TY - JOUR
T1 - Dose-Escalated Magnetic Resonance Image–Guided Abdominopelvic Reirradiation With Continuous Intrafraction Visualization, Soft Tissue Tracking, and Automatic Beam Gating
AU - Chuong, Michael D.
AU - Bryant, John M.
AU - Herrera, Roberto
AU - McCulloch, James
AU - Contreras, Jessika
AU - Kotecha, Rupesh
AU - Romaguera, Tino
AU - Alvarez, Diane
AU - Hall, Matthew D.
AU - Rubens, Muni
AU - Mehta, Minesh P.
AU - Kaiser, Adeel
AU - Tom, Martin
AU - Gutierrez, Alonso N.
AU - Mittauer, Kathryn E.
N1 - Funding Information:
Disclosures: Dr Chuong reports receiving grants, personal fees, and nonfinancial support from ViewRay, grants from AstraZeneca and Novocure, and personal fees from Sirtex, Accuray, and Advanced Accelerator Applications outside the submitted work. Dr Kotecha reports receiving personal fees and nonfinancial support from Elekta, grants from Novocure, Blue Earth Diagnostics, Medtronic, AstraZeneca, and Exelixis, and personal fees from Accuray and ViewRay outside the submitted work. Dr Alvarez reports receiving grants from Sirtex outside the submitted work. Dr Mehta reports receiving nonfinancial support from Sapience, Karyopharm, and Mevion and other from Oncoceutics outside the submitted work. Dr Gutierrez reports receiving personal fees and nonfinancial support from ViewRay outside the submitted work. Dr Mittauer reports receiving personal fees and nonfinancial support from ViewRay and other from MR Guidance, LLC, outside the submitted work. All other authors have no disclosures to declare.
Publisher Copyright:
© 2021 The Author(s)
PY - 2022/3/1
Y1 - 2022/3/1
N2 - Purpose: Compared with computed tomography, magnetic resonance (MR) image guidance offers significant advantages for radiation therapy (RT) that may be particularly beneficial for reirradiation (reRT). However, clinical outcomes of MR-guided reRT are not well described in the published literature. Methods and Materials: We performed a single-institution retrospective safety and efficacy analysis of reRT patients treated on the MRIdian Linac to targets within the abdomen or pelvis using continuous intrafraction MR-based motion management with automatic beam triggering. Fiducial markers were not used. Results: We evaluated 11 patients who received prior RT to a median of 50 Gy (range, 30-58.8 Gy) in 25 fractions (range, 5-28 fractions). The median interval to reRT was 26.8 months. The most frequently retreated sites were nodal metastases (36.4%) and pancreatic cancer (27.3%). The median reRT dose was 40 Gy (range, 25-54 Gy) in 6 fractions (range, 5-36 fractions); ultrahypofractionation (63.6%) was more common than hyperfractionation (36.4%). Daily on-table adaptive replanning was used for 3 patients (27.3%). With a median of 14 months’ follow-up from reRT completion (range, 6-32 months), the median and 1-year freedom from local progression were 29 months and 88.9%, respectively, and the median and 1-year overall survival were 17.5 months and 70.0%, respectively. One patient (9.1%) experienced acute grade 2 toxic effects; there were no acute or late treatment-related toxic effects of grade 3 or greater. Conclusions: Magnetic resonance–guided reRT appeared to be feasible and may facilitate safe dose escalation. Additional follow-up is needed to better assess long-term efficacy and late toxic effects. Prospective evaluation of this novel treatment strategy is warranted.
AB - Purpose: Compared with computed tomography, magnetic resonance (MR) image guidance offers significant advantages for radiation therapy (RT) that may be particularly beneficial for reirradiation (reRT). However, clinical outcomes of MR-guided reRT are not well described in the published literature. Methods and Materials: We performed a single-institution retrospective safety and efficacy analysis of reRT patients treated on the MRIdian Linac to targets within the abdomen or pelvis using continuous intrafraction MR-based motion management with automatic beam triggering. Fiducial markers were not used. Results: We evaluated 11 patients who received prior RT to a median of 50 Gy (range, 30-58.8 Gy) in 25 fractions (range, 5-28 fractions). The median interval to reRT was 26.8 months. The most frequently retreated sites were nodal metastases (36.4%) and pancreatic cancer (27.3%). The median reRT dose was 40 Gy (range, 25-54 Gy) in 6 fractions (range, 5-36 fractions); ultrahypofractionation (63.6%) was more common than hyperfractionation (36.4%). Daily on-table adaptive replanning was used for 3 patients (27.3%). With a median of 14 months’ follow-up from reRT completion (range, 6-32 months), the median and 1-year freedom from local progression were 29 months and 88.9%, respectively, and the median and 1-year overall survival were 17.5 months and 70.0%, respectively. One patient (9.1%) experienced acute grade 2 toxic effects; there were no acute or late treatment-related toxic effects of grade 3 or greater. Conclusions: Magnetic resonance–guided reRT appeared to be feasible and may facilitate safe dose escalation. Additional follow-up is needed to better assess long-term efficacy and late toxic effects. Prospective evaluation of this novel treatment strategy is warranted.
UR - http://www.scopus.com/inward/record.url?scp=85123578533&partnerID=8YFLogxK
U2 - 10.1016/j.adro.2021.100840
DO - 10.1016/j.adro.2021.100840
M3 - Article
C2 - 35146215
AN - SCOPUS:85123578533
SN - 2452-1094
VL - 7
JO - Advances in Radiation Oncology
JF - Advances in Radiation Oncology
IS - 2
M1 - 100840
ER -