Early toxicity and diffusion-weighted MRI assessment after Single-Dose Ablative Radiotherapy for PCa
PO-2092
Abstract
Early toxicity and diffusion-weighted MRI assessment after Single-Dose Ablative Radiotherapy for PCa
Authors: Raffaella Lucchini1, Davide Gandola2, Valeria Faccenda3, Giorgio Purrello1, Cammillo Talei Franzese2, Denis Panizza3, Stefano Arcangeli1
1University of Milan Bicocca, Radiation Oncology Department, Milan, Italy; 2University of Milan Bicocca, Diagnostic Radiology Department, Milan, Italy; 3ASST Monza, Medical Physics Department, Monza, Italy
Show Affiliations
Hide Affiliations
Purpose or Objective
To investigate diffusion-weighted (DW) MRI changes and early gastrointestinal (GI) and genitourinary (GU) side effects in patients with organ-confined unfavourable Prostate Cancer (PCa) following Single-Dose Ablative Radiotherapy (SDART).
Material and Methods
Fifteen patients included in the prospective clinical trial ‘‘ABRUPT” (NCT04831983) were treated with a single fraction of 24 Gy to the whole prostate with urethra sparing in association with androgen deprivation therapy (ADT) as per standard of care. Treatment was delivered on Linac platform with a Volumetric Modulated Arc Therapy (VMAT) and a real-time organ-motion electromagnetic tracking system. Multiparametric MRI was performed before SDART (time 0), one-hour post-SDART (time 1), and 3-month after treatment (time 2). Acute toxicity was evaluated with Common Terminology Criteria for Adverse Events version 5 (CTCAE_v5) scale. IPSS score and quality of life (QoL) metrics assessed with EORTC questionnaires QLQ-PR25/-C30 were also measured.
Results
Median age was 76 years (range 62-82). Median prostate volume was 33 cc (range 10-59). At 3-months follow-up none of the patients experienced GI toxicity, while GU side effects were observed only in three patients (two G1 and one G2). Median IPSS score decreased from 5 (range 0-12) at baseline to 4 (range 0-17) 3 months after treatment. At the same time points no significant changes in EORTC-QoL score were documented. An increase of ADC value of tumour lesion by 33% (range 5%-178%) and 59% (range 22%-164%) was registered at time 1 and time 2 respectively, compared to the baseline. Median prostate volume was found unchanged at time 1, while decreased by 24% (range 9%-59%) at time 2. At the last follow up all patients were found bNED, and four of them had a complete radiological response.
Conclusion
SDART irradiation of the whole prostate with urethra sparing was feasible and well tolerated. Our findings showed a correlation between early changes in ADC values after SDART and later tumour response in patients with unfavourable PCa. Long-term results are needed to confirm whether DW-MRI can be used as an early biomarker of treatment outcome in this setting.