{
  "abstract": "Purpose: Evidence remains limited for combining elective pelvic nodal SBRT, online MR-guided adaptation, and simultaneous integrated boost (SIB) to intraprostatic lesion (IPL) in high-risk localized prostate cancer. We evaluated adverse events (AEs), quality-of-life (QOL), adaptive workflow, and longitudinal clinical outcomes after adaptive MR-guided whole-pelvic SBRT with or without SIB. Methods: Consecutive PSMA-PET-staged patients treated on a prospective institutional protocol were analyzed. Treatment comprised 5-fraction MR-guided SBRT: 40 Gy to prostate, 33.5–35 Gy to proximal seminal vesicles, 25 Gy to elective pelvic lymphatics, and, when treated, 42.5 Gy to the IPL. Spacer use was clinician-selected. AEs were graded using CTCAE v5.0, and EPIC-50 outcomes were analyzed longitudinally. Results: Seventy-seven patients were treated (median follow-up, 37.7 months); 40 (51.9%) received SIB and 34 (44.2%) received a spacer. Acute grade ≥2 (G2+) GU AE occurred in 5/76 (6.6%), with no acute G2+ GI events. Late G2+ GU and GI AEs occurred in 5/72 (6.9%) and 7/72 (9.7%), respectively. SIB was not associated with more grade ≥2 AEs. Spacer use was associated with fewer late G2+ GI AE (0/30 vs. 7/42; P = 0.0366) and better late bowel QOL. SIB was associated with lower urinary QOL at the 24-month assessment, while this finding was not observed at subsequent assessments. Biochemical recurrence, radiological recurrence, and distant metastasis occurred in 2.6%, 3.9%, and 1.3%. Conclusions: Adaptive MR-guided whole-pelvic SBRT with optional SIB demonstrated favorable medium-term tolerability. These findings support the feasibility of integrating pelvic nodal SBRT, online adaptation, and focal boosting, and suggest that spacers may mitigate bowel morbidity. Prospective validation is warranted.",
  "abstract_shown": true,
  "affiliations": [
    "Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong, Hong Kong Special Administrative Region of China; Corresponding author at: Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, Happy Valley, China.",
    "Research Department, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong, Hong Kong Special Administrative Region of China",
    "Medical Physics Department, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong, Hong Kong Special Administrative Region of China",
    "Department of Radiotherapy, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong, Hong Kong Special Administrative Region of China"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Darren M.C. Poon"
    },
    {
      "affs": [
        1
      ],
      "name": "Jing Yuan"
    },
    {
      "affs": [
        2
      ],
      "name": "Bin Yang"
    },
    {
      "affs": [
        1
      ],
      "name": "Oi Lei Wong"
    },
    {
      "affs": [
        1
      ],
      "name": "Hiu Yi Wong"
    },
    {
      "affs": [
        2
      ],
      "name": "Mei Yan Tse"
    },
    {
      "affs": [
        2
      ],
      "name": "Chen-Yu Huang"
    },
    {
      "affs": [
        3
      ],
      "name": "Sin Ting Chiu"
    },
    {
      "affs": [
        2
      ],
      "name": "Siu Ki Yu"
    },
    {
      "affs": [
        3
      ],
      "name": "George Chiu"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/66qzc5nhv0esb.bib",
  "cited_by": 0,
  "doi": "10.1016/j.ctro.2026.101319",
  "fulltext_url": "http://www.sciencedirect.com/science/article/pii/S2405630826002144",
  "id": "66qzc5nhv0esb",
  "issns": [
    "2405-6308"
  ],
  "landing_url": "https://doi.org/10.1016/j.ctro.2026.101319",
  "language": "en",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
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    ],
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      "lcc",
      "R895-920"
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    [
      "lcc",
      "RC254-282"
    ],
    [
      "openalex",
      "2740|Prostate Cancer Diagnosis and Treatment"
    ]
  ],
  "openalex": "W7221610793",
  "pdf_url": "https://www.ctro.science/article/S2405-6308(26)00214-4/pdf",
  "pmcid": "PMC13718496",
  "pmid": "42960192",
  "published": "2026-10-13",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/66qzc5nhv0esb.ris",
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  "subjects": [
    {
      "field": "medicine",
      "origin": "lcc:RC254-282",
      "subfield": "oncology"
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  ],
  "title": "Adaptive MR-guided whole-pelvic SBRT with or without focal intraprostatic lesion boost for high-risk localized prostate Cancer: Adverse events and longitudinal quality-of-life outcomes",
  "title_text": "Adaptive MR-guided whole-pelvic SBRT with or without focal intraprostatic lesion boost for high-risk localized prostate Cancer: Adverse events and longitudinal quality-of-life outcomes",
  "type": "peer-reviewed",
  "updated_at": "2026-11-02T12:22:31Z",
  "url": "https://research.draconitic.com/paper/66qzc5nhv0esb",
  "venue": "Clinical and Translational Radiation Oncology",
  "versions": []
}