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Peer-reviewedCC BY-NC-NDClinical and Translational Radiation Oncology

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

  • Darren M.C. Poon1
  • Jing Yuan2
  • Bin Yang3
  • Oi Lei Wong2
  • Hiu Yi Wong2
  • Mei Yan Tse3
  • Chen-Yu Huang3
  • Sin Ting Chiu4
  • Siu Ki Yu3
  • George Chiu4
4 affiliations
  1. 1Comprehensive 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.
  2. 2Research Department, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong, Hong Kong Special Administrative Region of China
  3. 3Medical Physics Department, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong, Hong Kong Special Administrative Region of China
  4. 4Department of Radiotherapy, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong, Hong Kong Special Administrative Region of China
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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.

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Cite

BibTeXRIS
BibTeX
@article{poon2026adaptive,
  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}},
  author = {Darren M.C. Poon and Jing Yuan and Bin Yang and Oi Lei Wong and Hiu Yi Wong and Mei Yan Tse and Chen-Yu Huang and Sin Ting Chiu and Siu Ki Yu and George Chiu},
  journal = {Clinical and Translational Radiation Oncology},
  year = {2026},
  month = oct,
  doi = {10.1016/j.ctro.2026.101319},
  url = {https://doi.org/10.1016/j.ctro.2026.101319},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - 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
AU  - Darren M.C. Poon
AU  - Jing Yuan
AU  - Bin Yang
AU  - Oi Lei Wong
AU  - Hiu Yi Wong
AU  - Mei Yan Tse
AU  - Chen-Yu Huang
AU  - Sin Ting Chiu
AU  - Siu Ki Yu
AU  - George Chiu
PY  - 2026
DA  - 2026/10/13
JO  - Clinical and Translational Radiation Oncology
DO  - 10.1016/j.ctro.2026.101319
UR  - https://doi.org/10.1016/j.ctro.2026.101319
AB  - 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.
SN  - 2405-6308
ER  -