TY - JOUR
T1 - Stereotactic MR-Guided Online Adaptive Radiation Therapy (SMART) for Ultracentral Thorax Malignancies
T2 - Results of a Phase 1 Trial
AU - Henke, Lauren E.
AU - Olsen, Jeffrey R.
AU - Contreras, Jessika A.
AU - Curcuru, Austen
AU - DeWees, Todd A.
AU - Green, Olga L.
AU - Michalski, Jeff
AU - Mutic, Sasa
AU - Roach, Michael C.
AU - Bradley, Jeffrey D.
AU - Parikh, Parag J.
AU - Kashani, Rojano
AU - Robinson, Clifford G.
N1 - Funding Information:
Conflicts of interest: The authors listed here report the following financial relationships (authors not listed reported no relevant financial relationships). Dr Henke reports grants from ViewRay, Inc, during the conduct of the study; and grants and other from ViewRay, Inc, outside the submitted work. Dr Green reports personal fees and other from ViewRay, Inc, outside the submitted work. Dr Mutic reports grants and other from ViewRay, Inc; grants and other from Varian Medical Systems; other from Philips Healthcare; other from Siemens; other from TreatSafely,LLC; and other from Radialogica,LLC, outside the submitted work. Dr Roach reports grants and personal fees from Varian, outside the submitted work. Dr Bradley reports grants and other from ViewRay, Inc; grants from Mevion Medical Systems, Inc; and other from Varian, outside the submitted work. Dr Parikh reports grants from Philips Healthcare; grants and other from Varian Medical Systems; other from Holaira,Inc; other from Medtronic/Covidien; and grants from ViewRay, Inc, outside the submitted work. Dr Kashani reports grants and personal fees from ViewRay, Inc; and grants and personal fees from Varian Medical Systems, outside the submitted work. Dr Robinson reports grants and other from Varian Medical Systems; and other from Radiologica LLC, outside the submitted work.
Funding Information:
Sources of support: This study was funded by an industry research grant from ViewRay , Inc. The funding source had no role or involvement in study design, data collection, data analysis, interpretation of results, the writing of the manuscript, or the choice to submit the manuscript for publication. The content is solely the responsibility of the authors.
Funding Information:
This publication was additionally supported by the Washington University Institute of Clinical and Translational Sciences grant UL1T2000448 from the National Center for Advancing Translational Sciences . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Funding Information:
Sources of support: This study was funded by an industry research grant from ViewRay, Inc. The funding source had no role or involvement in study design, data collection, data analysis, interpretation of results, the writing of the manuscript, or the choice to submit the manuscript for publication. The content is solely the responsibility of the authors.This publication was additionally supported by the Washington University Institute of Clinical and Translational Sciences grant UL1T2000448 from the National Center for Advancing Translational Sciences. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.Conflicts of interest: The authors listed here report the following financial relationships (authors not listed reported no relevant financial relationships). Dr Henke reports grants from ViewRay, Inc, during the conduct of the study; and grants and other from ViewRay, Inc, outside the submitted work. Dr Green reports personal fees and other from ViewRay, Inc, outside the submitted work. Dr Mutic reports grants and other from ViewRay, Inc; grants and other from Varian Medical Systems; other from Philips Healthcare; other from Siemens; other from TreatSafely,LLC; and other from Radialogica,LLC, outside the submitted work. Dr Roach reports grants and personal fees from Varian, outside the submitted work. Dr Bradley reports grants and other from ViewRay, Inc; grants from Mevion Medical Systems, Inc; and other from Varian, outside the submitted work. Dr Parikh reports grants from Philips Healthcare; grants and other from Varian Medical Systems; other from Holaira,Inc; other from Medtronic/Covidien; and grants from ViewRay, Inc, outside the submitted work. Dr Kashani reports grants and personal fees from ViewRay, Inc; and grants and personal fees from Varian Medical Systems, outside the submitted work. Dr Robinson reports grants and other from Varian Medical Systems; and other from Radiologica LLC, outside the submitted work.
Publisher Copyright:
© 2018 The Authors
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Purpose: Stereotactic body radiation therapy (SBRT) is an effective treatment for oligometastatic or unresectable primary malignancies, although target proximity to organs at risk (OARs) within the ultracentral thorax (UCT) limits safe delivery of an ablative dose. Stereotactic magnetic resonance (MR)–guided online adaptive radiation therapy (SMART) may improve the therapeutic ratio using reoptimization to account for daily variation in target and OAR anatomy. This study assessed the feasibility of UCT SMART and characterized dosimetric and clinical outcomes in patients treated for UCT lesions on a prospective phase 1 trial. Methods and Materials: Five patients with oligometastatic (n = 4) or unresectable primary (n = 1) UCT malignancies underwent SMART. Initial plans prescribed 50 Gy in 5 fractions with goal 95% planning target volume (PTV) coverage by 95% of prescription, subject to strict OAR constraints. Daily real-time online adaptive plans were created as needed to preserve hard OAR constraints, escalate PTV dose, or both, based on daily setup MR image set anatomy. Treatment times, patient outcomes, and dosimetric comparisons were prospectively recorded. Results: All initial and daily adaptive plans met strict OAR constraints based on simulation and daily setup MR imaging anatomy, respectively. Four of the 5 patients received ≥1 adapted fraction. Ten of the 25 total delivered fractions were adapted. A total of 30% of plan adaptations were performed to improve PTV coverage; 70% were for reversal of ≥1 OAR violation. Local control by Response Evaluation Criteria in Solid Tumors was 100% at 3 and 6 months. No grade ≥3 acute (within 6 months of radiation completion) treatment-related toxicities were identified. Conclusions: SMART may allow PTV coverage improvement and/or OAR sparing compared with nonadaptive SBRT and may widen the therapeutic index of UCT SBRT. In this small prospective cohort, we found that SMART was clinically deliverable to 100% of patients, although treatment delivery times surpassed our predefined, timing-based feasibility endpoint. This technique is well tolerated, offering excellent local control with no identified acute grade ≥3 toxicity.
AB - Purpose: Stereotactic body radiation therapy (SBRT) is an effective treatment for oligometastatic or unresectable primary malignancies, although target proximity to organs at risk (OARs) within the ultracentral thorax (UCT) limits safe delivery of an ablative dose. Stereotactic magnetic resonance (MR)–guided online adaptive radiation therapy (SMART) may improve the therapeutic ratio using reoptimization to account for daily variation in target and OAR anatomy. This study assessed the feasibility of UCT SMART and characterized dosimetric and clinical outcomes in patients treated for UCT lesions on a prospective phase 1 trial. Methods and Materials: Five patients with oligometastatic (n = 4) or unresectable primary (n = 1) UCT malignancies underwent SMART. Initial plans prescribed 50 Gy in 5 fractions with goal 95% planning target volume (PTV) coverage by 95% of prescription, subject to strict OAR constraints. Daily real-time online adaptive plans were created as needed to preserve hard OAR constraints, escalate PTV dose, or both, based on daily setup MR image set anatomy. Treatment times, patient outcomes, and dosimetric comparisons were prospectively recorded. Results: All initial and daily adaptive plans met strict OAR constraints based on simulation and daily setup MR imaging anatomy, respectively. Four of the 5 patients received ≥1 adapted fraction. Ten of the 25 total delivered fractions were adapted. A total of 30% of plan adaptations were performed to improve PTV coverage; 70% were for reversal of ≥1 OAR violation. Local control by Response Evaluation Criteria in Solid Tumors was 100% at 3 and 6 months. No grade ≥3 acute (within 6 months of radiation completion) treatment-related toxicities were identified. Conclusions: SMART may allow PTV coverage improvement and/or OAR sparing compared with nonadaptive SBRT and may widen the therapeutic index of UCT SBRT. In this small prospective cohort, we found that SMART was clinically deliverable to 100% of patients, although treatment delivery times surpassed our predefined, timing-based feasibility endpoint. This technique is well tolerated, offering excellent local control with no identified acute grade ≥3 toxicity.
UR - http://www.scopus.com/inward/record.url?scp=85052937528&partnerID=8YFLogxK
U2 - 10.1016/j.adro.2018.10.003
DO - 10.1016/j.adro.2018.10.003
M3 - Article
C2 - 30706029
AN - SCOPUS:85052937528
SN - 2452-1094
VL - 4
SP - 201
EP - 209
JO - Advances in Radiation Oncology
JF - Advances in Radiation Oncology
IS - 1
ER -