Quantifying Intrafraction Motion and the Impact of Gating for MRI-guided Stereotactic Radiotherapy for Prostate Cancer: Analysis of the MRI arm from the MIRAGE Phase III Randomized Trial - ScienceDirect

Quantifying Intrafraction Motion and the Impact of Gating for MRI-guided Stereotactic Radiotherapy for Prostate Cancer: Analysis of the MRI arm from the MIRAGE Phase III Randomized Trial - ScienceDirect: 

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INTRODUCTION

In recent years, there has been an increase in the use of hypofractionated radiotherapy1 and ultrahypofractionated radiotherapy such as stereotactic body radiation therapy (SBRT)2 in the treatment of prostate cancer. The use of SBRT as definitive treatment for prostate cancer doubled from 2010 to 20152 and has recently been endorsed by the National Comprehensive Cancer Network as a standard treatment option for localized prostate cancer of all risk groups.3 The larger dose delivered per

Radiation Planning and Delivery

The MIRAGE trial was a phase III trial that randomized patients undergoing prostate SBRT 1:1 to MRgRT vs. CTgRT. Seventy nine (79) patients were included in the MRgRT arm. A planning margin of 2mm was placed around the prostate and proximal seminal vesicles clinical target volume (CTV) to generate the planning target volume (PTV). The PTV was treated to 40 Gy in five fractions on an MR-LINAC (MRIdian, ViewRay Inc, Denver, CO). Detailed treatment planning and delivery information was previously

GDC Characterization

Information of 391 fractions from all 79 patients treated on the MRgRT arm were available for analysis (no relevant data were available for two fractions from two patients, for a total of 391/395 eligible fractions included in this analysis). On a per fraction basis, the median GDC was 0.974 (interquartile range IQR 0.916- 0.983). The calculated GDCs for all patients are shown in Figure 1(a), while a histogram of the GDCs is shown in Figure 1(b). Of the 391 fractions, 77% had a GDC ≥0.9, 14%

DISCUSSION

In the current study, we interrogated prospectively collected treatment delivery records and cine images of 79 patients treated on the MRgRT arm of a phase III randomized trial. To the best of our knowledge, the current study is also the first that correlated detailed intrafraction prostate motion data with acute treatment toxicity.

Resulting from our log file analysis, the overall gating duty cycle (GDC) was high (median 0.974) for all fractions. In other words, most fractions exhibited little

CONCLUSIONS

MIRAGE, a phase III randomized trial, demonstrated that MRI-guided prostate SBRT was associated with lower acute GU and GI toxicities compared to CT-guided SBRT. However, dosimetry comparisons showed only modest differences, prompting investigating of other contributing factors, such as gating.

Gating duty cycle (GDC) analysis showed overall stable positioning of prostate during treatment, but a considerable proportion (23%) of fractions had a GDC of <0.9. Additionally, the occurrence of

Author Responsible for Statistical Analysis

Ting Martin Ma, martin.jhu@gmail.com

Funding Statement

This study was supported by grant P50CA09213 from the Prostate Cancer National Institutes of Health (NIH) Specialized Programs of Research Excellence (Dr. Kishan), grant PC210066 from the Department of Defense (Dr. Kishan), the Prostate Cancer Foundation and the American Society for Radiation Oncology (Dr. Kishan), and funding from the Chapgier, Bershad, De Silva, and McCarrick Families (Dr. Kishan).

Data Availability Statement for this Work

Research data are stored in an institutional repository

REFERENCES

  • 1. Pryor DI, Martin JM, Millar JL, et al. Evaluation of Hypofractionated Radiation Therapy Use and Patient-Reported Outcomes in Men With Nonmetastatic Prostate Cancer in Australia and New Zealand. JAMA network open. 2021;4(11):e2129647.

  • 2. Mahase SS, D'Angelo D, Kang J, Hu JC, Barbieri CE, Nagar H. Trends in the Use of Stereotactic Body Radiotherapy for Treatment of Prostate Cancer in the United States. JAMA network open. 2020;3(2):e1920471.

  • 3. National Comprehensive Cancer Network. NCCN Clinical

Declaration of Competing Interest

Dr. Neylon reports consulting fees from ViewRay. Dr. Ma reports consulting fees from Varian Medical Systems, ViewRay. Dr. Kishan reports consulting fees and speaking honoraria from Varian Medical Systems, ViewRay, Janssen, and Boston Scientific; low-value stock in ViewRay; and serving on the Janssen advisory board. Dr. Cao reports consulting fees and speaking honoraria from Varian and ViewRay. Dr. Savjani reports research funding from NVIDIA, Siemens, Varian, StratPharma, and UCLA. Dr. Low

Acknowledgements

We wish to thank all the patients, family members, and clinical support staff from that participated and/or assisted in this study.

© 2023 Elsevier Inc. All rights reserved.

 

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