ReviewClinical and translational radiation oncology2026
Salvage stereotactic MR-Guided adaptive radiotherapy (SMART) re-irradiation for locally recurrent prostate Cancer: Clinical and dosimetric outcomes.
Review in Clinical and translational radiation oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Daily adaptive 1.5 T MR-Linac image-guided re-irradiation for prostate cancer: an international retrospective experience.Clinical and translational radiation oncology · 2027Article
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13 authors.
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Abstract
Introduction: Stereotactic ablative radiotherapy (SABR) is a salvage option for locally recurrent prostate cancer (LRPC); however, challenges remain. Stereotactic MRguided Adaptive Radiotherapy (SMART) permits daily adaptation, real-time tracking and automated beam gating, allowing critical organ sparing while potentially improving target coverage. Equivalent Dose in 2 Gy fraction (EQD2) calculation allows accurate organs-at-risk (OAR) dose accumulation in re-irradiation.We report safety and efficacy of daily SMART re-irradiation for LRPC, alongside an EQD2-based OAR tolerance calculation method. Methods: Salvage SMART to histologically proven non-metastatic hormone-sensitive LRPC was retrospectively analysed. Inclusion criteria included: ≥18 months post-RT, prostate-specific antigen (PSA) ≤ 30 ng/mL, PSA doubling-time > 6 months, International Prostate Symptom Score (IPSS) ≤ 19, prostate ≤ 80 cc and cT1-T3a/b.Reirradiation regimens were 30-35 Gy/5 fractions. Dose-boost and hormone therapy were allowed. Rectal spacer was recommended.Outcomes included toxicity, local control (LC), biochemical relapse-free survival (bRFS), progression free survival (PFS) and overall survival (OS). EQD2-based workflow to estimate OAR cumulative constraints was reported. Results: Between 2019 and 2023, nineteen patients underwent salvage-SMART to whole-gland (n = 12), hemi-gland (n = 5) or seminal vesicle (n = 2) at a median 87 months (range 35-587) from first radiotherapy. All 95 delivered fractions underwent online adaptation, meeting all estimated OAR.With 21 months follow-up, acute grade 2 genitourinary (GU) toxicity was 21 % with no acute ≥ grade 3 GU or ≥ grade 2 gastrointestinal (GI) toxicity observed. Late GU grade 3 toxicity occurred in 3 patients (15.7 %).OS was 100%; bRFS 73.7%; LC 84.2%; and median-PFS was not reached. One and two-year PFS were 94.7% and 89.4%. One and two-year LC was 100%. Two contralateral intraprostatic failures followed hemi-gland treatment were observed. Conclusion: Daily adaptive SMART re-irradiation is a feasible, non-invasive salvage option for LRPC, combining high LC with low toxicity. Our experience supports integrating MR- guidance with an individualized EQD2-informed planning.
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