Initial Clinical Experience of MR-Guided Radiotherapy for Non-Small Cell Lung Cancer

Crockett, Cathryn; Samson, Pamela; Chuter, Robert; Dubec, Michael; Faivre-Finn, Corinne; Green, Olga L.; Hackett, S.; McDonald, Fiona; Robinson, Clifford G.; Shiarli, A.; Straza, Michael; Verhoeff, Joost J.C.; Werner‐Wasik, Maria; Vlacich, Gregory; Cobben, D.

doi:10.3389/fonc.2021.617681

Cited by 28 publications

(18 citation statements)

References 61 publications

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“…Other possibilities are adaptations based on PET-CT or CT, which, however, are associated with additional radiation exposure [ 45 , 53 ], or MR-guided adaptations. The advantages of adapted MR-guided radiotherapy are that MR imaging is possible without ionizing radiation [ 55 , 56 ], MR images have a better soft tissue contrast than in CT, which facilitates delineation of the OAR and the target [ 57 – 60 ], and MR-guided ART allows for real-time monitoring [ 58 , 61 ] and can be combined with functional imaging to assess tumor response to therapy. This offers the possibility to adjust the therapy based on the biological information [ 58 ].…”

Section: Discussionmentioning

confidence: 99%

Dosimetric benefits of adaptive radiation therapy for patients with stage III non-small cell lung cancer

et al. 2023

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Background Daily adaptive radiation therapy (ART) of patients with non-small cell lung cancer (NSCLC) lowers organs at risk exposure while maintaining the planning target volume (PTV) coverage. Thus, ART allows an isotoxic approach with increased doses to the PTV that could improve local tumor control. Herein we evaluate daily online ART strategies regarding their impact on relevant dose-volume metrics. Methods Daily cone-beam CTs (1 × n = 28, 1 × n = 29, 11 × n = 30) of 13 stage III NSCLC patients were converted into synthetic CTs (sCTs). Treatment plans (TPs) were created retrospectively on the first-fraction sCTs (sCT1) and subsequently transferred unaltered to the sCTs of the remaining fractions of each patient (sCT2−n) (IGRT scenario). Two additional TPs were generated on sCT2−n: one minimizing the lung-dose while preserving the D95%(PTV) (isoeffective scenario), the other escalating the D95%(PTV) with a constant V20Gy(lungipsilateral) (isotoxic scenario). Results Compared to the original TPs predicted dose, the median D95%(PTV) in the IGRT scenario decreased by 1.6 Gy ± 4.2 Gy while the V20Gy(lungipsilateral) increased in median by 1.1% ± 4.4%. The isoeffective scenario preserved the PTV coverage and reduced the median V20Gy(lungipsilateral) by 3.1% ± 3.6%. Furthermore, the median V5%(heart) decreased by 2.9% ± 6.4%. With an isotoxic prescription, a median dose-escalation to the gross target volume of 10.0 Gy ± 8.1 Gy without increasing the V20Gy(lungipsilateral) and V5%(heart) was feasible. Conclusions We demonstrated that even without reducing safety margins, ART can reduce lung-doses, while still reaching adequate target coverage or escalate target doses without increasing ipsilateral lung exposure. Clinical benefits by means of toxicity and local control of both strategies should be evaluated in prospective clinical trials.

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Section: Discussionmentioning

confidence: 99%

Dosimetric benefits of adaptive radiation therapy for patients with stage III non-small cell lung cancer

et al. 2023

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“…Furthermore, the application of MRgRT in this setting has its inherent advantages. Due to the incorporation of a 0.35 T MR scanner, superior soft tissue contrast aids in more accurate delineation of central tumours in close proximity to mediastinal structures [ 4 ]. Online MRgRT ensures daily plan adaptation in particular in challenging cases e.g.…”

Section: Discussionmentioning

confidence: 99%

“…Online MR-guided radiotherapy is a promising novel advancement in the field of radiation oncology allowing for superior real-time tumour visualisation, plan adaptation to anatomical changes and improved motion management [ 4 – 6 ]. Based on our previous experience, the Ludwig Maximilian University of Munich ethics committee approved a protocol (reference number: 20-793) for MRgRT in high-risk patients.…”

Section: Introductionmentioning

confidence: 99%

MR-guided radiotherapy in node-positive non-small cell lung cancer and severely limited pulmonary reserve: a report proposing a new clinical pathway for the management of high-risk patients

et al. 2022

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Introduction Online MR-guided radiotherapy (MRgRT) is a relatively novel advancement in the field of radiation oncology, ensuring superior soft-tissue visualisation, allowing for online plan adaptation to anatomical and functional interfractional changes and improved motion management. Platinum-based chemoradiation followed by durvalumab is the recommended treatment for stage IIB(N1)/III NSCLC. However, this is only the case for patients with favourable risk factors and sufficient pulmonary function and reserve. Methods Herein, we present a technical report on tumour motion and breathing curve analyses of the first patient with node-positive stage IIB NSCLC and severely compromised pulmonary function and reserve [total lung capacity (TLC) 8.78L/132% predicted, residual volume (RV) 6.35L/271% predicted, vital capacity (VC) max 2.43L/58% predicted, FEV1 1.19L/38% predicted, DLCO-SB corrected for hemoglobin 2.76 mmol/min/kPa/30% predicted] treated in a prospective observational study with moderately hypofractionated MRgRT to a total dose of 48.0 Gy/16 daily fractions on the MRIdian system (Viewray Inc, Oakwood, USA). Results Radiotherapy was well tolerated with no relevant toxicity. First follow-up imaging at 3 months post-radiotherapy showed a partial remission. The distinctive features of this case are the patient’s severely compromised pulmonary function and the first online MR-guided accelerated hypofractionated radiotherapy treatment for primary node-positive NSCLC. Conclusions This technical report describes the first patient treated in a prospective observational study evaluating the feasibility of this relatively novel technology in stage IIB(N1)/III disease, proposing a clinical pathway for the management of high-risk patients.

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“…Even if for thoracic lymphoma a clinical benefit of MRgRT is expected it must be noted that MRI use in lung has lagged behind because of inherent barriers arising from the physics of the lung itself. However, with new MRI sequences and the application of functional imaging, utility for this imaging technique in the thorax region is emerging [22] , [23] . Nevertheless, radiotherapy for (Hodgkin or non-Hodgkin) lymphomas is given after induction chemotherapy at a moment that almost no or limited volume change is expected during the radiotherapy course.…”

Section: Discussionmentioning

confidence: 99%

The potential role of MR-guided adaptive radiotherapy in pediatric oncology: Results from a SIOPE-COG survey

Seravalli

Kroon

Buatti

et al. 2021

Clinical and Translational Radiation Oncology

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Highlights An international survey assessed the potential role of MRgRT in pediatrics. The Dutch National cohort has been used to put results into a clinical perspective. A potential toxicity/outcome benefit is expected for 55%/24% of primary sites. A potential toxicity/outcome benefit is expected for 62%/38% of metastatic sites. Consortium-based collaboration is essential to validate expectations.

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Initial Clinical Experience of MR-Guided Radiotherapy for Non-Small Cell Lung Cancer

Cited by 28 publications

References 61 publications

Dosimetric benefits of adaptive radiation therapy for patients with stage III non-small cell lung cancer

Dosimetric benefits of adaptive radiation therapy for patients with stage III non-small cell lung cancer

MR-guided radiotherapy in node-positive non-small cell lung cancer and severely limited pulmonary reserve: a report proposing a new clinical pathway for the management of high-risk patients

The potential role of MR-guided adaptive radiotherapy in pediatric oncology: Results from a SIOPE-COG survey

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