High Dose Adaptive MRI Guided Radiation Therapy Improves Overall Survival of Inoperable Pancreatic Cancer

Abstract

3-74 m). 121 (77.5%) had local control and progression occurred in 22.5%. 86 fiducial markers were placed in the liver with a 2.4% complications rate (grade 1-2). Local control (LC) at 1, 2 and 3 years was 93%, 81% and 64%. Univariate analyses showed a better LC for lesions < 5 cm (pZ0.001, HRZ0,26) and BED 10Gy 100 Gy (p<0.021). Median OS (OS) was 62 months. Actuarial OS at 1, 2, 3 and 5 years was 98%, 90%, 80% and 54% respectively. 4.5% of acute toxicity grade I (transient transaminitis) was reported. Late toxicity grade 3 was reported in 1 patient (1.5%) and grade 4 in another patient (1.5%). 68 patients were treated of 106 lung metastases (33.8% with 3 lesions); median follow-up was 18 months (3-67 m). 88 fiducial markers were placed guided by CT with a pneumothorax rate of 26,4% (18 patients), 7 were treated successfully with a drainage. 91.8% of the lesions achieved LC and progression occurred in 8.2%. The local control at 1,2 and 3 years was 94%, 92% and 85%. Univariate analyses showed better LC in lesions < 3 cm (pZ0.018, HRZ6.4) and BED 10Gy 132 Gy (p<0.005). Median OS was 59 months. Actuarial OS at 1, 2 , 3 and 5 years was 96%, 91%, 79%, and 49.6% respectively. 4.5% of acute toxicity grade I and 2.9% of late toxicity grade 3 was reported. Conclusion: Our clinical experience shows that SBRT with intrafraction control of tumor motion guided by internal fiducials and a Gating technique is a very safe and efficient treatment for patients with lung and liver metastases. The results in terms of toxicity and local control are excellent with a very promising long survival for these patients at 3 and 5 years.

B0 field homogeneity recommendations, specifications, and measurement units for MRI in radiation therapy

“…Magnetic resonance imaging field homogeneity criteria were developed to address four concerns: (a) spatial integrity for brain SRS; (b) image blurring during large volume (body) treatment planning; (c) fat-water chemical shift effects on simulations and MR-IGRT associated with the prostate and breast; and (d) bSSFP null banding associated with large volume MR-IGRT (e.g., adaptive MR-IGRT 33 ).…”

MRI-Linear Accelerator Radiotherapy Systems

“…The commercialisation of two of the four current systems secures the future of MRI-Linac in the clinic, with business cases reliant on many system installations over the coming years. The early clinical findings for pancreatic cancer [23] have raised tremendous interest in the community, and experts in the field predict that MRI-Linac will become the standard clinical system in radiotherapy over the next decades.…”

Magnetic resonance imaging (MRI) compared with computed tomography (CT) for interobserver agreement of gross tumor volume delineation in pancreatic cancer: a multi-institutional contouring study on behalf of the AIRO group for gastrointestinal cancers

“…Due to the high soft tissue resolution, MRI could be considered for RT planning, improving delineation accuracy, as an adjunct to CT simulators. Then, with MRI-guided RT a dose escalation may potentially be pursued with an improvement in clinical outcomes and acceptable toxicities, as reported in preliminary experience [10].…”