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Grimbergen G, Eijkelenkamp H, Snoeren LM, Bahij R, Bernchou U, van der Bijl E, Heerkens HD, Binda S, Ng SS, Bouchart C, Paquier Z, Brown K, Khor R, Chuter R, Freear L, Dunlop A, Mitchell RA, Erickson BA, Hall WA, Godoy Scripes P, Tyagi N, de Leon J, Tran C, Oh S, Renz P, Shessel A, Taylor E, Intven MP, Meijer GJ. Treatment planning for MR-guided SBRT of pancreatic tumors on a 1.5 T MR-Linac: A global consensus protocol. Clin Transl Radiat Oncol 2024; 47:100797. [PMID: 38831754 PMCID: PMC11145226 DOI: 10.1016/j.ctro.2024.100797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/17/2024] [Accepted: 05/17/2024] [Indexed: 06/05/2024] Open
Abstract
Background and purpose Treatment planning for MR-guided stereotactic body radiotherapy (SBRT) for pancreatic tumors can be challenging, leading to a wide variation of protocols and practices. This study aimed to harmonize treatment planning by developing a consensus planning protocol for MR-guided pancreas SBRT on a 1.5 T MR-Linac. Materials and methods A consortium was founded of thirteen centers that treat pancreatic tumors on a 1.5 T MR-Linac. A phased planning exercise was conducted in which centers iteratively created treatment plans for two cases of pancreatic cancer. Each phase was followed by a meeting where the instructions for the next phase were determined. After three phases, a consensus protocol was reached. Results In the benchmarking phase (phase I), substantial variation between the SBRT protocols became apparent (for example, the gross tumor volume (GTV) D99% ranged between 36.8 - 53.7 Gy for case 1, 22.6 - 35.5 Gy for case 2). The next phase involved planning according to the same basic dosimetric objectives, constraints, and planning margins (phase II), which led to a large degree of harmonization (GTV D99% range: 47.9-53.6 Gy for case 1, 33.9-36.6 Gy for case 2). In phase III, the final consensus protocol was formulated in a treatment planning system template and again used for treatment planning. This not only resulted in further dosimetric harmonization (GTV D99% range: 48.2-50.9 Gy for case 1, 33.5-36.0 Gy for case 2) but also in less variation of estimated treatment delivery times. Conclusion A global consensus protocol has been developed for treatment planning for MR-guided pancreatic SBRT on a 1.5 T MR-Linac. Aside from harmonizing the large variation in the current clinical practice, this protocol can provide a starting point for centers that are planning to treat pancreatic tumors on MR-Linac systems.
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Affiliation(s)
- Guus Grimbergen
- Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands
| | - Hidde Eijkelenkamp
- Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands
| | - Louk M.W. Snoeren
- Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands
| | - Rana Bahij
- Department of Oncology, Odense University Hospital, Denmark
| | - Uffe Bernchou
- Department of Oncology, Odense University Hospital, Denmark
- Department of Clinical Research, University of Southern Denmark, Denmark
| | - Erik van der Bijl
- Department of Radiation Oncology, Radboudumc, Nijmegen, The Netherlands
| | - Hanne D. Heerkens
- Department of Radiation Oncology, Radboudumc, Nijmegen, The Netherlands
| | - Shawn Binda
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sylvia S.W. Ng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Christelle Bouchart
- Department of Radiation Oncology, HUB Institut Jules Bordet, Brussels, Belgium
| | - Zelda Paquier
- Department of Radiation Oncology, HUB Institut Jules Bordet, Brussels, Belgium
| | - Kerryn Brown
- Radiation Oncology, ONJ Centre, Austin Health, Heidelberg, Victoria, Australia
| | - Richard Khor
- Radiation Oncology, ONJ Centre, Austin Health, Heidelberg, Victoria, Australia
| | | | | | - Alex Dunlop
- The Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Robert Adam Mitchell
- The Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Beth A. Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - William A. Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Paola Godoy Scripes
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Neelam Tyagi
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Charles Tran
- GenesisCare, Darlinghurst, New South Wales, Australia
| | - Seungjong Oh
- Division of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Paul Renz
- Division of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Andrea Shessel
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Edward Taylor
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Martijn P.W. Intven
- Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands
| | - Gert J. Meijer
- Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands
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Beckert R, Schiff JP, Morris E, Samson P, Kim H, Laugeman E. The impact of an Advanced Practice Radiation Therapist contouring for a CBCT-based adaptive radiotherapy program. Tech Innov Patient Support Radiat Oncol 2024; 30:100242. [PMID: 38495830 PMCID: PMC10940769 DOI: 10.1016/j.tipsro.2024.100242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/26/2024] [Accepted: 02/29/2024] [Indexed: 03/19/2024] Open
Abstract
We successfully implemented an APRT specializing in CBCT-guided online adaptive contouring. These data show statistical improvements in contouring time with APRT-led vs non-APRT led ART contouring, suggesting that an APRT specifically trained to manage the ART process may reduce physician workload and patient treatment time.
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Affiliation(s)
- Robbie Beckert
- Department of Radiation Oncology Washington University School of Medicine in St. Louis, 4921 Parkview Place, MSC: 35-LL-8224, St. Louis, MO 63110, United States
| | - Joshua P Schiff
- Department of Radiation Oncology Washington University School of Medicine in St. Louis, 4921 Parkview Place, MSC: 35-LL-8224, St. Louis, MO 63110, United States
| | - Eric Morris
- Department of Radiation Oncology Washington University School of Medicine in St. Louis, 4921 Parkview Place, MSC: 35-LL-8224, St. Louis, MO 63110, United States
| | - Pamela Samson
- Department of Radiation Oncology Washington University School of Medicine in St. Louis, 4921 Parkview Place, MSC: 35-LL-8224, St. Louis, MO 63110, United States
| | - Hyun Kim
- Department of Radiation Oncology Washington University School of Medicine in St. Louis, 4921 Parkview Place, MSC: 35-LL-8224, St. Louis, MO 63110, United States
| | - Eric Laugeman
- Department of Radiation Oncology Washington University School of Medicine in St. Louis, 4921 Parkview Place, MSC: 35-LL-8224, St. Louis, MO 63110, United States
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Jiang W, Shi X, Zhang X, Li Z, Yue J. Feasibility and safety of contrast-enhanced magnetic resonance-guided adaptive radiotherapy for upper abdominal tumors: A preliminary exploration. Phys Imaging Radiat Oncol 2024; 30:100582. [PMID: 38765880 PMCID: PMC11099332 DOI: 10.1016/j.phro.2024.100582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/22/2024] Open
Abstract
This study investigates the use of contrast-enhanced magnetic resonance (MR) in MR-guided adaptive radiotherapy (MRgART) for upper abdominal tumors. Contrast-enhanced T1-weighted MR (cT1w MR) using half doses of gadoterate was used to guide daily adaptive radiotherapy for tumors poorly visualized without contrast. The use of gadoterate was found to be feasible and safe in 5-fraction MRgART and could improve the contrast-to-noise ratio of MR images. And the use of cT1w MR could reduce the interobserver variation of adaptive tumor delineation compared to plain T1w MR (4.41 vs. 6.58, p < 0.001) and T2w MR (4.41 vs. 7.42, p < 0.001).
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Affiliation(s)
- Wenheng Jiang
- Department of Graduate, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xihua Shi
- Department of Radiation Physics, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xiang Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Zhenjiang Li
- Department of Radiation Physics, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jinbo Yue
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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Moreira A, Li W, Berlin A, Carpino-Rocca C, Chung P, Conroy L, Dang J, Dawson LA, Glicksman RM, Hosni A, Keller H, Kong V, Lindsay P, Shessel A, Stanescu T, Taylor E, Winter J, Yan M, Letourneau D, Milosevic M, Velec M. Prospective evaluation of patient-reported anxiety and experiences with adaptive radiation therapy on an MR-linac. Tech Innov Patient Support Radiat Oncol 2024; 29:100240. [PMID: 38445180 PMCID: PMC10912905 DOI: 10.1016/j.tipsro.2024.100240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/13/2024] [Accepted: 02/26/2024] [Indexed: 03/07/2024] Open
Abstract
Purpose An integrated magnetic resonance scanner and linear accelerator (MR-linac) was implemented with daily online adaptive radiation therapy (ART). This study evaluated patient-reported experiences with their overall hospital care as well as treatment in the MR-linac environment. Methods Patients pre-screened for MR eligibility and claustrophobia were referred to simulation on a 1.5 T MR-linac. Patient-reported experience measures were captured using two validated surveys. The 15-item MR-anxiety questionnaire (MR-AQ) was administered immediately after the first treatment to rate MR-related anxiety and relaxation. The 40-item satisfaction with cancer care questionnaire rating doctors, radiation therapists, the services and care organization and their outpatient experience was administered immediately after the last treatment using five-point Likert responses. Results were analyzed using descriptive statistics. Results 205 patients were included in this analysis. Multiple sites were treated across the pelvis and abdomen with a median treatment time per fraction of 46 and 66 min respectively. Patients rated MR-related anxiety as "not at all" (87%), "somewhat" (11%), "moderately" (1%) and "very much so" (1%). Positive satisfaction responses ranged from 78 to 100% (median 93%) across all items. All radiation therapist-specific items were rated positively as 96-100%. The five lowest rated items (range 78-85%) were related to general provision of information, coordination, and communication. Overall hospital care was rated positively at 99%. Conclusion In this large, single-institution prospective cohort, all patients had low MR-related anxiety and completed treatment as planned despite lengthy ART treatments with the MR-linac. Patients overall were highly satisfied with their cancer care involving ART using an MR-linac.
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Affiliation(s)
- Amanda Moreira
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Winnie Li
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Alejandro Berlin
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Cathy Carpino-Rocca
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Peter Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Leigh Conroy
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Jennifer Dang
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Laura A. Dawson
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Rachel M. Glicksman
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Ali Hosni
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Harald Keller
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Vickie Kong
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Patricia Lindsay
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Andrea Shessel
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Teo Stanescu
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Edward Taylor
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Jeff Winter
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Michael Yan
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Daniel Letourneau
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Michael Milosevic
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Michael Velec
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
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Zhou Y, Lalande A, Chevalier C, Baude J, Aubignac L, Boudet J, Bessieres I. Deep learning application for abdominal organs segmentation on 0.35 T MR-Linac images. Front Oncol 2024; 13:1285924. [PMID: 38260833 PMCID: PMC10800957 DOI: 10.3389/fonc.2023.1285924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/30/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Linear accelerator (linac) incorporating a magnetic resonance (MR) imaging device providing enhanced soft tissue contrast is particularly suited for abdominal radiation therapy. In particular, accurate segmentation for abdominal tumors and organs at risk (OARs) required for the treatment planning is becoming possible. Currently, this segmentation is performed manually by radiation oncologists. This process is very time consuming and subject to inter and intra operator variabilities. In this work, deep learning based automatic segmentation solutions were investigated for abdominal OARs on 0.35 T MR-images. Methods One hundred and twenty one sets of abdominal MR images and their corresponding ground truth segmentations were collected and used for this work. The OARs of interest included the liver, the kidneys, the spinal cord, the stomach and the duodenum. Several UNet based models have been trained in 2D (the Classical UNet, the ResAttention UNet, the EfficientNet UNet, and the nnUNet). The best model was then trained with a 3D strategy in order to investigate possible improvements. Geometrical metrics such as Dice Similarity Coefficient (DSC), Intersection over Union (IoU), Hausdorff Distance (HD) and analysis of the calculated volumes (thanks to Bland-Altman plot) were performed to evaluate the results. Results The nnUNet trained in 3D mode achieved the best performance, with DSC scores for the liver, the kidneys, the spinal cord, the stomach, and the duodenum of 0.96 ± 0.01, 0.91 ± 0.02, 0.91 ± 0.01, 0.83 ± 0.10, and 0.69 ± 0.15, respectively. The matching IoU scores were 0.92 ± 0.01, 0.84 ± 0.04, 0.84 ± 0.02, 0.54 ± 0.16 and 0.72 ± 0.13. The corresponding HD scores were 13.0 ± 6.0 mm, 16.0 ± 6.6 mm, 3.3 ± 0.7 mm, 35.0 ± 33.0 mm, and 42.0 ± 24.0 mm. The analysis of the calculated volumes followed the same behavior. Discussion Although the segmentation results for the duodenum were not optimal, these findings imply a potential clinical application of the 3D nnUNet model for the segmentation of abdominal OARs for images from 0.35 T MR-Linac.
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Affiliation(s)
- You Zhou
- Department of Medical Physics, Centre Georges-François Leclerc, Dijon, France
- Institut de Chimie Moléculaire de l’Université de Bourgogne (ICMUB) Laboratory, Centre National de la Recherche Scientifique (CNRS) 6302, University of Burgundy, Dijon, France
| | - Alain Lalande
- Institut de Chimie Moléculaire de l’Université de Bourgogne (ICMUB) Laboratory, Centre National de la Recherche Scientifique (CNRS) 6302, University of Burgundy, Dijon, France
- Medical Imaging Department, University Hospital of Dijon, Dijon, France
| | - Cédric Chevalier
- Department of Radiotherapy, Centre Georges-François Leclerc, Dijon, France
| | - Jérémy Baude
- Department of Radiotherapy, Centre Georges-François Leclerc, Dijon, France
| | - Léone Aubignac
- Department of Medical Physics, Centre Georges-François Leclerc, Dijon, France
| | - Julien Boudet
- Department of Medical Physics, Centre Georges-François Leclerc, Dijon, France
| | - Igor Bessieres
- Department of Medical Physics, Centre Georges-François Leclerc, Dijon, France
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Prime S, Schiff JP, Hosni A, Stanescu T, Dawson LA, Henke LE. The Use of MR-Guided Radiation Therapy for Liver Cancer. Semin Radiat Oncol 2024; 34:36-44. [PMID: 38105091 DOI: 10.1016/j.semradonc.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
The role of radiotherapy in the management of primary and metastatic liver malignancies has expanded in recent years due to advances such as IGRT and SBRT. MRI-guided radiotherapy (MRgRT) has arisen as an excellent option for the management of hepatocellular carcinoma, cholangiocarcinoma, and liver metastases due to the ability to combine improved hepatic imaging with conformal treatment planning paradigms like adaptive radiotherapy and advanced motion management techniques. Herein we review the data for MRgRT for liver malignancies, as well as describe workflow and technical considerations for the 2 commercially available MRgRT delivery platforms.
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Affiliation(s)
- Sabrina Prime
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO
| | - Joshua P Schiff
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO
| | - Ali Hosni
- Radiation Medicine Program, Princess Margaret Cancer Centre, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Teodor Stanescu
- Radiation Medicine Program, Princess Margaret Cancer Centre, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Laura A Dawson
- Radiation Medicine Program, Princess Margaret Cancer Centre, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Lauren E Henke
- University Hospitals/Case Western Reserve University, Department of Radiation Oncology, Cleveland, OH.
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Riis HL, Chick J, Dunlop A, Tilly D. The Quality Assurance of a 1.5 T MR-Linac. Semin Radiat Oncol 2024; 34:120-128. [PMID: 38105086 DOI: 10.1016/j.semradonc.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
The recent introduction of a commercial 1.5 T MR-linac system has considerably improved the image quality of the patient acquired in the treatment unit as well as enabling online adaptive radiation therapy (oART) treatment strategies. Quality Assurance (QA) of this new technology requires new methodology that allows for the high field MR in a linac environment. The presence of the magnetic field requires special attention to the phantoms, detectors, and tools to perform QA. Due to the design of the system, the integrated megavoltage imager (MVI) is essential for radiation beam calibrations and QA. Additionally, the alignment between the MR image system and the radiation isocenter must be checked. The MR-linac system has vendor-supplied phantoms for calibration and QA tests. However, users have developed their own routine QA systems to independently check that the machine is performing as required, as to ensure we are able to deliver the intended dose with sufficient certainty. The aim of this work is therefore to review the MR-linac specific QA procedures reported in the literature.
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Affiliation(s)
- Hans Lynggaard Riis
- Department of Oncology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Joan Chick
- The Joint Department of Physics, The Royal Marsden Hospital and the Institute of Cancer Research, London, UK
| | - Alex Dunlop
- The Joint Department of Physics, The Royal Marsden Hospital and the Institute of Cancer Research, London, UK
| | - David Tilly
- Department of Immunology, Genetics and Pathology, Medical Radiation Physics, Uppsala University, Uppsala, Sweden; Medical Physics, Uppsala University Hospital, Uppsala, Sweden
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Prasad Venkatesulu B, Ness E, Ross D, Saripalli AL, Abood G, Badami A, Cotler S, Dhanarajan A, Knab LM, Lee B, Molvar C, Sethi A, Small W, Refaat T. MRI-guided Real-time Online Gated Stereotactic Body Radiation Therapy for Liver Tumors. Am J Clin Oncol 2023; 46:530-536. [PMID: 37708212 DOI: 10.1097/coc.0000000000001042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
BACKGROUND Liver tumors are commonly encountered in oncology. The study aimed to assess the impact of magnetic resonance imaging (MRI)-guided stereotactic body radiation therapy (SBRT) (MRgSBRT) on disease-related outcomes and the toxicity profile. METHODS Patients who received MRgSBRT from 2019 to 2021 for primary and metastatic liver tumors were included in this analysis. The protocol for treatment simulation included Gadoxetate disodium injection followed by a single-dimensional post-exhale MRI (0.35-T MRI linear accelerator) and computed tomography simulation. The patient demographics and treatment-related outcomes were assessed. The time-to-event curves were analyzed for freedom from local progression (FFLP) and overall survival (OS). RESULTS A total of 35 patients were eligible for analysis with a median age of 70 years (range 25 to 95). The median follow-up was 19.4 months (range 1 to 37 mo). The one-year OS was 77.7%, with an estimated 3 years of 47.9%. Patients with the locally controlled disease had a better median OS of 27.8 months (95% CI [23.8-31.6]) compared with 13.5 months (95% CI [5.6-21.3], P =0.007) in patients with local disease progression. The 1-year FFLP was 95.6%, and 3-year estimated FFLP was 87.1%. Patients who received a radiation dose of biologically equivalent dose≥100 Gy had FFLP of 30.9 months (95% CI [28.7-33.1]) compared with 13.3 months (95% CI [5.3-21.3], P =0.004) in patients who received <100 Gy biologically equivalent dose. CONCLUSION MRI-guided SBRT provides optimal local control, associated with improved OS in a heavily morbid, pretreated older cohort of patients with reasonable safety profiles.
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Affiliation(s)
| | | | | | | | | | - Ami Badami
- Division of Hematology/Oncology, Department of Medicine, Cardinal Bernardin Cancer Center
| | - Scott Cotler
- Department of Diagnostic Radiology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - Asha Dhanarajan
- Division of Hematology/Oncology, Department of Medicine, Cardinal Bernardin Cancer Center
| | | | | | - Christopher Molvar
- Department of Diagnostic Radiology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL
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Uno T, Tsuneda M, Abe K, Fujita Y, Harada R, Saito M, Kanazawa A, Kodate A, Abe Y, Ikeda Y, Nemoto MW, Yokota H. A new workflow of the on-line 1.5-T MR-guided adaptive radiation therapy. Jpn J Radiol 2023; 41:1316-1322. [PMID: 37354344 PMCID: PMC10613593 DOI: 10.1007/s11604-023-01457-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/04/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE The aim of this study was to develop a new workflow for 1.5-T magnetic resonance (MR)-guided on-line adaptive radiation therapy (MRgART) and assess its feasibility in achieving dose constraints. MATERIALS AND METHODS We retrospectively evaluated the clinical data of patients who underwent on-line adaptive radiation therapy using a 1.5-T MR linear accelerator (MR-Linac). The workflow in MRgART was established by reviewing the disease site, number of fractions, and re-planning procedures. Five cases of prostate cancer were selected to evaluate the feasibility of the new workflow with respect to achieving dose constraints. RESULTS Between December 2021 and September 2022, 50 consecutive patients underwent MRgART using a 1.5-T MR-Linac. Of these, 20 had prostate cancer, 10 had hepatocellular carcinoma, 6 had pancreatic cancer, 5 had lymph node oligo-metastasis, 3 had renal cancer, 3 had bone metastasis, 2 had liver metastasis from colon cancer, and 1 had a mediastinal tumor. Among a total of 247 fractions, 235 (95%) were adapt-to-shape (ATS)-based re-planning. The median ATS re-planning time in all 50 cases was 17 min. In the feasibility study, all dose constraint sets were met in all 5 patients by ATS re-planning. Conversely, a total of 14 dose constraints in 5 patients could not be achieved by virtual plan without using adaptive re-planning. These dose constraints included the minimum dose received by the highest irradiated volume of 1 cc in the planning target volume and the maximum dose of the rectal/bladder wall. CONCLUSION A new workflow of 1.5-T MRgART was established and found to be feasible. Our evaluation of the dose constraint achievement demonstrated the effectiveness of the workflow.
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Affiliation(s)
- Takashi Uno
- Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba, 260-8670, Japan.
| | - Masato Tsuneda
- Department of Radiation Oncology, MR Linac ART Division, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba, 260-8670, Japan
| | - Kota Abe
- Department of Radiation Oncology, MR Linac ART Division, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba, 260-8670, Japan
| | - Yukio Fujita
- Department of Radiation Oncology, MR Linac ART Division, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba, 260-8670, Japan
| | - Rintaro Harada
- Department of Radiology, Chiba University Hospital, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba, 260-8670, Japan
| | - Makoto Saito
- Department of Radiology, Chiba University Hospital, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba, 260-8670, Japan
| | - Aki Kanazawa
- Department of Radiology, Chiba University Hospital, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba, 260-8670, Japan
| | - Asuka Kodate
- Department of Radiology, Chiba University Hospital, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba, 260-8670, Japan
| | - Yukinao Abe
- Department of Radiology, Chiba University Hospital, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba, 260-8670, Japan
| | - Yohei Ikeda
- Department of Radiology, Chiba University Hospital, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba, 260-8670, Japan
| | - Miho Watanabe Nemoto
- Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba, 260-8670, Japan
| | - Hajime Yokota
- Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba, 260-8670, Japan
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10
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Wu C, Murray V, Siddiq SS, Tyagi N, Reyngold M, Crane C, Otazo R. Real-time 4D MRI using MR signature matching (MRSIGMA) on a 1.5T MR-Linac system. Phys Med Biol 2023; 68:10.1088/1361-6560/acf3cc. [PMID: 37619588 PMCID: PMC10513779 DOI: 10.1088/1361-6560/acf3cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/24/2023] [Indexed: 08/26/2023]
Abstract
Objective. To develop real-time 4D MRI using MR signature matching (MRSIGMA) for volumetric motion imaging in patients with pancreatic cancer on a 1.5T MR-Linac system.Approach. Two consecutive MRI scans with 3D golden-angle radial stack-of-stars acquisitions were performed on ten patients with inoperable pancreatic cancer. The complete first scan (905 angles) was used to compute a 4D motion dictionary including ten pairs of 3D motion images and signatures. The second scan was used for real-time imaging, where each angle (275 ms) was processed separately to match it to one of the dictionary entries. The complete second scan was also used to compute a 4D reference to assess motion tracking performance.Dicecoefficients of the gross tumor volume (GTV) and two organs-at-risk (duodenum-stomach and small bowel) were calculated between signature matching and reference. In addition, volume changes, displacements, center of mass shifts, andDicescores over time were calculated to characterize motion.Main results. Total imaging latency of MRSIGMA (acquisition + matching) was less than 300 ms. TheDicecoefficients were 0.87 ± 0.06 (GTV), 0.86 ± 0.05 (duodenum-stomach), and 0.85 ± 0.05 (small bowel), which indicate high accuracy (high mean value) and low uncertainty (low standard deviation) of MRSIGMA for real-time motion tracking. The center of mass shift was 3.1 ± 2.0 mm (GTV), 5.3 ± 3.0 mm (duodenum-stomach), and 3.4 ± 1.5 mm (small bowel). TheDicescores over time (0.97 ± [0.01-0.03]) were similarly high for MRSIGMA and reference scans in all the three contours.Significance. This work demonstrates the feasibility of real-time 4D MRI using MRSIGMA for volumetric motion tracking on a 1.5T MR-Linac system. The high accuracy and low uncertainty of real-time MRSIGMA is an essential step towards continuous treatment adaptation of tumors affected by real-time respiratory motion and could ultimately improve treatment safety by optimizing ablative dose delivery near gastrointestinal organs.
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Affiliation(s)
- Can Wu
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Victor Murray
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Syed S. Siddiq
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Neelam Tyagi
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Marsha Reyngold
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Christopher Crane
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ricardo Otazo
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
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11
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Wang H, Liu X, Song Y, Yin P, Zou J, Shi X, Yin Y, Li Z. Feasibility study of adaptive radiotherapy for esophageal cancer using artificial intelligence autosegmentation based on MR-Linac. Front Oncol 2023; 13:1172135. [PMID: 37361583 PMCID: PMC10289262 DOI: 10.3389/fonc.2023.1172135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
Objective We proposed a scheme for automatic patient-specific segmentation in Magnetic Resonance (MR)-guided online adaptive radiotherapy based on daily updated, small-sample deep learning models to address the time-consuming delineation of the region of interest (ROI) in the adapt-to-shape (ATS) workflow. Additionally, we verified its feasibility in adaptive radiation therapy for esophageal cancer (EC). Methods Nine patients with EC who were treated with an MR-Linac were prospectively enrolled. The actual adapt-to-position (ATP) workflow and simulated ATS workflow were performed, the latter of which was embedded with a deep learning autosegmentation (AS) model. The first three treatment fractions of the manual delineations were used as input data to predict the next fraction segmentation, which was modified and then used as training data to update the model daily, forming a cyclic training process. Then, the system was validated in terms of delineation accuracy, time, and dosimetric benefit. Additionally, the air cavity in the esophagus and sternum were added to the ATS workflow (producing ATS+), and the dosimetric variations were assessed. Results The mean AS time was 1.40 [1.10-1.78 min]. The Dice similarity coefficient (DSC) of the AS model gradually approached 1; after four training sessions, the DSCs of all ROIs reached a mean value of 0.9 or more. Furthermore, the planning target volume (PTV) of the ATS plan showed a smaller heterogeneity index than that of the ATP plan. Additionally, V5 and V10 in the lungs and heart were greater in the ATS+ group than in the ATS group. Conclusion The accuracy and speed of artificial intelligence-based AS in the ATS workflow met the clinical radiation therapy needs of EC. This allowed the ATS workflow to achieve a similar speed to the ATP workflow while maintaining its dosimetric advantage. Fast and precise online ATS treatment ensured an adequate dose to the PTV while reducing the dose to the heart and lungs.
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Affiliation(s)
- Huadong Wang
- Department of Graduate, Shandong First Medical University (Shandong Academy of Medical Sciences), Jinan, China
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xin Liu
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- Department of Clinical Medicine, Southwestern Medical University, Luzhou, China
| | - Yajun Song
- Department of Graduate, Shandong First Medical University (Shandong Academy of Medical Sciences), Jinan, China
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Peijun Yin
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- College of Physics and Electronic Science, Shandong Normal University, Jinan, China
| | - Jingmin Zou
- Department of Graduate, Shandong First Medical University (Shandong Academy of Medical Sciences), Jinan, China
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xihua Shi
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yong Yin
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Zhenjiang Li
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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12
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Chuong MD, Palm RF, Tjong MC, Hyer DE, Kishan AU. Advances in MRI-Guided Radiation Therapy. Surg Oncol Clin N Am 2023; 32:599-615. [PMID: 37182995 DOI: 10.1016/j.soc.2023.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Image guidance for radiation therapy (RT) has evolved over the last few decades and now is routinely performed using cone-beam computerized tomography (CBCT). Conventional linear accelerators (LINACs) that use CBCT have limited soft tissue contrast, are not able to image the patient's internal anatomy during treatment delivery, and most are not capable of online adaptive replanning. RT delivery systems that use MRI have become available within the last several years and address many of the imaging limitations of conventional LINACs. Herein, the authors review the technical characteristics and advantages of MRI-guided RT as well as emerging clinical outcomes.
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Affiliation(s)
- Michael D Chuong
- Department of Radiation Oncology, Miami Cancer Institute, 8900 North Kendall Drive, Miami, FL 33176, USA.
| | - Russell F Palm
- Department of Radiation Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Michael C Tjong
- Department of Radiation Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Daniel E Hyer
- Department of Radiation Oncology, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242, USA
| | - Amar U Kishan
- Department of Radiation Oncology, University of California Los Angeles, 1338 S Hope Street, Los Angeles, CA 90015, USA
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13
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Lee SL, Bassetti MF, Rusthoven CG. The Role of Stereotactic Body Radiation Therapy in the Management of Liver Metastases. Semin Radiat Oncol 2023; 33:181-192. [PMID: 36990635 DOI: 10.1016/j.semradonc.2022.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
The liver is a common site for metastatic spread for various primary tumor histologies. Stereotactic body radiation therapy (SBRT) is a non-invasive treatment technique with broad patient candidacy for the ablation of tumors in the liver and other organs. SBRT involves focused, high-dose radiation therapy delivered in one to several treatments, resulting in high rates of local control. Use of SBRT for ablation of oligometastatic disease has increased in recent years and emerging prospective data have demonstrated improvements in progression free and overall survival in some settings. When delivering SBRT to liver metastases, clinicians must balance the priorities of delivering ablative tumor dosing while respecting dose constraints to surrounding organs at risk (OARs). Motion management techniques are crucial for meeting dose constraints, ensuring low rates of toxicity, maintaining quality of life, and can allow for dose escalation. Advanced radiotherapy delivery approaches including proton therapy, robotic radiotherapy, and real-time MR-guided radiotherapy may further improve the accuracy of liver SBRT. In this article, we review the rationale for oligometastases ablation, the clinical outcomes with liver SBRT, tumor dose and OAR considerations, and evolving strategies to improve liver SBRT delivery.
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Affiliation(s)
- Sangjune Laurence Lee
- Division of Radiation Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, AB, Canada.
| | - Michael F Bassetti
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Chad G Rusthoven
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO
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14
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Grimbergen G, Eijkelenkamp H, van Vulpen JK, van de Ven S, Raaymakers BW, Intven MP, Meijer GJ. Feasibility of online radial magnetic resonance imaging for adaptive radiotherapy of pancreatic tumors. Phys Imaging Radiat Oncol 2023; 26:100434. [PMID: 37034029 PMCID: PMC10074242 DOI: 10.1016/j.phro.2023.100434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 03/22/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023] Open
Abstract
Background and purpose Online adaptive magnetic resonance (MR)-guided treatment planning for pancreatic tumors on 1.5T systems typically employs Cartesian 3D T 2w magnetic resonance imaging (MRI). The main disadvantage of this sequence is that respiratory motion results in substantial blurring in the abdomen, which can hamper delineation accuracy. This study investigated the use of two motion-robust radial MRI sequences as main delineation scan for pancreatic MR-guided radiotherapy. Materials and methods Twelve patients with pancreatic tumors were imaged with a 3D T 2w scan, a Periodically Rotated Overlapping ParallEL Lines with Enhanced Reconstruction (PROPELLER) scan (partially overlapping strips), and a 3D Vane scan (stack-of-stars), on a 1.5T MR-Linac under abdominal compression. The scans were assessed by three radiation oncologists for their suitability for online adaptive delineation. A quantitative comparison was made for gradient entropy and the effect of motion on apparent target position. Results The PROPELLER scans were selected as first preference in 56% of the cases, the 3D T 2w in 42% and the 3D Vane in 3%. PROPELLER scans sometimes contained a large interslice variation which would have compromised delineation. Gradient entropy was significantly higher in 3D T 2w patient scans. The apparent target position was more sensitive to motion amplitude in the PROPELLER scans, but substantial offsets did not occur under 10 mm peak-to-peak. Conclusion PROPELLER MRI may be a superior imaging sequence for pancreatic MRgRT compared to standard Cartesian sequences. The large interslice variation should be mitigated through further sequence optimization before PROPELLER can be adopted for online treatment adaptation.
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15
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Muacevic A, Adler JR, Miyake Y, Arato T, Starbuck W. Biologically Equivalent Dose Comparison Between Magnetic Resonance-Guided Adaptive and Computed Tomography-Guided Internal Target Volume-Based Stereotactic Body Radiotherapy for Liver Tumors. Cureus 2023; 15:e33478. [PMID: 36756023 PMCID: PMC9902058 DOI: 10.7759/cureus.33478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2023] [Indexed: 01/09/2023] Open
Abstract
Background and aim Magnetic resonance (MR) imaging has been increasingly adopted in the field of radiotherapy, and the most advanced MR image-guided radiotherapy is known as MR-guided online adaptive radiotherapy (MRgOART), which integrates MRI and linac systems. Few attempts have yet been made to directly compare treatment outcomes between the MRgOART and standard computed tomography (CT)-guided radiotherapy (CTgRT). Besides, it is reported that the biologically equivalent dose (BED) may be a good predictor of the local control (LC) and the overall survival (OS) for liver tumors. The purpose of this study is to compare the BEDs between the MRgOART and the CTgRT by way of virtual isotoxic planning for liver tumors. The hypothesis of this study is therefore that the MRgOART increases LC and OS as compared to the CTgRT. Materials and methods Using the five patient cases available, isotoxic planning was performed. For CTgRT, an internal target volume (ITV) was defined, and the planning target volume (PTV) was created by adding an isotropic margin of 10 mm. For MRgRT, a gross tumor volume (GTV) was defined, and the PTV was created by adding an isotropic margin of 5 mm. Each tumor size was virtually adjusted so that the CTgRT plans resulted in BED <100 Gy under the condition that the nearest organs at risk receive maximum tolerated doses. Subsequently, the BED was recalculated for MRgOART plans with the adjusted tumor size. Results and discussion It was found that the BEDs of the MRgOART plans always exceeded 100 Gy and were approximately 20 Gy larger than those of the corresponding CTgRT plans. Literature shows that superior overall survival rates for liver tumors were observed when BED was >100 Gy as compared to BED <100 Gy, suggesting that MR-guided adaptive planning may potentially lead to better treatment outcomes for liver tumors. We have also observed a case where the duodenum largely moved and abutted the liver after the CT images were acquired, indicating a significant disadvantage of the standard CTgRT because such abutting is not observable by the cone-beam CT immediately before treatment. Conclusion A highly accelerated evidence-creation procedure to suggest the clinical superiority of MRgOART has been arguably proposed with promising results. The sample size is small and limits the extent to which the findings in this study can be generalized. Further virtual clinical trials within the radiotherapy community are awaited with more clinical outcomes data.
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16
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Weykamp F, Katsigiannopulos E, Piskorski L, Regnery S, Hoegen P, Ristau J, Renkamp CK, Liermann J, Forster T, Lang K, König L, Rippke C, Buchele C, Debus J, Klüter S, Hörner-Rieber J. Dosimetric Benefit of Adaptive Magnetic Resonance-Guided Stereotactic Body Radiotherapy of Liver Metastases. Cancers (Basel) 2022; 14:cancers14246041. [PMID: 36551527 PMCID: PMC9775484 DOI: 10.3390/cancers14246041] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/04/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
(1) Background: To assess dosimetry benefits of stereotactic magnetic resonance (MR)-guided online adaptive radiotherapy (SMART) of liver metastases. (2) Methods: This is a subgroup analysis of an ongoing prospective registry including patients with liver metastases. Patients were treated at the MRIdian Linac between February 2020 and April 2022. The baseline plan was recalculated based on the updated anatomy of the day to generate the predicted plan. This predicted plan could then be re-optimized to create an adapted plan. (3) Results: Twenty-three patients received 30 SMART treatment series of in total 36 liver metastases. Most common primary tumors were colorectal- and pancreatic carcinoma (26.1% respectively). Most frequent fractionation scheme (46.6%) was 50 Gy in five fractions. The adapted plan was significantly superior compared to the predicted plan in regard to planning-target-volume (PTV) coverage, PTV overdosing, and organs-at-risk (OAR) dose constraints violations (91.5 vs. 38.0%, 6 vs. 19% and 0.6 vs. 10.0%; each p < 0.001). Plan adaptation significantly increased median BEDD95 by 3.2 Gy (p < 0.001). Mean total duration of SMART was 72.4 min. (4) Conclusions: SMART offers individualized ablative irradiation of liver metastases tailored to the daily anatomy with significant superior tumor coverage and improved sparing of OAR.
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Affiliation(s)
- Fabian Weykamp
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Correspondence:
| | - Efthimios Katsigiannopulos
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
| | - Lars Piskorski
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
| | - Sebastian Regnery
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Philipp Hoegen
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Jonas Ristau
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - C. Katharina Renkamp
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
| | - Jakob Liermann
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Tobias Forster
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Kristin Lang
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Carolin Rippke
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
| | - Carolin Buchele
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Heidelberg, 69120 Heidelberg, Germany
| | - Sebastian Klüter
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
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17
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Goodburn RJ, Philippens MEP, Lefebvre TL, Khalifa A, Bruijnen T, Freedman JN, Waddington DEJ, Younus E, Aliotta E, Meliadò G, Stanescu T, Bano W, Fatemi‐Ardekani A, Wetscherek A, Oelfke U, van den Berg N, Mason RP, van Houdt PJ, Balter JM, Gurney‐Champion OJ. The future of MRI in radiation therapy: Challenges and opportunities for the MR community. Magn Reson Med 2022; 88:2592-2608. [PMID: 36128894 PMCID: PMC9529952 DOI: 10.1002/mrm.29450] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 01/11/2023]
Abstract
Radiation therapy is a major component of cancer treatment pathways worldwide. The main aim of this treatment is to achieve tumor control through the delivery of ionizing radiation while preserving healthy tissues for minimal radiation toxicity. Because radiation therapy relies on accurate localization of the target and surrounding tissues, imaging plays a crucial role throughout the treatment chain. In the treatment planning phase, radiological images are essential for defining target volumes and organs-at-risk, as well as providing elemental composition (e.g., electron density) information for radiation dose calculations. At treatment, onboard imaging informs patient setup and could be used to guide radiation dose placement for sites affected by motion. Imaging is also an important tool for treatment response assessment and treatment plan adaptation. MRI, with its excellent soft tissue contrast and capacity to probe functional tissue properties, holds great untapped potential for transforming treatment paradigms in radiation therapy. The MR in Radiation Therapy ISMRM Study Group was established to provide a forum within the MR community to discuss the unmet needs and fuel opportunities for further advancement of MRI for radiation therapy applications. During the summer of 2021, the study group organized its first virtual workshop, attended by a diverse international group of clinicians, scientists, and clinical physicists, to explore our predictions for the future of MRI in radiation therapy for the next 25 years. This article reviews the main findings from the event and considers the opportunities and challenges of reaching our vision for the future in this expanding field.
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Affiliation(s)
- Rosie J. Goodburn
- Joint Department of PhysicsInstitute of Cancer Research and Royal Marsden NHS Foundation TrustLondonUnited Kingdom
| | | | - Thierry L. Lefebvre
- Department of PhysicsUniversity of CambridgeCambridgeUnited Kingdom
- Cancer Research UK Cambridge Research InstituteUniversity of CambridgeCambridgeUnited Kingdom
| | - Aly Khalifa
- Department of Medical BiophysicsUniversity of TorontoTorontoOntarioCanada
| | - Tom Bruijnen
- Department of RadiotherapyUniversity Medical Center UtrechtUtrechtNetherlands
| | | | - David E. J. Waddington
- Faculty of Medicine and Health, Sydney School of Health Sciences, ACRF Image X InstituteThe University of SydneySydneyNew South WalesAustralia
| | - Eyesha Younus
- Department of Medical Physics, Odette Cancer CentreSunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Eric Aliotta
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Gabriele Meliadò
- Unità Operativa Complessa di Fisica SanitariaAzienda Ospedaliera Universitaria Integrata VeronaVeronaItaly
| | - Teo Stanescu
- Department of Radiation Oncology, University of Toronto and Medical Physics, Princess Margaret Cancer CentreUniversity Health NetworkTorontoOntarioCanada
| | - Wajiha Bano
- Joint Department of PhysicsInstitute of Cancer Research and Royal Marsden NHS Foundation TrustLondonUnited Kingdom
| | - Ali Fatemi‐Ardekani
- Department of PhysicsJackson State University (JSU)JacksonMississippiUSA
- SpinTecxJacksonMississippiUSA
- Department of Radiation OncologyCommunity Health Systems (CHS) Cancer NetworkJacksonMississippiUSA
| | - Andreas Wetscherek
- Joint Department of PhysicsInstitute of Cancer Research and Royal Marsden NHS Foundation TrustLondonUnited Kingdom
| | - Uwe Oelfke
- Joint Department of PhysicsInstitute of Cancer Research and Royal Marsden NHS Foundation TrustLondonUnited Kingdom
| | - Nico van den Berg
- Department of RadiotherapyUniversity Medical Center UtrechtUtrechtNetherlands
| | - Ralph P. Mason
- Department of RadiologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Petra J. van Houdt
- Department of Radiation OncologyNetherlands Cancer InstituteAmsterdamNetherlands
| | - James M. Balter
- Department of Radiation OncologyUniversity of MichiganAnn ArborMichiganUSA
| | - Oliver J. Gurney‐Champion
- Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam UMCUniversity of AmsterdamAmsterdamNetherlands
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