Stereotactic magnetic resonance-guided online adaptive radiotherapy of adrenal metastases combines high ablative doses with optimized sparing of organs at risk

Hoegen, Philipp; Katsigiannopulos, Efthimios; Buchele, Carolin; Regnery, Sebastian; Weykamp, Fabian; Sandrini, Elisabetta; Ristau, Jonas; Liermann, Jakob; Meixner, Eva; Förster, Tobias; Renkamp, C. Katharina; Schlüter, Fabian; Rippke, Carolin; Debus, Jürgen; Klüter, Sebastian; Hörner-Rieber, Juliane

doi:10.1016/j.ctro.2022.100567

Cited by 9 publications

(16 citation statements)

References 44 publications

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“…Studies have found significant volume and positional changes during the course of AGM SBRT for the GTV [30] , [39] and nearby OARs [15] , [29] . This variability has significant implications for the treatment plan, as a majority of fractions in the present study (64 %) required adaption to meet OAR constraints and/or target coverage goals, which is consistent with the literature (69–99 %) [16] , [17] , [38] . MRgSBRT adapted plans have been shown to significantly improve PTV coverage and reduce the dose to OARs [14] , [17] , [29] , [38] .…”

Section: Discussionsupporting

confidence: 89%

“…This variability has significant implications for the treatment plan, as a majority of fractions in the present study (64 %) required adaption to meet OAR constraints and/or target coverage goals, which is consistent with the literature (69–99 %) [16] , [17] , [38] . MRgSBRT adapted plans have been shown to significantly improve PTV coverage and reduce the dose to OARs [14] , [17] , [29] , [38] . Rodriguez et al conducted an analysis of 20 patients with AGM who underwent adaptive MRgRT who were replanned for volumetric modulated arc therapy (VMAT) CT-image guided radiation therapy (IGRT) [16] .…”

Section: Discussionsupporting

confidence: 89%

“…However, in contrast to the present study, none of these 3 studies utilized any adaptive planning. Despite a relatively high prescribed dose (median BED 10 100 Gy), no instances of grade 3+ toxicity occurred following MRgSBRT in the present study, which is consistent with the AGM MRgSBRT literature [17] , [38] . Since the majority of cases in the present study (74 %) required adaptive planning to meet OAR constraints for at least one fraction, it is likely that this feature of MRgSBRT reduced the risk of toxicity.…”

Section: Discussionsupporting

confidence: 89%

See 2 more Smart Citations

Multi-institutional experience of MR-guided stereotactic body radiation therapy for adrenal gland metastases

Mills,

Kotecha,

Herrera

et al. 2024

Clinical and Translational Radiation Oncology

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 89%

See 1 more Smart Citation

Multi-institutional experience of MR-guided stereotactic body radiation therapy for adrenal gland metastases

Mills,

Kotecha,

Herrera

et al. 2024

Clinical and Translational Radiation Oncology

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“…MR-guided SBRT (MRgSBRT), with its ability to better visualize soft tissue and track tumors during treatment, has been shown to be a novel but reproducible and accurate treatment modality that may reduce treatment volumes and may consequently minimize toxicity [10] . Early single-institution clinical outomes of adrenal SBRT with MRgRT have also been published [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] . The main aim of this multi-institutional pooled analysis was to report the clinical outcomes and toxicities after adrenal MRgSBRT on a 0.35 T MR-linac.…”

Section: Introductionmentioning

confidence: 99%

Factors influencing local control after MR-guided stereotactic body radiotherapy (MRgSBRT) for adrenal metastases

Ugurluer,

Schneiders,

Corradini

et al. 2024

Clinical and Translational Radiation Oncology

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“…the baseline plans often deviate from the predicted plans. Of course, SMART also yields the opportunity to adapt our plans to such anatomical changes [ 10 , 14 – 17 ]. Currently available commercial systems offer online plan adaptation on a daily basis but do not support dose accumulation of all adapted fractions.…”

Section: Introductionmentioning

confidence: 99%

Comparison of different dose accumulation strategies to estimate organ doses after stereotactic magnetic resonance-guided adaptive radiotherapy

Regnery,

Leiner,

Buchele

et al. 2023

Radiat Oncol

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Introduction Re-irradiation is frequently performed in the era of precision oncology, but previous doses to organs-at-risk (OAR) must be assessed to avoid cumulative overdoses. Stereotactic magnetic resonance-guided online adaptive radiotherapy (SMART) enables highly precise ablation of tumors close to OAR. However, OAR doses may change considerably during adaptive treatment, which complicates potential re-irradiation. We aimed to compare the baseline plan with different dose accumulation techniques to inform re-irradiation. Patients & methods We analyzed 18 patients who received SMART to lung or liver tumors inside prospective databases. Cumulative doses were calculated inside the planning target volumes (PTV) and OAR for the adapted plans and theoretical non-adapted plans via (1) cumulative dose volume histograms (DVH sum plan) and (2) deformable image registration (DIR)-based dose accumulation to planning images (DIR sum plan). We compared cumulative dose parameters between the baseline plan, DVH sum plan and DIR sum plan using equivalent doses in 2 Gy fractions (EQD2). Results Individual patients presented relevant increases of near-maximum doses inside the proximal bronchial tree, spinal cord, heart and gastrointestinal OAR when comparing adaptive treatment to the baseline plans. The spinal cord near-maximum doses were significantly increased in the liver patients (D2% median: baseline 6.1 Gy, DIR sum 8.1 Gy, DVH sum 8.4 Gy, p = 0.04; D0.1 cm³ median: baseline 6.1 Gy, DIR sum 8.1 Gy, DVH sum 8.5 Gy, p = 0.04). Three OAR overdoses occurred during adaptive treatment (DIR sum: 1, DVH sum: 2), and four more intense OAR overdoses would have occurred during non-adaptive treatment (DIR sum: 4, DVH sum: 3). Adaptive treatment maintained similar PTV coverages to the baseline plans, while non-adaptive treatment yielded significantly worse PTV coverages in the lung (D95% median: baseline 86.4 Gy, DIR sum 82.4 Gy, DVH sum 82.2 Gy, p = 0.006) and liver patients (D95% median: baseline 87.4 Gy, DIR sum 82.1 Gy, DVH sum 81.1 Gy, p = 0.04). Conclusion OAR doses can increase during SMART, so that re-irradiation should be planned based on dose accumulations of the adapted plans instead of the baseline plan. Cumulative dose volume histograms represent a simple and conservative dose accumulation strategy.

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Stereotactic magnetic resonance-guided online adaptive radiotherapy of adrenal metastases combines high ablative doses with optimized sparing of organs at risk

Cited by 9 publications

References 44 publications

Multi-institutional experience of MR-guided stereotactic body radiation therapy for adrenal gland metastases

Multi-institutional experience of MR-guided stereotactic body radiation therapy for adrenal gland metastases

Factors influencing local control after MR-guided stereotactic body radiotherapy (MRgSBRT) for adrenal metastases

Comparison of different dose accumulation strategies to estimate organ doses after stereotactic magnetic resonance-guided adaptive radiotherapy

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