a 1.5T MR-linac. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07669-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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