Fast and robust online adaptive planning in stereotactic MR-guided adaptive radiation therapy (SMART) for pancreatic cancer

Bohoudi, O.; Bruynzeel, A.; Senan, Suresh; Cuijpers, J.P.; Slotman, Ben J.; Lagerwaard, Frank J.; Palacios, Miguel

doi:10.1016/j.radonc.2017.07.028

Cited by 280 publications

(257 citation statements)

References 34 publications

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“…This has to be the future of radiotherapy, and great moves have actually been made in this direction with the recent development and introduction of MRI-Linac hybrid devices. 30,31 Indeed, although the re-calculation of a new plan each day may seem challenging, as GPU based dose calculations near maturity, it appears that sub-second dose calculations (and optimizations) are just around the corner. However, as with all apparently simple advances, the devil is always in the detail, and there are three "devils" in this case plan evaluation, plan QA, and dose accumulation.…”

Section: Reducing Margins (Predictions 23 and 24)mentioning

confidence: 99%

What will the medical physics of proton therapy look like 10 yr from now? A personal view

Lomax

2018

Medical Physics

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Despite growing rapidly, proton therapy is still a relatively immature treatment modality, at least in comparison to conventional radiotherapy using photons. As such, in this article, the author gives a very personal view of some of the potential areas for development in medical physics for proton therapy in the next 10 yr by identifying six topics for detailed discussion. The first of these are all related to reducing various “parameters” of proton therapy treatments (size and cost, treatment times, penumbras, and margins), while the second group are related to providing more quantitative “knowledge” about the quality of the treatments we are delivering. In conclusion, there is much interesting and important work still to be done in many areas of medical physics related to proton therapy, of which, the topics selected here are just the tip of the iceberg.

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Section: Reducing Margins (Predictions 23 and 24)mentioning

confidence: 99%

What will the medical physics of proton therapy look like 10 yr from now? A personal view

Lomax

2018

Medical Physics

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“…MRgRT offers excellent visualization of the stomach, duodenum, small, and large intestines in the setting of abdominal RT and thus can account for interfractional variability of these organs . The ability to adapt treatment plans daily allows for improved target volume coverage while meeting OAR constraints that is necessitated by daily gastrointestinal (GI) organ motion and deformation . While dose escalation with MRgRT appears technically feasible and can spare OARs from high doses of radiation, it is not clear whether this leads to changes in clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

Using adaptive magnetic resonance image‐guided radiation therapy for treatment of inoperable pancreatic cancer

et al. 2019

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Background Adaptive magnetic resonance imaging‐guided radiation therapy (MRgRT) can escalate dose to tumors while minimizing dose to normal tissue. We evaluated outcomes of inoperable pancreatic cancer patients treated using MRgRT with and without dose escalation. Methods We reviewed 44 patients with inoperable pancreatic cancer treated with MRgRT. Treatments included conventional fractionation, hypofractionation, and stereotactic body radiation therapy. Patients were stratified into high‐dose (biologically effective dose [BED 10 ] >70) and standard‐dose groups (BED 10 ≤70). Overall survival (OS), freedom from local failure (FFLF) and freedom from distant failure (FFDF) were evaluated using Kaplan‐Meier method. Cox regression was performed to identify predictors of OS. Acute gastrointestinal (GI) toxicity was assessed for 6 weeks after completion of RT. Results Median follow‐up was 17 months. High‐dose patients (n = 24, 55%) had statistically significant improvement in 2‐year OS (49% vs 30%, P = 0.03) and trended towards significance for 2‐year FFLF (77% vs 57%, P = 0.15) compared to standard‐dose patients (n = 20, 45%). FFDF at 18 months in high‐dose vs standard‐dose groups was 24% vs 48%, respectively ( P = 0.92). High‐dose radiation (HR: 0.44; 95% confidence interval [CI]: 0.21‐0.94; P = 0.03) and duration of induction chemotherapy (HR: 0.84; 95% CI: 0.72‐0.98; P = 0.03) were significantly correlated with OS on univariate analysis but neither factor was independently predictive on multivariate analysis. Grade 3+ GI toxicity occurred in three patients in the standard‐dose group and did not occur in the high‐dose group. Conclusions Patients treated with dose‐escalated MRgRT demonstrated improved OS. Prospective evaluation of high‐dose RT regimens with standardized treatment parameters in inoperable pancreatic cancer patients is warranted.

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“…Stereotactic MR-guided adaptive radiation therapy has been demonstrated to provide an accurate and robust online adaptive solution for SBRT treatment using an MR-guided Co-60 therapy system [3,7,14]. However, due to the limitation of Cobalt source size and MLC leaf resolution, MR-guided stereotactic radiosurgery (MRgSRS) for intracranial treatment is not feasible on the Cobalt unit.…”

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confidence: 99%

Evaluation of a magnetic resonance guided linear accelerator for stereotactic radiosurgery treatment

Wen

Kim

Doemer

et al. 2018

Radiotherapy and Oncology

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Introduction: The purpose of this study was to investigate the systematic localization accuracy, treatment planning capability, and delivery accuracy of an integrated magnetic resonance imaging guided Linear Accelerator (MR-Linac) platform for stereotactic radiosurgery. Materials and methods: The phantom for the end-to-end test comprises three different compartments: a rectangular MR/CT target phantom, a Winston–Lutz cube, and a rectangular MR/CT isocenter phantom. Hidden target tests were performed at gantry angles of 0, 90, 180, and 270 degrees to quantify the systematic accuracy. Five patient plans with a total of eleven lesions were used to evaluate the dosimetric accuracy. Single-isocenter IMRT treatment plans using 10–15 coplanar beams were generated to treat the multiple metastases. Results: The end-to-end localization accuracy of the system was 1.0 ± 0.1 mm. The conformity index, homogeneity index and gradient index of the plans were 1.26 ± 0.22, 1.22 ± 0.10, and 5.38 ± 1.44, respectively. The average absolute point dose difference between measured and calculated dose was 1.64 ± 1. 90%, and the mean percentage of points passing the 3%/1 mm gamma criteria was 96.87%. Conclusions: Our experience demonstrates that excellent plan quality and delivery accuracy was achievable on the MR-Linac for treating multiple brain metastases with a single isocenter.

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Fast and robust online adaptive planning in stereotactic MR-guided adaptive radiation therapy (SMART) for pancreatic cancer

Cited by 280 publications

References 34 publications

What will the medical physics of proton therapy look like 10 yr from now? A personal view

What will the medical physics of proton therapy look like 10 yr from now? A personal view

Using adaptive magnetic resonance image‐guided radiation therapy for treatment of inoperable pancreatic cancer

Evaluation of a magnetic resonance guided linear accelerator for stereotactic radiosurgery treatment

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