Accelerated hypofractionated magnetic resonance-guided adaptive radiotherapy for oligoprogressive non-small cell lung cancer

Rosa, Alonso La; Mittauer, K.E.; Chuong, Michael D.; Hall, Matthew D; Kütük, Tuğçe; Bassiri, Nema; McCulloch, James; Alvarez, Diane; Herrera, Robert; Gutiérrez, Alonso N.; Tolakanahalli, Ranjini; Mehta, Minesh P.; Kotecha, Rupesh

doi:10.1016/j.meddos.2023.05.002

Cited by 2 publications

(3 citation statements)

References 35 publications

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“…The total prescribed dose was 60 Gy in 15 fractions, with the clinical target goal of 99% and 95% of the GTV and PTV, respectively, to be covered by 100% of the prescription dose. Our institutional treatment plan directives (target coverage and OAR constraints) have been described previously [ 5 ]. Baseline intensity-modulated radiation therapy (IMRT) step-and-shoot treatment plans with a median of 18 beams (range: 15–21) and 88 segments (range: 56–126) were generated based on the simulation breath-hold MR scan.…”

Section: Methodsmentioning

confidence: 99%

“…For example, it is primarily applicable to limited treatment volumes (≤5 cm) away from critical organs at risk (OARs). Consequently, when addressing the primary lung site and associated regional lymphadenopathy, conventionally fractionated schedules are still frequently employed [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, it allows for the creation of an on-table plan (adaptive on-line plan) tailored to the specific new anatomy, if necessary. Notably, our institution has previously outlined our workflow for accelerated hypofractionated MRgART for ultracentral lung tumors [ 5 ]. This report represents the inaugural investigation into a consecutive cohort of patients with ultra-central lung tumors treated with MRgART to report treatment characteristics, dosimetry evaluations at initial plan development and daily treatment imaging, and early outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Accelerated Hypofractionated Magnetic Resonance Guided Adaptive Radiation Therapy for Ultracentral Lung Tumors

La Rosa,

Mittauer,

Bassiri

et al. 2024

Tomography

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Radiotherapy for ultracentral lung tumors represents a treatment challenge, considering the high rates of high-grade treatment-related toxicities with stereotactic body radiation therapy (SBRT) or hypofractionated schedules. Accelerated hypofractionated magnetic resonance-guided adaptive radiation therapy (MRgART) emerged as a potential game-changer for tumors in these challenging locations, in close proximity to central organs at risk, such as the trachea, proximal bronchial tree, and esophagus. In this series, 13 consecutive patients, predominantly male (n = 9), with a median age of 71 (range (R): 46–85), underwent 195 MRgART fractions (all 60 Gy in 15 fractions) to metastatic (n = 12) or primary ultra-central lung tumors (n = 1). The median gross tumor volumes (GTVs) and planning target volumes (PTVs) were 20.72 cc (R: 0.54–121.65 cc) and 61.53 cc (R: 3.87–211.81 cc), respectively. The median beam-on time per fraction was 14 min. Adapted treatment plans were generated for all fractions, and indications included GTV/PTV undercoverage, OARs exceeding tolerance doses, or both indications in 46%, 18%, and 36% of fractions, respectively. Eight patients received concurrent systemic therapies, including immunotherapy (four), chemotherapy (two), and targeted therapy (two). The crude in-field loco-regional control rate was 92.3%. No CTCAE grade 3+ toxicities were observed. Our results offer promising insights, suggesting that MRgART has the potential to mitigate toxicities, enhance treatment precision, and improve overall patient care in the context of ultracentral lung tumors.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Accelerated Hypofractionated Magnetic Resonance Guided Adaptive Radiation Therapy for Ultracentral Lung Tumors

La Rosa,

Mittauer,

Bassiri

et al. 2024

Tomography

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Harnessing the Power of Radiotherapy for Lung Cancer: A Narrative Review of the Evolving Role of Magnetic Resonance Imaging Guidance

Cheng,

Lee,

Lee

2024

Cancers

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Compared with computed tomography (CT), magnetic resonance imaging (MRI) traditionally plays a very limited role in lung cancer management, although there is plenty of room for improvement in the current CT-based workflow, for example, in structures such as the brachial plexus and chest wall invasion, which are difficult to visualize with CT alone. Furthermore, in the treatment of high-risk tumors such as ultracentral lung cancer, treatment-associated toxicity currently still outweighs its benefits. The advent of MR-Linac, an MRI-guided radiotherapy (RT) that combines MRI with a linear accelerator, could potentially address these limitations. Compared with CT-based technologies, MR-Linac could offer superior soft tissue visualization, daily adaptive capability, real-time target tracking, and an early assessment of treatment response. Clinically, it could be especially advantageous in the treatment of central/ultracentral lung cancer, early-stage lung cancer, and locally advanced lung cancer. Increasing demands for stereotactic body radiotherapy (SBRT) for lung cancer have led to MR-Linac adoption in some cancer centers. In this review, a broad overview of the latest research on imaging-guided radiotherapy (IGRT) with MR-Linac for lung cancer management is provided, and development pertaining to artificial intelligence is also highlighted. New avenues of research are also discussed.

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Accelerated hypofractionated magnetic resonance-guided adaptive radiotherapy for oligoprogressive non-small cell lung cancer

Cited by 2 publications

References 35 publications

Accelerated Hypofractionated Magnetic Resonance Guided Adaptive Radiation Therapy for Ultracentral Lung Tumors

Accelerated Hypofractionated Magnetic Resonance Guided Adaptive Radiation Therapy for Ultracentral Lung Tumors

Harnessing the Power of Radiotherapy for Lung Cancer: A Narrative Review of the Evolving Role of Magnetic Resonance Imaging Guidance

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