MR-guided stereotactic body radiation therapy for intracardiac and pericardial metastases

Sim, Austin J.; Palm, Russell; Delozier, Kirby B.; Feygelman, Vladimir; Latifi, Kujtim; Redler, Gage; Washington, Iman; Wuthrick, Evan; Rosenberg, Stephen A.

doi:10.1016/j.ctro.2020.10.006

Cited by 17 publications

(8 citation statements)

References 24 publications

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“…Currently, SMART data are very limited for these rare tumors. A single institutional experiment in five patients with cardiac lesions that were treated with SMART reported excellent tumor coverage and minimal toxicity [ 64 ]. Larger series are required to optimize the dosage for various histologies and to better explore the role of MRgRT in cardiac tumors.…”

Section: Smart Clinical Applicationsmentioning

confidence: 99%

Stereotactic Magnetic Resonance-Guided Adaptive and Non-Adaptive Radiotherapy on Combination MR-Linear Accelerators: Current Practice and Future Directions

Bryant

Weygand

Keit

et al. 2023

Cancers

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Stereotactic body radiotherapy (SBRT) is an effective radiation therapy technique that has allowed for shorter treatment courses, as compared to conventionally dosed radiation therapy. As its name implies, SBRT relies on daily image guidance to ensure that each fraction targets a tumor, instead of healthy tissue. Magnetic resonance imaging (MRI) offers improved soft-tissue visualization, allowing for better tumor and normal tissue delineation. MR-guided RT (MRgRT) has traditionally been defined by the use of offline MRI to aid in defining the RT volumes during the initial planning stages in order to ensure accurate tumor targeting while sparing critical normal tissues. However, the ViewRay MRIdian and Elekta Unity have improved upon and revolutionized the MRgRT by creating a combined MRI and linear accelerator (MRL), allowing MRgRT to incorporate online MRI in RT. MRL-based MR-guided SBRT (MRgSBRT) represents a novel solution to deliver higher doses to larger volumes of gross disease, regardless of the proximity of at-risk organs due to the (1) superior soft-tissue visualization for patient positioning, (2) real-time continuous intrafraction assessment of internal structures, and (3) daily online adaptive replanning. Stereotactic MR-guided adaptive radiation therapy (SMART) has enabled the safe delivery of ablative doses to tumors adjacent to radiosensitive tissues throughout the body. Although it is still a relatively new RT technique, SMART has demonstrated significant opportunities to improve disease control and reduce toxicity. In this review, we included the current clinical applications and the active prospective trials related to SMART. We highlighted the most impactful clinical studies at various tumor sites. In addition, we explored how MRL-based multiparametric MRI could potentially synergize with SMART to significantly change the current treatment paradigm and to improve personalized cancer care.

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Section: Smart Clinical Applicationsmentioning

confidence: 99%

Stereotactic Magnetic Resonance-Guided Adaptive and Non-Adaptive Radiotherapy on Combination MR-Linear Accelerators: Current Practice and Future Directions

Bryant

Weygand

Keit

et al. 2023

Cancers

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“…One group successfully treated five patients with cardiac or pericardial metastatic lesions who were symptomatic from involvement by using MRgRT [ 81 ]. The median prescribed dose to PTV was 40 Gy, with a range of 40–50 Gy delivered in 5 fractions on non-consecutive days.…”

Section: Future Endeavorsmentioning

confidence: 99%

Towards Accurate and Precise Image-Guided Radiotherapy: Clinical Applications of the MR-Linac

Randall

Ram-Mohan

Das

et al. 2022

JCM

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Advances in image-guided radiotherapy have brought about improved oncologic outcomes and reduced toxicity. The next generation of image guidance in the form of magnetic resonance imaging (MRI) will improve visualization of tumors and make radiation treatment adaptation possible. In this review, we discuss the role that MRI plays in radiotherapy, with a focus on the integration of MRI with the linear accelerator. The MR linear accelerator (MR-Linac) will provide real-time imaging, help assess motion management, and provide online adaptive therapy. Potential advantages and the current state of these MR-Linacs are highlighted, with a discussion of six different clinical scenarios, leading into a discussion on the future role of these machines in clinical workflows.

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“…MRI-guided stereotactic body radiotherapy (SBRT) might be considered for palliative purposes and symptom relief in metastatic disease or to eradicate single cardiac metastases or small cardiac masses. MRI guidance limits exposure to radiation and cardiotoxicity, using a dose of 40 Gy in five fractions [102].…”

Section: New Therapeutic Strategies and Future Perspectivesmentioning

confidence: 99%

Primary Soft Tissue Sarcoma of the Heart: An Emerging Chapter in Cardio-Oncology

Scicchitano¹,

Sergi

Cameli

et al. 2021

Biomedicines

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Primary malignant cardiac tumors are rare, with a prevalence of about 0.01% among all cancer histotypes. At least 60% of them are primary soft tissue sarcomas of the heart (pSTS-h) that represent almost 1% of all STSs. The cardiac site of origin is the best way to classify pSTS-h as it is directly linked to the surgical approach for cancer removal. Indeed, histological differentiation should integrate the classification to provide insights into prognosis and survival expectancy of the patients. The prognosis of pSTS-h is severe and mostly influenced by the primary localization of the tumor, the difficulty in achieving complete surgical and pharmacological eradication, and the aggressive biological features of malignant cells. This review aims to provide a detailed literature overview of the most relevant issues on primary soft tissue sarcoma of the heart and highlight potential diagnostic and therapeutic future perspectives.

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MR-guided stereotactic body radiation therapy for intracardiac and pericardial metastases

Cited by 17 publications

References 24 publications

Stereotactic Magnetic Resonance-Guided Adaptive and Non-Adaptive Radiotherapy on Combination MR-Linear Accelerators: Current Practice and Future Directions

Stereotactic Magnetic Resonance-Guided Adaptive and Non-Adaptive Radiotherapy on Combination MR-Linear Accelerators: Current Practice and Future Directions

Towards Accurate and Precise Image-Guided Radiotherapy: Clinical Applications of the MR-Linac

Primary Soft Tissue Sarcoma of the Heart: An Emerging Chapter in Cardio-Oncology

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