The MIRAGE Trial—Optical Illusion or the Future of Prostate Stereotactic Radiotherapy?
Mené entre 2020 et 2021 sur 156 patients atteints d'un cancer de la prostate (âge médian : 71 ans), cet essai randomisé de phase III évalue la toxicité génito-urinaire et gastro-intestinale de 2 techniques de guidage de radiothérapie corporelle stéréotaxique, l'une par IRM et l'autre par tomodensitométrie
Improving the accuracy of radiotherapy delivery is a fundamental goal of the radiation oncology community. Over 2 decades, we have observed the implementation of novel radiotherapy techniques in prostate cancer, such as intensity-modulated and volumetric arc radiotherapy, as well as treatment verification optimization, such as cone-beam computed tomography (CT) and marker tracking. Accordingly, these continuing technology advances have facilitated reduced radiotherapy toxicity over time. However, none of these new technologies were formally tested in the context of a gold standard randomized clinical trial to prove superiority over standard of care. Therefore, determining which of these interventions have contributed to these improvements is exceedingly difficult. In this context, in this issue of JAMA Oncology, Kishan et al deliver the primary outcome of the MIRAGE phase 3 trial testing the magnetic resonance imaging (MRI)–linear accelerator (LINAC) in the context of prostate stereotactic body radiotherapy (SBRT). Randomized clinical trials of technology implementation are difficult to execute; thus, the authors should be particularly commended for this work.
JAMA Oncology , éditorial, 2022