Evaluation of clinical parallel workflow in online adaptive MR-guided Radiotherapy: A detailed assessment of treatment session times

Votta, Claudio; Iacovone, Sara; Turco, Gabriele; Carrozzo, Valerio; Vagni, Marica; Scalia, Aurora; Chiloiro, Giuditta; Meffe, Guenda; Nardini, Matteo; Panza, Giulia; Placidi, Lorenzo; Romano, Angela; Cornacchione, Patrizia; Gambacorta, Maria Antonietta; Boldrini, Luca

doi:10.1016/j.tipsro.2024.100239

Cited by 2 publications

(3 citation statements)

References 36 publications

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“…Therefore, our approach would rather allow tighter margins for both target and OAR without compromising on target coverage or OAR constraints. The median treatment time of 15 min was equivalent to other MRIdian A3i deliveries of tumor tracking only ( 19 ). MRIdian A3i parallel workflow efficiency gains of 30% reduction in online adaptive replanning times have been previously reported ( 19 ).…”

Section: Discussionmentioning

confidence: 88%

“…The median treatment time of 15 min was equivalent to other MRIdian A3i deliveries of tumor tracking only ( 19 ). MRIdian A3i parallel workflow efficiency gains of 30% reduction in online adaptive replanning times have been previously reported ( 19 ). The workflow presented here can be adopted for the definitive treatment of any thoracic, abdominal, or pelvic target with dose-limiting OAR in close proximity to ablative doses with an isotoxicity approach.…”

Section: Discussionmentioning

confidence: 88%

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Case report: Intrafraction dose-guided tracking for gastrointestinal organ-at-risk isotoxicity delivery on an MR-guided radiotherapy system

Yarlagadda,

Weiss,

Chuong

et al. 2024

Front. Oncol.

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In the current era of high-precision radiation therapy, real-time magnetic resonance (MR)-guided tracking of the tumor and organs at risk (OARs) is a novel approach that enables accurate and safe delivery of high-dose radiation. Organ tracking provides a general sense of the need for daily online adaptation but lacks precise information regarding exact dosimetry. To overcome this limitation, we developed the methodology for monitoring intrafraction motion with real-time MR-guided isodose line-based tracking of an OAR in combination with anatomic tumor-based tracking and reported the first case treated with this approach. An isolated para-aortic (PA) nodal recurrence from carcinosarcoma of the endometrium was treated with an ablative dose of 50 Gy in five fractions using MR-guided radiotherapy (MRgRT). This report demonstrates the feasibility, workflow, dosimetric constraints, and treatment paradigm for real-time isodose line-based OAR tracking and gating to enable an isotoxicity delivery approach. This innovative treatment strategy effectively tracked the intrafraction motion of both the target and OAR independently and enhanced the accuracy of structure localization in time and space with a more precise dosimetric evaluation.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 88%

Case report: Intrafraction dose-guided tracking for gastrointestinal organ-at-risk isotoxicity delivery on an MR-guided radiotherapy system

Yarlagadda,

Weiss,

Chuong

et al. 2024

Front. Oncol.

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“…These stations could be arranged side by side, or, as in our clinic, two are in the Linac's room and another in a consultation room. Simultaneous work allows us to maintain treatment times similar to those described in the literature, with a median of 39 minutes for pancreatic cases, even though our radiation oncologists have to verify the contours of RTTs, and daily re-optimization was performed in all patients [28]. Additionally, we developed a rotating schedule among our clinicians that allows them to participate in the MR-Linac workflow, with adaptations comparable to the first clinical consultation, thus increasing operational efficiency.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and Acute Toxicity of Hypo-Fractionated Radiotherapy on 0.35T MR-LINAC: The First Prospective Study in Spain

Gonsalves,

Ocanto,

Meilan

et al. 2024

Cancers

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This observational, descriptive, longitudinal, and prospective basket-type study (Registry #5289) prospectively evaluated the feasibility and acute toxicity of hypo-fractionated radiotherapy on the first 0.35T MR-LINAC in Spain. A total of 37 patients were included between August and December 2023, primarily with prostate tumors (59.46%), followed by pancreatic tumors (32.44%). Treatment regimens typically involved extreme hypo-fractionated radiotherapy, with precise dose delivery verified through quality assurance measures. Acute toxicity assessment at treatment completion revealed manageable cystitis, with one case persisting at the three-month follow-up. Gastrointestinal toxicity was minimal. For pancreatic tumors, daily adaptation of organ-at-risk (OAR) and gross tumor volume (GTV) was practiced, with median doses to OAR within acceptable limits. Three patients experienced gastrointestinal toxicity, mainly nausea. Overall, the study demonstrates the feasibility and safety of extreme hypo-fractionated radiotherapy on a 0.35T MR-LINAC, especially for challenging anatomical sites like prostate and pancreatic tumors. These findings support the feasibility of MR-LINAC-based radiotherapy in delivering precise treatments with minimal toxicity, highlighting its potential for optimizing cancer treatment strategies.

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Evaluation of clinical parallel workflow in online adaptive MR-guided Radiotherapy: A detailed assessment of treatment session times

Cited by 2 publications

References 36 publications

Case report: Intrafraction dose-guided tracking for gastrointestinal organ-at-risk isotoxicity delivery on an MR-guided radiotherapy system

Case report: Intrafraction dose-guided tracking for gastrointestinal organ-at-risk isotoxicity delivery on an MR-guided radiotherapy system

Feasibility and Acute Toxicity of Hypo-Fractionated Radiotherapy on 0.35T MR-LINAC: The First Prospective Study in Spain

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