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Dosereduksjon i strålebehandling av prostatakreft ved bruk av MR-Linac i to fraksjoner (DESTINATION 2)

3. november 2026 oppdatert av: The Netherlands Cancer Institute

Dosereduksjon ved strålebehandling av prostatakreft ved bruk av MR-Linac i 2 fraksjoner

The goal of this clinical trial is to find out whether lowering the radiation dose to parts of the prostate without visible tumor on MRI can reduce side effects while still effectively treating prostate cancer in men with low or intermediate-risk prostate cancer.

The main questions it aims to answer are:

  • Does reducing the radiation dose to healthy prostate tissue lower the risk of bowel and urinary side effects?
  • Can we maintain good cancer control by keeping a high dose for MRI-visible tumor areas?

Researchers will compare two treatment approaches:

  • One group receives a uniform high dose to the entire prostate.
  • The other group receives a lower dose to healthy prostate tissue and a high dose only to visible tumor areas.

Participants will:

  • Receive two sessions of MRI-guided radiotherapy using an MR-Linac.
  • Complete questionnaires about urinary, bowel, and sexual health before and after treatment.
  • Have follow-up visits to monitor side effects and PSA levels for up to 2 years.

Studieoversikt

Status

Rekruttering

Forhold

Intervensjon / Behandling

Studietype

Intervensjonell

Registrering (Antatt)

54

Fase

  • Ikke aktuelt

Kontakter og plasseringer

Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.

Studiekontakt

  • Navn: Floris Pos, MD, PhD
  • Telefonnummer: +31205129111
  • E-post: f.pos@nki.nl

Studiesteder

      • Amsterdam, Nederland, 1066CX
        • Rekruttering
        • The Netherlands Cancer Institute
        • Ta kontakt med:
          • Floris Pos, MD, PhD
          • Telefonnummer: +31205129111
          • E-post: f.pos@nki.nl
        • Ta kontakt med:

Deltakelseskriterier

Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.

Kvalifikasjonskriterier

Alder som er kvalifisert for studier

18 år og eldre (Voksen, Eldre voksen)

Tar imot friske frivillige

Nei

Kjønn som er kvalifisert for studier

Mann

Beskrivelse

Inclusion Criteria:

  1. Men aged ≥18 years
  2. Histological confirmation of prostate adenocarcinoma requiring radical radiotherapy
  3. Gleason score 3+3, 3+4 or 4+3 (ISUP Grade groups (GG) 1, 2 or 3)
  4. MRI-visible tumour(s) of PIRADS v2 grade 3 or higher and able to be delineated on T2 and diffusion-weighted imaging +/- dynamic contrast-enhanced imaging. Tumour nodule visible on MRI should be considered able to be boosted by treating clinician and <2.5cm in maximal dimension. MRI must be performed within 3 months of trial entry
  5. The MRI-defined lesion must be confirmed as malignant on biopsies (any Gleason grade is sufficient as long as Gleason score is reported).
  6. MRI stages mT1 and T2 or mT3a with ≤ 1mm tumour outside gland AND otherwise favourable intermediate risk characteristics (Gleason 3+3, 3+4)(as staged by AJCC TNM 2018)
  7. PSA <20 ng/ml prior to starting androgen deprivation therapy (ADT).
  8. WHO Performance status 0-2
  9. Ability of the participant to understand and the willingness to sign a written informed consent (IC) form.
  10. Ability/willingness to comply with the patient reported outcome questionnaires schedule throughout the study.

Exclusion Criteria:

  1. Contraindications to MRI (e.g. pacemaker, potentially mobile metal implant, claustrophobia)
  2. IPSS Score > 19
  3. High grade disease (GG3) occult to MRI-defined lesion. As a guide, any pathology for which you would consider surveillance is allowed outside of the MRI-defined area.
  4. Prostate volume >90cc
  5. Comorbidities which predispose to significant toxicity (e.g. inflammatory bowel disease) or preclude long term follow up
  6. Hip replacement, or other pelvic metalwork which causes artefact on diffusion-weighted imaging
  7. Previous pelvic radiotherapy
  8. Patients needing >6 months of ADT due to disease parameters.
  9. Previous invasive malignancy within the last 2 years excluding basal or squamous cell carcinomas of the skin, low risk non-muscle invasive bladder cancer (assuming cystoscopic follow up now negative) or small renal masses on surveillance.

Studieplan

Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.

Hvordan er studiet utformet?

Designdetaljer

  • Primært formål: Behandling
  • Tildeling: Randomisert
  • Intervensjonsmodell: Parallell tildeling
  • Masking: Ingen (Open Label)

Våpen og intervensjoner

Deltakergruppe / Arm
Intervensjon / Behandling
Annen: Uniform dosering SBRT

27 Gy dose in 2 fractions to the whole prostate+/- seminal vesicles with a 0mm PTV margin using MR-linac

Annen: Nedtrappet dose SBRT

The benign prostate +/- SV CTV will receive 20 Gy in 2 fractions with a 0mm PTV margin using MR-linac. The intraprostatic tumor masses (on MRI) will receive 27 Gy in 2 fractions. A 4mm GTV to PTV margin will be added to the in-traprostatic MR visible tumour to form PTV 27Gy.

Hva måler studien?

Primære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Acute GU toxicity
Tidsramme: within 13 weeks of starting radiotherapy

Physician-reported acute Grade 2 or higher CTCAE GU toxicity observed within 13 weeks of starting radiotherapy

within 13 weeks of starting radiotherapy

Sekundære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Dosimetry
Tidsramme: During Radiotherapy treatment of 8 days

Estimate the accumulated dose differences between treatment arms in terms of dose to prostate CTV, rectum, urethra and bladder

During Radiotherapy treatment of 8 days
Late GI toxicity
Tidsramme: 1 and 2 years after radiotherapy treatment

Physician reported late GI toxicity according to CTCAE v5.0

1 and 2 years after radiotherapy treatment
Biochemical relapse-free survival
Tidsramme: 2 years

Assess biochemical relapse-free survival for 2 years

2 years
Severity of erectile dysfunction experienced by patient
Tidsramme: Before radiotherapy treatment, and at 6, 12 and 24 months after radiotherapy treatment

The IIEF-5 patient reported outcomes (PROs) assess the acute severity of erectile dysfunction

Before radiotherapy treatment, and at 6, 12 and 24 months after radiotherapy treatment
Acute GI toxicity
Tidsramme: At baseline, after the last fraction, and 2, 4 and 12 weeks after radiotherapy treatment

Physician reported acute GI toxicity according to CTCAE v5.0

At baseline, after the last fraction, and 2, 4 and 12 weeks after radiotherapy treatment
Late GU toxicity
Tidsramme: 1 and 2 years after radiotherapy treatment

Physician reported late GU toxicity according to CTCAE v5.0

1 and 2 years after radiotherapy treatment
Late sexual toxicity
Tidsramme: 1 and 2 years after radiotherapy treatment

Physician reported late sexual toxicity according to CTCAE v5.0

1 and 2 years after radiotherapy treatment
Severity of urinary symptoms (GU) experienced by patient
Tidsramme: Before radiotherapy treatment, after the last fraction, at 2, 4 and 12 weeks post-treatment, and at 6, 12 and 24 months after radiotherapy treatment

The patient reported outcomes (PROs) International Prostate Symptoms Score (IPSS) assess the severity of urinary symptoms what the patient experiences

Before radiotherapy treatment, after the last fraction, at 2, 4 and 12 weeks post-treatment, and at 6, 12 and 24 months after radiotherapy treatment
Health-related quality of life experienced by patient
Tidsramme: Before start radiotherapy, week 4 and week 12, at 6, 12 and 24 months after radiotherapy treatment.

The EPIC-26 patient reported outcomes (PROs) assess the health-related quality of life

Before start radiotherapy, week 4 and week 12, at 6, 12 and 24 months after radiotherapy treatment.

Samarbeidspartnere og etterforskere

Det er her du vil finne personer og organisasjoner som er involvert i denne studien.

Sponsor

Samarbeidspartnere

Studierekorddatoer

Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.

Studer hoveddatoer

Studiestart (Faktiske)

17. november 2025

Primær fullføring (Antatt)

1. februar 2027

Studiet fullført (Antatt)

1. desember 2028

Datoer for studieregistrering

Først innsendt

2. oktober 2025

Først innsendt som oppfylte QC-kriteriene

2. februar 2026

Først lagt ut (Faktiske)

6. februar 2026

Oppdateringer av studieposter

Sist oppdatering lagt ut (Faktiske)

6. november 2026

Siste oppdatering sendt inn som oppfylte QC-kriteriene

3. november 2026

Sist bekreftet

1. november 2026

Mer informasjon

Begreper knyttet til denne studien

Andre studie-ID-numre

  • M24DTI

Plan for individuelle deltakerdata (IPD)

Planlegger du å dele individuelle deltakerdata (IPD)?

JA

IPD-planbeskrivelse

It is intended that data will be shared within the MOMENTUM collaboration, between centres delivering treatment in the same way as DESTINATION2. Pseudonymised data will be stored within MOMENTUM for at least 5 years. Storage will be cloud based and as the treating centre we will have free access to the data and control over who else can assess it.

IPD-delingstidsramme

5 years

Legemiddel- og utstyrsinformasjon, studiedokumenter

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Nei

Studerer et amerikansk FDA-regulert enhetsprodukt

Nei

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