PET and MRI guided adaptive radiotherapy: Rational, feasibility and benefit

Thureau, S.; Briens, A.; Decazes, Pierre; Castelli, J.; Barateau, A.; García, R.; Thariat, J.; Crevoisier, R. de

doi:10.1016/j.canrad.2020.06.017

Cited by 8 publications

(6 citation statements)

References 101 publications

(97 reference statements)

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“…Furthermore, MRI not only is suitable for initial radiotherapy of tumors but also may be used for retreatment, because it can distinguish between changes caused by cancer recurrence and changes caused by fibrosis after treatment. It can also better depict risk organs (OAR) to avoid doses in RTP ( 30 – 32 ). At present, texture analysis, automatic delineation, 4D-MRI, MRI accelerator, and other emerging technologies are gradually applied in clinical settings ( 33 – 36 ).…”

Section: Discussionmentioning

confidence: 99%

Reduction of inter-observer variability using MRI and CT fusion in delineating of primary tumor for radiotherapy in lung cancer with atelectasis

Zhang

Min

et al. 2022

Front. Oncol.

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PurposeTo compare the difference between magnetic resonance imaging (MRI) and computed tomography (CT) in delineating the target area of lung cancer with atelectasis.MethodA retrospective analysis was performed on 15 patients with lung cancer accompanied by atelectasis. All positioning images were transferred to Eclipse treatment planning systems (TPSs). Six MRI sequences (T1WI, T1WI+C, T1WI+C Delay, T1WI+C 10 minutes, T2WI, DWI) were registered with positioning CT. Five radiation oncologists delineated the tumor boundary to obtain the gross tumor volume (GTV). Conformity index (CI) and dice coefficient (DC) were used to measure differences among observers.ResultsThe differences in delineation mean volumes, CI, and DC among CT and MRIs were significant. Multiple comparisons were made between MRI sequences and CT. Among them, DWI, T2WI, and T1WI+C 10 minutes sequences were statistically significant with CT in mean volumes, DC, and CI. The mean volume of DWI, T2WI, and T1WI+C 10 minutes sequence in the target area is significantly smaller than that on the CT sequence, but the consistency is higher than that of CT sequences.ConclusionsThe recognition of atelectasis by MRI was better than that by CT, which could reduce interobserver variability of primary tumor delineation in lung cancer with atelectasis. Among them, DWI, T2WI, T1WI+C 10 minutes may be a better choice to improve the GTV delineation of lung cancer patients with atelectasis.

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Section: Discussionmentioning

confidence: 99%

Reduction of inter-observer variability using MRI and CT fusion in delineating of primary tumor for radiotherapy in lung cancer with atelectasis

Zhang

Min

et al. 2022

Front. Oncol.

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“…As we seek to improve oncological outcomes, radiation oncology has been directed to engage in a new APM to mitigate financial toxicity for patients [14,15] as well as the cost of the national cancer care burden which is estimated to reach USD 246 billion in 2030 [16]. In its current form, the RO-APM is treatment agnostic and techniques with higher overhead such as proton therapy [17,18] and MRgART [19,20] will be differentially impacted despite emerging potential benefits to patients. A similar report on adaptive treatment reimbursement under the RO-APM demonstrated lower but substantial decreases in reimbursement for pancreas (−36%), lung (−23%) and liver (−8%) malignancies and suggested that implementation of the APM would limit growth and innovation [21].…”

Section: Discussionmentioning

confidence: 99%

Assessment of MRI-Linac Economics under the RO-APM

Palm

Eicher²,

Sim

et al. 2021

JCM

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The implementation of the radiation oncology alternative payment model (RO-APM) has raised concerns regarding the development of MRI-guided adaptive radiotherapy (MRgART). We sought to compare technical fee reimbursement under Fee-For-Service (FFS) to the proposed RO-APM for a typical MRI-Linac (MRL) patient load and distribution of 200 patients. In an exploratory aim, a modifier was added to the RO-APM (mRO-APM) to account for the resources necessary to provide this care. Traditional Medicare FFS reimbursement rates were compared to the diagnosis-based reimbursement in the RO-APM. Reimbursement for all selected diagnoses were lower in the RO-APM compared to FFS, with the largest differences in the adaptive treatments for lung cancer (−89%) and pancreatic cancer (−83%). The total annual reimbursement discrepancy amounted to −78%. Without implementation of adaptive replanning there was no difference in reimbursement in breast, colorectal and prostate cancer between RO-APM and mRO-APM. Accommodating online adaptive treatments in the mRO-APM would result in a reimbursement difference from the FFS model of −47% for lung cancer and −46% for pancreatic cancer, mitigating the overall annual reimbursement difference to −54%. Even with adjustment, the implementation of MRgART as a new treatment strategy is susceptible under the RO-APM.

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“…Functional and anatomical data can be used not only prior to treatment, but also during and after treatment to guide ART, by improving the tumor targeting while better sparing the OARs, as well as determine tumor response ( 87 ). If the ART approach has been based first historically on per-treatment CT and/or CBCT images, it is now possible with MRI-linear accelerator (MRI-linac), combining an MRI and a linear accelerator, allowing an MRI acquisition before each treatment delivery ( 88 ).…”

Section: Clinical Applicationsmentioning

confidence: 99%

Trimodality PET/CT/MRI and Radiotherapy: A Mini-Review

Decazes

Hinault

Veresezan³

et al. 2021

Front. Oncol.

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Computed tomography (CT) has revolutionized external radiotherapy by making it possible to visualize and segment the tumors and the organs at risk in a three-dimensional way. However, if CT is a now a standard, it presents some limitations, notably concerning tumor characterization and delineation. Its association with functional and anatomical images, that are positron emission tomography (PET) and magnetic resonance imaging (MRI), surpasses its limits. This association can be in the form of a trimodality PET/CT/MRI. The objective of this mini-review is to describe the process of performing this PET/CT/MRI trimodality for radiotherapy and its potential clinical applications. Trimodality can be performed in two ways, either a PET/MRI fused to a planning CT (possibly with a pseudo-CT generated from the MRI for the planning), or a PET/CT fused to an MRI and then registered to a planning CT (possibly the CT of PET/CT if calibrated for radiotherapy). These examinations should be performed in the treatment position, and in the second case, a patient transfer system can be used between the PET/CT and MRI to limit movement. If trimodality requires adapted equipment, notably compatible MRI equipment with high-performance dedicated coils, it allows the advantages of the three techniques to be combined with a synergistic effect while limiting their disadvantages when carried out separately. Trimodality is already possible in clinical routine and can have a high clinical impact and good inter-observer agreement, notably for head and neck cancers, brain tumor, prostate cancer, cervical cancer.

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PET and MRI guided adaptive radiotherapy: Rational, feasibility and benefit

Cited by 8 publications

References 101 publications

Reduction of inter-observer variability using MRI and CT fusion in delineating of primary tumor for radiotherapy in lung cancer with atelectasis

Reduction of inter-observer variability using MRI and CT fusion in delineating of primary tumor for radiotherapy in lung cancer with atelectasis

Assessment of MRI-Linac Economics under the RO-APM

Trimodality PET/CT/MRI and Radiotherapy: A Mini-Review

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