Abstract
Simple SummaryThe biological features of prostate cancer as a tumor with a low alpha beta ratio have led clinicians to consider the use of higher doses per fraction, thus gaining an advantage both in terms of clinical outcomes and of logistic opportunities. To date, moderate hypofractionated schedules are supported by several international clinical guidelines. The subsequent step was represented by the adoption of extreme hypofractionated schedules, for which recent literature data report non-inferiority results for the five-fractions regimens. In this scenario, the recent introduction of MR-guided daily adaptive radiotherapy is a potential paradigm shift, given the ability to increase the resolution of the pelvis anatomy and to take into account of the daily variations in shape and size of the nearby healthy structures.In this review we summarize the currently available evidence about the role of hybrid machines for MR-guided radiotherapy for prostate stereotactic body radiotherapy. Given the novelty of this technology, to date few data are accessible, but they all report very promising results in terms of tolerability and preliminary clinical outcomes. Most of the studies highlight the favorable impact of on-board magnetic resonance imaging as a means to improve target and organs at risk identification with a consequent advantage in terms of dosimetric results, which is expected to relate to a more favorable toxicity pattern. Still, the longer treatment time per session may potentially affect the patient’s compliance to the treatment, although first quality of life assessment studies have reported substantial tolerability and no major impact on quality of life. Finally, in this review we hypothesize some future scenarios of further investigation, based on the possibility to explore the superior anatomy visualization and the role of daily adapted treatments provided by hybrid MR-Linacs.
Highlights
Prostate cancer (PC) is the most frequently diagnosed tumor in the male population in Europe [1], with high survival rates
Very promising results are available in the literature and the role of extreme hypofractionation is expected to gain more attractiveness with the recent introduction of Magnetic Resonance (MR)-guided RT performed with Linacs equipped with on-board MR-imaging [14,15,16,17]
To date, the published evidence remains quite sparse. [28,29] In this narrative review, we aim to present the preliminary data currently available in the scientific literature on the implementation of hybrid Linacs with on-board MR-imaging for daily-adaptive stereotactic body radiotherapy (SBRT) of the prostate and the future potential challenges arising from the introduction of this technique
Summary
Prostate cancer (PC) is the most frequently diagnosed tumor in the male population in Europe [1], with high survival rates. There are several data supporting PC as a tumor with a low alpha-beta ratio that is more sensitive to higher doses per fraction [5,6,7]. This biological characteristic is the main basis for the worldwide propagation of hypofractionated schedules, which were initially supported by a large number of studies and are currently implemented in several international clinical practice guidelines [8,9,10,11]. Very promising results are available in the literature and the role of extreme hypofractionation is expected to gain more attractiveness with the recent introduction of Magnetic Resonance (MR)-guided RT performed with Linacs equipped with on-board MR-imaging [14,15,16,17]
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