MRI guided stereotactic radiotherapy for locally advanced pancreatic cancer

Heerkens, H.D.; Vulpen, Marco van; Erickson, Beth; Reerink, O.; Intven, Martijn; Berg, C. A. van den; Molenaar, I.; Vleggaar, Frank P.; Meijer, G.J.

doi:10.1259/bjr.20170563

Cited by 37 publications

(43 citation statements)

References 43 publications

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“…The concept of MR guidance on RT refers to various different issues, including the information added to the contouring of target volumes. Heerkens and colleagu es have described how multiparametric MR pretreatment scanning could improve the conventional Linac-based SBRT administration [ 86 ]. They defined target and OAR motion by the registration of four-dimensional (4D) CTscan simulations with both contrast-enhanced CT scan and MR (using a 1.5 Tesla scanner).…”

Section: Future Directionsmentioning

confidence: 99%

Basics and Frontiers on Pancreatic Cancer for Radiation Oncology: Target Delineation, SBRT, SIB Technique, MRgRT, Particle Therapy, Immunotherapy and Clinical Guidelines

Cellini

Arcelli

Simoni

et al. 2020

Cancers

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Pancreatic cancer represents a modern oncological urgency. Its management is aimed to both distal and local disease control. Resectability is the cornerstone of treatment aim. It influences the clinical presentation’s definitions as up-front resectable, borderline resectable and locally advanced (unresectable). The main treatment categories are neoadjuvant (preoperative), definitive and adjuvant (postoperative). This review will focus on (i) the current indications by the available national and international guidelines; (ii) the current standard indications for target volume delineation in radiotherapy (RT); (iii) the emerging modern technologies (including particle therapy and Magnetic Resonance [MR]-guided-RT); (iv) stereotactic body radiotherapy (SBRT), as the most promising technical delivery application of RT in this framework; (v) a particularly promising dose delivery technique called simultaneous integrated boost (SIB); and (vi) a multimodal integration opportunity: the combination of RT with immunotherapy.

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Section: Future Directionsmentioning

confidence: 99%

Basics and Frontiers on Pancreatic Cancer for Radiation Oncology: Target Delineation, SBRT, SIB Technique, MRgRT, Particle Therapy, Immunotherapy and Clinical Guidelines

Cellini

Arcelli

Simoni

et al. 2020

Cancers

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“…Given the ablative doses and the potential to injury, the translation in a clinical trial of the present strategy should be approached with a special attention to tumor and organ motion. Nowadays, MRI‐based image guidance has become a reality and the first experiences with MRI‐guided linear accelerators for the delivery of SBRT for pancreatic cancer have been recently reported 39 . This new technology not only offers a superior soft tissue imaging compared to cone beam CT but also allows the opportunity for adaptive replanning when significant interfraction variation is highlighted, 40 potentially increasing the safety and effectiveness of treatment.…”

Section: Discussionmentioning

confidence: 99%

Automated treatment planning as a dose escalation strategy for stereotactic radiation therapy in pancreatic cancer

Cilla

Ianiro

Romano

et al. 2020

J Applied Clin Med Phys

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Purpose: To assess the feasibility of automated stereotactic volumetric modulated arc therapy (SBRT-VMAT) planning using a simultaneous integrated boost (SIB) approach as a dose escalation strategy for SBRT in pancreatic cancer. Methods: Twelve patients with pancreatic cancer were retrospectively replanned. Dose prescription was 30 Gy to the planning target volume (PTV) and was escalated up to 50 Gy to the boost target volume (BTV) using a SIB technique in 5 fractions. All plans were generated by Pinnacle 3 Autoplanning using 6MV dual-arc VMAT technique for flattened (FF) and flattening filter-free beams (FFF). An overlap volume (OLV) between the PRV duodenum and the PTV was defined to correlate with the ability to boost the BTV. Dosimetric metrics for BTV and PTV coverage, maximal doses for serial OARs, integral dose, conformation numbers, and dose contrast indexes were used to analyze the dosimetric results. Dose accuracy was validated using the PTW Octavius-4D phantom together with the 1500 2D-array. Differences between FF and FFF plans were quantified using the Wilcoxon matched-pair signed rank. Results: Full prescription doses to the 95% of PTV and BTV can be delivered to patients with no OLV. BTV mean dose was >90% of the prescribed doses for all patients at all dose levels. Compared to FF plans, FFF plans showed significant reduced integral doses, larger number of MUs, and reduced beam-on-times up to 51% for the highest dose level. Despite plan complexity, pre-treatment verification reported a gamma pass-rate greater than the acceptance threshold of 95% for all FF and FFF plans for 3%-2 mm criteria. Conclusions: The SIB-SBRT strategy with Autoplanning was dosimetrically feasible. Ablative doses up to 50 Gy in 5 fractions can be delivered to the BTV for almost all patients respecting all the normal tissue constraints. A prospective clinical trial based on SBRT strategy using SIB-VMAT technique with FFF beams seems to be justified.

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“…Consequently, a need for new ways of visualizing and reporting dose and morphometric alterations will soon arise. Centers that lack MRL machines but are interested in MRIgRT for abdominal cancers may find the workflow outlined in Heerkens et al (72) informative. This phase I trial demonstrated a favorable toxicity profile (no treatment-attributable grade 3 acute or late toxicities) in 20 patients with unresectable pancreatic cancer who received 24 Gy/3 fx SBRT planned with multiparametric MRI sequences and sagittal cine MRI.…”

Section: Workflow Considerations For Integrated Mr Linear Acceleratorsmentioning

confidence: 99%

“Après Mois, Le Déluge”: Preparing for the Coming Data Flood in the MRI-Guided Radiotherapy Era

et al. 2019

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Magnetic resonance imaging provides a sea of quantitative and semi-quantitative data. While radiation oncologists already navigate a pool of clinical (semantic) and imaging data, the tide will swell with the advent of hybrid MRI/linear accelerator devices and increasing interest in MRI-guided radiotherapy (MRIgRT), including adaptive MRIgRT. The variety of MR sequences (of greater complexity than the single parameter Hounsfield unit of CT scanning routinely used in radiotherapy), the workflow of adaptive fractionation, and the sheer quantity of daily images acquired are challenges for scaling this technology. Biomedical informatics, which is the science of information in biomedicine, can provide helpful insights for this looming transition. Funneling MRIgRT data into clinically meaningful information streams requires committing to the flow of inter-institutional data accessibility and interoperability initiatives, standardizing MRIgRT dosimetry methods, streamlining MR linear accelerator workflow, and standardizing MRI acquisition and post-processing. This review will attempt to conceptually ford these topics using clinical informatics approaches as a theoretical bridge.

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MRI guided stereotactic radiotherapy for locally advanced pancreatic cancer

Abstract: This trial was registered at www.clinicaltrials.gov (NCT01898741) on July 9, 2013.

Cited by 37 publications

References 43 publications

Basics and Frontiers on Pancreatic Cancer for Radiation Oncology: Target Delineation, SBRT, SIB Technique, MRgRT, Particle Therapy, Immunotherapy and Clinical Guidelines

Basics and Frontiers on Pancreatic Cancer for Radiation Oncology: Target Delineation, SBRT, SIB Technique, MRgRT, Particle Therapy, Immunotherapy and Clinical Guidelines

Automated treatment planning as a dose escalation strategy for stereotactic radiation therapy in pancreatic cancer

“Après Mois, Le Déluge”: Preparing for the Coming Data Flood in the MRI-Guided Radiotherapy Era

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