ArticleClinical and translational radiation oncology2026
Post-prostatectomy magnetic resonance-guided adaptive salvage radiotherapy: early toxicity and biochemical outcomes from a prospective single center cohort.
Article 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. Not yet cited in PubMed.
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Abstract
Purpose: Magnetic resonance-guided adaptive radiotherapy (MRgART) may support daily anatomical adaptation in salvage post-prostatectomy radiotherapy (sPPRT). This prospective single-center cohort reports early clinician-assessed toxicities and biochemical outcomes following post-prostatectomy MRgART. Methods: Patients ≥6-months post-radical prostatectomy with positive margins, biochemical recurrence, and/or PSMA-PET/MRI-detected local or nodal recurrence were prospectively recruited to undergo MRgART to the prostate bed +/- pelvic lymph node irradiation. Patients were treated using a daily Adapt-to-Shape (ATS) workflow. PSA levels and clinician-reported gastrointestinal (GI) and genitourinary (GU) toxicities were recorded at baseline, 3, 6, and 12 months post-treatment and at most recent clinical follow-up. Results: Fifty-one patients underwent salvage post-prostatectomy MRgART. Prescriptions included 52.5 Gy/20 fractions, 55 Gy/20 fractions, 64 Gy/32 fractions, 66 Gy/33 fractions, 68 Gy/34 fractions, or 70 Gy/35 fractions. A simultaneous integrated boost (SIB - additional 4.0-12.5 Gy) was delivered in 24 patients based on PSMA-PET and/or MRI findings. Median follow-up was 20.8 months (95% CI 17.8-34.1 months). At 3 months, 47% developed acute GU toxicity (39% grade 1; 8% grade ≥2). At 12 months, 25 patients reported GU toxicity (40% grade 1; 10% grade ≥2). GI toxicities were 12% acutely and 12% at 12 months. In exploratory subgroup analysis, no statistically significant toxicity difference was observed between patients receiving SIB and those not receiving SIB. Excluding 20 patients receiving ADT, PSA measurements demonstrated a median 95.2% reduction at 3 months post-treatment. Conclusions: Post-prostatectomy MRgART, with or without PSMA-PET/MRI-guided SIB, was feasible in this prospective single-center cohort and was associated with favourable early clinician-reported toxicity. SIB was not associated with a significant increase in early or late toxicity in exploratory analysis. Longer follow-up, reporting, patient-reported outcomes, and larger comparative studies are required to confirm durability of toxicity outcomes and define longer-term biochemical control.
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