TY - JOUR
T1 - Stereotactic MR-guided online adaptive radiotherapy reirradiation (SMART reRT) for locally recurrent pancreatic adenocarcinoma
T2 - A case report
AU - Doty, Delia G.
AU - Chuong, Michael D.
AU - Gomez, Andres G.
AU - Bryant, John
AU - Contreras, Jessika
AU - Romaguera, Tino
AU - Alvarez, Diane
AU - Kotecha, Rupesh
AU - Mehta, Minesh P.
AU - Gutierrez, Alonso N.
AU - Mittauer, Kathryn E.
N1 - Funding Information:
Ms. Doty has nothing to disclose. Dr. Chuong reports personal fees from ViewRay Inc, personal fees from Sirtex, personal fees from Advanced Accelerator Applications, grants from ViewRay Inc, grants from AstraZeneca, grants from Novocure, outside the submitted work. Mr. Gomez has nothing to disclose. Dr. Bryant has nothing to disclose. Dr. Contreras has nothing to disclose. Dr. Romaguera has nothing to disclose. Ms. Alvarez has nothing to disclose. Dr. Kotecha reports personal fees from Elsevier, personal fees from Elekta AB, personal fees from Accuray Inc, personal fees from Novocure Inc, personal fees from Viewray Inc, outside the submitted work. Dr. Mehta reports personal fees from Zap, personal fees from Mevion, personal fees from Karyopharm, personal fees from Tocagen, personal fees from AstraZeneca, personal fees from Oncoceutics, outside the submitted work. Dr. Gutierrez has nothing to disclose. Dr. Mittauer reports personal fees from ViewRay Inc, other from MR Guidance LLC, grants from ViewRay Inc, outside the submitted work.
Publisher Copyright:
© 2021 American Association of Medical Dosimetrists
PY - 2021/12/1
Y1 - 2021/12/1
N2 - Introduction: Stereotactic MR-guided online adaptive radiation therapy (SMART) has demonstrated a superior radiotherapeutic ratio for pancreatic patients, by enabling dose escalation while minimizing the dose to the proximal gastrointestinal organs at risk through online adaptive radiotherapy. The safe delivery of stereotactic body radiation therapy (SBRT) is of particular importance in the reirradiation setting and has been historically limited to CT-based nonadaptive modalities. Herein, we report the first use of online adaptive radiotherapy in the reirradiation setting, specifically for treatment of locally recurrent pancreatic adenocarcinoma through SMART reirradiation (SMART reRT). Case description: We describe the treatment of a 68-year-old male who was diagnosed with, unresectable locally advanced pancreatic adenocarcinoma. Initial treatment included FOLFIRINOX followed by 45 Gy in 25 fractions on a helical intensity-modulated radiotherapy (IMRT) device with concurrent capecitabine, followed by a boost of 14.4 Gy in 8 fractions to a on an MR-guided radiotherapy (MRgRT) linac. At approximately 12 months from initial radiotherapy, the patient experienced local progression of the pancreas body/tail and therefore SMART reRT of 50 Gy in 5 fractions was initiated. The technical considerations of cumulative dose for gastrointestinal organs across multiple courses, treatment planning principles, and adaptive radiotherapy details are outlined in this case study. The patient tolerated treatment well with minimal fatigue. Conclusions: The therapeutic ratio of reirradiation may be improved using daily MR guidance with online adaptive replanning, especially for lesions in proximity to critical structures. Future studies are warranted to assess long-term outcomes of dose escalated MR-guided reRT, define OAR dose constraints for reRT, and assess cumulative dose across the adapted SMART reRT fractions and the original RT plan.
AB - Introduction: Stereotactic MR-guided online adaptive radiation therapy (SMART) has demonstrated a superior radiotherapeutic ratio for pancreatic patients, by enabling dose escalation while minimizing the dose to the proximal gastrointestinal organs at risk through online adaptive radiotherapy. The safe delivery of stereotactic body radiation therapy (SBRT) is of particular importance in the reirradiation setting and has been historically limited to CT-based nonadaptive modalities. Herein, we report the first use of online adaptive radiotherapy in the reirradiation setting, specifically for treatment of locally recurrent pancreatic adenocarcinoma through SMART reirradiation (SMART reRT). Case description: We describe the treatment of a 68-year-old male who was diagnosed with, unresectable locally advanced pancreatic adenocarcinoma. Initial treatment included FOLFIRINOX followed by 45 Gy in 25 fractions on a helical intensity-modulated radiotherapy (IMRT) device with concurrent capecitabine, followed by a boost of 14.4 Gy in 8 fractions to a on an MR-guided radiotherapy (MRgRT) linac. At approximately 12 months from initial radiotherapy, the patient experienced local progression of the pancreas body/tail and therefore SMART reRT of 50 Gy in 5 fractions was initiated. The technical considerations of cumulative dose for gastrointestinal organs across multiple courses, treatment planning principles, and adaptive radiotherapy details are outlined in this case study. The patient tolerated treatment well with minimal fatigue. Conclusions: The therapeutic ratio of reirradiation may be improved using daily MR guidance with online adaptive replanning, especially for lesions in proximity to critical structures. Future studies are warranted to assess long-term outcomes of dose escalated MR-guided reRT, define OAR dose constraints for reRT, and assess cumulative dose across the adapted SMART reRT fractions and the original RT plan.
KW - Adaptive radiotherapy
KW - MR-guided radiotherapy
KW - Pancreatic radiotherapy
KW - Reirradiation
KW - SBRT
UR - http://www.scopus.com/inward/record.url?scp=85107794114&partnerID=8YFLogxK
U2 - 10.1016/j.meddos.2021.04.006
DO - 10.1016/j.meddos.2021.04.006
M3 - Article
C2 - 34120803
AN - SCOPUS:85107794114
SN - 0958-3947
VL - 46
SP - 384
EP - 388
JO - Medical Dosimetry
JF - Medical Dosimetry
IS - 4
ER -