MR-guided radiotherapy in rectal cancer: First clinical experience of an innovative technology

Chiloiro, G.; Boldrini, Luca; Meldolesi, Elisa; Re, Alessia; Cellini, Francesco; Cusumano, D.; Corvari, Barbara; Mantini, Giovanna; Boccadoro, Mario; Valentini, Vincenzo; Gambacorta, Maria Antonietta

doi:10.1016/j.ctro.2019.04.006

Cited by 54 publications

(52 citation statements)

References 44 publications

(52 reference statements)

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“…The better visualization of therapy volumes obtained with MRI and the aforementioned delivery solutions may successfully limit the unnecessary irradiation of the organs at risk and the subsequent toxicity as previously reported in other sites [9], [10], [11].…”

Section: Discussionmentioning

confidence: 71%

Hybrid MRI guided radiotherapy in locally advanced cervical cancer: Case report of an innovative personalized therapeutic approach

Boldrini

Chiloiro

Pesce

et al. 2020

Clinical and Translational Radiation Oncology

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Section: Discussionmentioning

confidence: 71%

Hybrid MRI guided radiotherapy in locally advanced cervical cancer: Case report of an innovative personalized therapeutic approach

Boldrini

Chiloiro

Pesce

et al. 2020

Clinical and Translational Radiation Oncology

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“…The Elekta Unity® (Elekta AB, Stockholm, Sweden) hybrid system combines a 1.5 Tesla (T) MR with a 7 MV flattening filter free accelerator mounted on a rotating gantry system that provides real-time, ‘‘on-board’’ MRI in the treatment room to guide IMRT planning and delivery based on daily anatomy changes [22] , [23] , [24] . For each treatment fraction, T2-weighted scans were performed before and after radiation delivery (pre-treatment and post-treatment T2w-2 min).…”

Section: Methodsmentioning

confidence: 99%

1.5 T MR-linac planning study to compare two different strategies of rectal boost irradiation

Bonomo

Russo

Nachbar³

et al. 2021

Clinical and Translational Radiation Oncology

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“…Recent developments in improved image quality for treatment guidance, such as MRI-guided radiotherapy and CBCT guidance, as well as developments in fast and precise auto-contouring [ 18 ] and auto-planning ‘marks the beginning of a new era’ [ 19 ]. Online adaptive treatment, based on both MRI and CBCT guidance, is now a real possibility [ 19 – 22 ] and surely promising in reducing dose to the OARs even further.…”

Section: Introductionmentioning

confidence: 99%

Online adaptive radiotherapy compared to plan selection for rectal cancer: quantifying the benefit

et al. 2020

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Background: To compare online adaptive radiation therapy (ART) to a clinically implemented plan selection strategy (PS) with respect to dose to the organs at risk (OAR) for rectal cancer. Methods: The first 20 patients treated with PS between May-September 2016 were included. This resulted in 10 short (SCRT) and 10 long (LCRT) course radiotherapy treatment schedules with a total of 300 Conebeam CT scans (CBCT). New dual arc VMAT plans were generated using auto-planning for both the online ART and PS strategy. For each fraction bowel bag, bladder and mesorectum were delineated on daily Conebeam CTs. The dose distribution planned was used to calculate daily DVHs. Coverage of the CTV was calculated, as defined by the dose received by 99% of the CTV volume (D99%). The volume of normal tissue irradiated with 95% of the prescribed fraction dose was calculated by calculating the volume receiving 95% of the prescribed fraction or more dose minus the volume of the CTV. For each fraction the difference between the plan selection and online adaptive strategy of each DVH parameter was calculated, as well as the average difference per patient. Results: Target coverage remained the same for online ART. The median volume of the normal tissue irradiated with 95% of the prescribed dose dropped from 642 cm3 (PS) to 237 cm3 (online-ART)(p < 0.001). Online ART reduced dose to the OARs for all tested dose levels for SCRT and LCRT (p < 0.001). For V15Gy of the bowel bag the median difference over all fractions of all patients was − 126 cm 3 in LCRT, while the average difference per patient ranged from − 206 cm 3 to − 40 cm 3. For SCRT the median difference was − 62 cm 3 , while the range of the average difference per patient was − 105 cm3 to − 51 cm 3. For V15Gy of the bladder the median difference over all fractions of all patients was 26% in LCRT, while the average difference per patient ranged from − 34 to 12%. For SCRT the median difference of V95% was − 8%, while the range of the average difference per patient was − 29 to 0%. Conclusions: Online ART for rectal cancer reduces dose the OARs significantly compared to a clinically implemented plan selection strategy, without compromising target coverage. Trial registration: Medical Research Involving Human Subjects Act (WMO) does not apply to this study and was retrospectively approved by the Medical Ethics review Committee of the Academic Medical Center (W19_357 # 19.

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MR-guided radiotherapy in rectal cancer: First clinical experience of an innovative technology

Cited by 54 publications

References 44 publications

Hybrid MRI guided radiotherapy in locally advanced cervical cancer: Case report of an innovative personalized therapeutic approach

Hybrid MRI guided radiotherapy in locally advanced cervical cancer: Case report of an innovative personalized therapeutic approach

1.5 T MR-linac planning study to compare two different strategies of rectal boost irradiation

Online adaptive radiotherapy compared to plan selection for rectal cancer: quantifying the benefit

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