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22nd January 2023

MRI-guided radiotherapy in the management of prostate cancer patients

New research from Jonsson Comprehensive Cancer Center, University of California – Los Angeles Health Sciences, finds that MRI guidance results in fewer toxicities and better quality of life for men who undergo radiotherapy for localized prostate cancer. The precise targeting capabilities of MRI-guided radiotherapy make it a suitable option for treatment.

Technological advancements over the years are making it possible to aim radiation more precisely than in the past. Methods such as conformal radiation therapy, intensity-modulated radiation therapy, and proton beam radiation are springing up to help doctors avoid giving radiation to normal tissues. These methods seek to increase the effectiveness of radiation therapy while reducing the side effects. Newer methods like CT-guided radiotherapy are adjudged to offer more advantages. And more recently, the sophisticated MRI-guided radiotherapy has taken the floor on the discussion table.

MRI guidance offers tangible benefits for patients. Compared to the standard CT guidance, it stands clear above. MRI-guided technology has the ability to dramatically reduce planning margins, thus providing more focused treatment with less injury to nearby normal tissues and organs. Although MRI is more costly than CT technology in terms of equipment expenses and longer treatment times, offering considerable benefits over the latter will most certainly make patients choose an MRI-guided technology.

Stereotactic body radiotherapy for prostate cancer has been reported to cause organ dysfunction. This type of external radiation therapy delivers radiation in five or fewer precisely targeted doses, and although it is an established and generally well-tolerated form of treatment, it has been noted to cause toxicities resulting in urinary, bowel, and sexual dysfunction in some patients. This clinical trial tagged MIRAGE (an acronym for Magnetic Resonance Imaging-Guided Stereotactic Body Radiotherapy for Prostate Cancer) was led by scientists at UCLA and included 154 analyzable patients with prostate cancer who were randomized to either an MRI-guidance arm (78 patients) or a CT-guidance arm (76 patients).

This study also included outcome measures assessed by patients as well as physicians which allowed both parties to assess and judge the effect of MRI guidance from their ends. The patients and the doctors treating them expressed that MRI-guided therapy was associated with fewer side effects and better quality of life over more than three months of follow-up.

Following interim findings presented at the 2022 ASCO Genitourinary (GU) Cancers Symposium in San Francisco, results from the first randomized phase III clinical trial to directly compare MRI-guided stereotactic body radiotherapy with CT-guided therapy are published in JAMA Oncology.

“In this trial, we demonstrated that the reduction in treatment volumes facilitated by MRI guidance leads to a significant reduction in moderate physician-scored toxicity and to a reduction in the proportion of patients noting significant decrements in patient-reported outcome metrics in the near term,” said Dr Amar Kishan, a radiation oncologist at the David Geffen School of Medicine at UCLA and the UCLA Jonsson Comprehensive Cancer Center. “Although additional studies will need to confirm these benefits over time, we’re hopeful that these results will lead to better outcomes for men with prostate cancer.” Dr Kishan is the study’s lead author, working closely with other authors like Ting Martin Ma, James M. Lamb, Michael Steinberg, Holly Wilhalme, Maria Casado, Ke Sheng, Daniel A. Low, Nicholas G. Nickols, Sahil Sharma, Yingli Yang, Jonathan Pham, Vincent Basehart, Yu Gao, Minsong Cao, and John Neylon, all of UCLA.

Globally, many medical centers have embarked on research into the causes, prevention, detection, testing, and treatment of prostate cancer. Newer treatments are currently being developed, and improvements are being made to many standard prostate cancer treatment methods. For instance, even though it is one of the oldest treatment methods, surgical techniques are constantly being improved on in order to remove all of the cancer while lowering the risk of complications and side effects from the surgery.


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