TY - JOUR
T1 - Multi-Institutional Outcomes of Stereotactic Magnetic Resonance Image Guided Adaptive Radiation Therapy With a Median Biologically Effective Dose of 100 Gy10 for Non-bone Oligometastases
AU - Kutuk, Tugce
AU - Herrera, Robert
AU - Mustafayev, Teuta Z.
AU - Gungor, Gorkem
AU - Ugurluer, Gamze
AU - Atalar, Banu
AU - Kotecha, Rupesh
AU - Hall, Matthew D.
AU - Rubens, Muni
AU - Mittauer, Kathryn E.
AU - Contreras, Jessika A.
AU - McCulloch, James
AU - Kalman, Noah S.
AU - Alvarez, Diane
AU - Romaguera, Tino
AU - Gutierrez, Alonso N.
AU - Garcia, Jacklyn
AU - Kaiser, Adeel
AU - Mehta, Minesh P.
AU - Ozyar, Enis
AU - Chuong, Michael D.
N1 - Funding Information:
Disclosures: Dr Kotecha reports honoraria from Accuray Inc, Elekta AB, ViewRay Inc, Novocure Inc, Elsevier Inc, and Brainlab and institutional research funding from Medtronic Inc, Blue Earth Diagnostics Ltd., Novocure Inc, GT Medical Technologies, AstraZeneca, Exelixis, ViewRay Inc, and Brainlab. Dr Hall reports honorarium from Accuray, Inc.; is a Proton Collaborative Group Executive Committee Institutional Representative and a voting member, Miami Cancer Institute (unpaid); receives grant funding from Live Like Bella Pediatric Cancer Research Initiative, and a Florida Department of Health grant (8LA04). Dr Mittauer reports honoraria, consulting, and research funding from ViewRay Inc and is a cofounder of MR Guidance LLC. Dr Contreras reports consulting fees from Boston Scientific. Kalman reports being an advisory board participant for Naveris. Dr Gutierrez reports honoraria from ViewRay Inc, Elekta AB, IBA S.A, and ownership of uPlan Oncology. Dr Mehta reports consulting fees from Mevion, Zap, Sapience, Blue Earth Diagnostics, IBA, and Xoft, NRG Oncology leadership role, stock or stock options for Chimerix, and is on the Board of Directors of Oncoceutics. Dr Chuong reports honoraria from ViewRay, Sirtex, is on the advisory board for ViewRay, and receives research funding from ViewRay, Novocure, StratPharma. All other authors have no disclosures to declare.
Publisher Copyright:
© 2022 The Author(s)
PY - 2022/11/1
Y1 - 2022/11/1
N2 - Purpose: Randomized data show a survival benefit of stereotactic ablative body radiation therapy in selected patients with oligometastases (OM). Stereotactic magnetic resonance guided adaptive radiation therapy (SMART) may facilitate the delivery of ablative dose for OM lesions, especially those adjacent to historically dose-limiting organs at risk, where conventional approaches preclude ablative dosing. Methods and Materials: The RSSearch Registry was queried for OM patients (1-5 metastatic lesions) treated with SMART. Freedom from local progression (FFLP), freedom from distant progression (FFDP), progression-free survival (PFS), and overall survival (LS) were estimated using the Kaplan-Meier method. FFLP was evaluated using RECIST 1.1 criteria. Toxicity was evaluated using Common Terminology Criteria for Adverse Events version 4 criteria. Results: Ninety-six patients with 108 OM lesions were treated on a 0.35 T MR Linac at 2 institutions between 2018 and 2020. SMART was delivered to mostly abdominal or pelvic lymph nodes (48.1%), lung (18.5%), liver and intrahepatic bile ducts (16.7%), and adrenal gland (11.1%). The median prescribed radiation therapy dose was 48.5 Gy (range, 30-60 Gy) in 5 fractions (range, 3-15). The median biologically effective dose corrected using an alpha/beta value of 10 was 100 Gy10 (range, 48-180). No acute or late grade 3+ toxicities were observed with median 10 months (range, 3-25) follow-up. Estimated 1-year FFLP, FFDP, PFS, and OS were 92.3%, 41.1%, 39.3%, and 89.6%, respectively. Median FFDP and PFS were 8.9 months (95% confidence interval, 5.2-12.6 months) and 7.6 months (95% confidence interval, 4.5-10.6 months), respectively. Conclusions: To our knowledge, this represents the largest analysis of SMART using ablative dosing for non-bone OM. A median prescribed biologically effective dose of 100 Gy10 resulted in excellent early FFLP and no significant toxicity, likely facilitated by continuous intrafraction MR visualization, breath hold delivery, and online adaptive replanning. Additional prospective evaluation of dose-escalated SMART for OM is warranted.
AB - Purpose: Randomized data show a survival benefit of stereotactic ablative body radiation therapy in selected patients with oligometastases (OM). Stereotactic magnetic resonance guided adaptive radiation therapy (SMART) may facilitate the delivery of ablative dose for OM lesions, especially those adjacent to historically dose-limiting organs at risk, where conventional approaches preclude ablative dosing. Methods and Materials: The RSSearch Registry was queried for OM patients (1-5 metastatic lesions) treated with SMART. Freedom from local progression (FFLP), freedom from distant progression (FFDP), progression-free survival (PFS), and overall survival (LS) were estimated using the Kaplan-Meier method. FFLP was evaluated using RECIST 1.1 criteria. Toxicity was evaluated using Common Terminology Criteria for Adverse Events version 4 criteria. Results: Ninety-six patients with 108 OM lesions were treated on a 0.35 T MR Linac at 2 institutions between 2018 and 2020. SMART was delivered to mostly abdominal or pelvic lymph nodes (48.1%), lung (18.5%), liver and intrahepatic bile ducts (16.7%), and adrenal gland (11.1%). The median prescribed radiation therapy dose was 48.5 Gy (range, 30-60 Gy) in 5 fractions (range, 3-15). The median biologically effective dose corrected using an alpha/beta value of 10 was 100 Gy10 (range, 48-180). No acute or late grade 3+ toxicities were observed with median 10 months (range, 3-25) follow-up. Estimated 1-year FFLP, FFDP, PFS, and OS were 92.3%, 41.1%, 39.3%, and 89.6%, respectively. Median FFDP and PFS were 8.9 months (95% confidence interval, 5.2-12.6 months) and 7.6 months (95% confidence interval, 4.5-10.6 months), respectively. Conclusions: To our knowledge, this represents the largest analysis of SMART using ablative dosing for non-bone OM. A median prescribed biologically effective dose of 100 Gy10 resulted in excellent early FFLP and no significant toxicity, likely facilitated by continuous intrafraction MR visualization, breath hold delivery, and online adaptive replanning. Additional prospective evaluation of dose-escalated SMART for OM is warranted.
UR - http://www.scopus.com/inward/record.url?scp=85136251774&partnerID=8YFLogxK
U2 - 10.1016/j.adro.2022.100978
DO - 10.1016/j.adro.2022.100978
M3 - Article
C2 - 35647412
AN - SCOPUS:85136251774
SN - 2452-1094
VL - 7
JO - Advances in Radiation Oncology
JF - Advances in Radiation Oncology
IS - 6
M1 - 100978
ER -