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MRI-Guided Radiotherapy Bests CT Guidance for Prostate Cancer

Benefits seen for genitourinary and gastrointestinal toxic effects

By Lori Solomon HealthDay Reporter

WEDNESDAY, Jan. 18, 2023 (HealthDay News) — Magnetic resonance imaging (MRI)-guided radiotherapy offers significant benefit over computed tomography (CT)-guided therapy for treatment of prostate cancer, according to a study published online Jan. 12 in JAMA Oncology.

Amar U. Kishan, M.D., from University of California in Los Angeles, and colleagues assessed whether aggressive margin reduction with MRI guidance significantly reduces acute grade 2 or greater genitourinary toxic effects after prostate stereotactic body radiotherapy (SBRT) versus CT guidance (79 versus 77 patients). A prespecified interim futility analysis was conducted after 100 patients reached ≥90 days after SBRT.

The researchers found that the incidence of acute grade 2 or greater genitourinary toxic effects was significantly lower with MRI versus CT guidance (24.4 versus 43.4 percent), as was the incidence of acute grade 2 or greater gastrointestinal toxic effects (0.0 versus 10.5 percent). At one month, MRI guidance was associated with a significantly smaller percentage of patients with a ≥15-point increase in the International Prostate Symptom Score (6.8 versus 19.4 percent) and a significantly reduced percentage of patients with a clinically significant (≥12-point) decrease in Expanded Prostate Cancer Index Composite-26 bowel scores (25 versus 50 percent).

“In this randomized clinical trial, compared with CT-guidance, MRI-guided SBRT significantly reduced both moderate acute physician-scored toxic effects and decrements in patient-reported quality of life,” the authors write. “Longer-term follow-up will confirm whether these notable benefits persist.”

Several authors disclosed financial ties to ViewRay, maker of the MRI-guided radiation therapy system used in the study.

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