MR-LINAC, a New Partner in Radiation Oncology: Current Landscape

Abstract

Technological advances in radiation oncology are oriented towards improving treatment precision and tumor control. Among these advances, magnetic-resonance-image-guided radiation therapy (MRgRT) stands out, with technological advances to deliver targeted treatments adapted to a tumor’s anatomy on the day while minimizing incidental exposure to organs at risk, offering an unprecedented therapeutic advantage compared to X-ray-based IGRT delivery systems. This new technology changes the traditional workflow in radiation oncology and requires an evolution in team coordination to administer more precise treatments. Once implemented, it paves the way for newer indication for radiation therapy to safely deliver higher doses than ever before, with better preservation of healthy tissues to optimize patient outcomes. In this narrative review, we assess the technical aspects of the novel linear accelerators that can deliver MRgRT and summarize the available published experience to date, focusing on oncological results and future challenges.

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

“…Currently, prostate tumors [5] and pancreatic tumors [6] emerge as locations with the most significant benefit and experience from guided adapted approaches, though the list continues to grow. Reports are promising, with minimal acute toxicity rates that do not impact the quality of life and confirm reasonable local control [4]. In this study, we prospectively evaluate the feasibility and acute toxicity of patients undergoing hypo-fractionated radiotherapy on a 0.35T MR-LINAC.…”

“…This is due to the limited tolerance of organs at risk (OARs) to ionizing radiation and the significant mobility of structures such as ultra-central lung tumors or those in the upper abdomen. Further clinical studies are waiting for other locations where dose escalation has shown promising clinical advantages [3,4]. Currently, prostate tumors [5] and pancreatic tumors [6] emerge as locations with the most significant benefit and experience from guided adapted approaches, though the list continues to grow.…”