Implementing stereotactic accelerated partial breast irradiation using magnetic resonance guided radiation therapy

Abstract

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Movement assessment of breast and organ-at-risks using free-breathing, self-gating 4D magnetic resonance imaging workflow for breast cancer radiation therapy

“…It had overall good delineation of OAR in 4D MRI images [3] , with coverage comparable to a CT examination. The analysis of the distance between the OAR showed a dominant head-feet motion in the chest and heart region when the breast (without surgery in our case) was not prone to large amplitude movements [17] , [18] , [19] in our proposed treatment setup.…”

“…Our free-breathing approach could satisfy the needs of partial breast irradiation strategies [18] , [19] , [20] . As has been shown [21] , 4D MRI using T1w GRE sequences was useful for characterizing the position of marker clips.…”

“…Overall, our approach may lead to reduced dose in the breast, reducing medium/long term toxicity. The introduction of 4D MRI could change breast treatment workflows as finding the proper slices for motion assessment is no longer necessary during the scan session in comparison with 2D MRI dynamic acquisition across phases of the respiratory cycle [18] . In combination with 4DCT or DIBH CT for planning, it potentially leads to optimal image registration for planning in one case and/or reduction of irradiation [7] .…”

Single-fraction high-dose-rate brachytherapy: a scoping review on outcomes and toxicities for all disease sites

“…There is an ongoing clinical trial with a balloon-based single-fraction technique, which has not reported oncologic outcomes yet [ 57 ], but has reported limited severe toxicities to date. Single-fraction external beam treatments are also being developed both in the pre-operative and post-operative spaces [ 58 ]. Continued work in this space is needed to determine the ideal single-fraction dose, and long-term oncologic and toxicity outcomes.…”

Adaptive radiotherapy for breast cancer

“…Here, no additional margins for the PTV were used, minimal intrafraction motion of the tumor bed was observed [32] and a seroma reduction was documented through repeated MR scanning during the course of radiotherapy [33] , suggesting MR as an optimal imaging modality for ART in the adjuvant PBI setting. More recently, MR-guided adjuvant PBI at the 0.35 T (MRdian, ViewRay) [34] , [35] and 1.5 T MR-Linac (Unity, Elekta) [36] , [37] have been successfully delivered. Treatments could be performed in a short time, with daily plan adaptation taking on average four minutes and a cumulative in-room time of 25 min [36] .…”