MRI-guided Radiotherapy (MRgRT) for Treatment of Oligometastases: Review of Clinical Applications and Challenges

Chetty, Indrin J.; Doemer, Anthony; Dolan, Jennifer L.; Kim, Joshua; Cunningham, Justine M; Dragovic, Jadranka; Feldman, Aharon; Walker, Eleanor M.; Elshaikh, Mohamed A.; Adil, Khaled; Movsas, Benjamin; Parikh, Parag J.

doi:10.1016/j.ijrobp.2022.07.027

Cited by 14 publications

(4 citation statements)

References 170 publications

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“…MRgRT is considered to be one of the most promising techniques used to deliver ablative RT doses in challenging anatomical locations, safely and effectively, and may play a pivotal role in the treatment of oligometastatic disease [ 21 ]. Recent reports from other monoinstitutional retrospective studies that implemented the SMART approach in primary and secondary malignancies demonstrated a high tolerance profile with G3 toxicity rates ranging from 0 to 8% and no G4 toxicity, with promising disease control rates [ 6 , 22 – 26 ].…”

Section: Discussionmentioning

confidence: 99%

Magnetic resonance-guided stereotactic body radiation therapy (MRgSBRT) for oligometastatic patients: a single-center experience

et al. 2023

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Purpose Stereotactic body radiotherapy is increasingly used for the treatment of oligometastatic disease. Magnetic resonance-guided stereotactic radiotherapy (MRgSBRT) offers the opportunity to perform dose escalation protocols while reducing the unnecessary irradiation of the surrounding organs at risk. The aim of this retrospective, monoinstitutional study is to evaluate the feasibility and clinical benefit (CB) of MRgSBRT in the setting of oligometastatic patients. Materials and methods Data from oligometastatic patients treated with MRgSBRT were collected. The primary objectives were to define the 12-month progression-free survival (PFS) and local progression-free survival (LPFS) and 24-month overall survival (OS) rate. The objective response rate (ORR) included complete response (CR) and partial response (PR). CB was defined as the achievement of ORR and stable disease (SD). Toxicities were also assessed according to the CTCAE version 5.0 scale. Results From February 2017 to March 2021, 59 consecutive patients with a total of 80 lesions were treated by MRgSBRT on a 0.35 T hybrid unit. CR and PR as well as SD were observed in 30 (37.5%), 7 (8.75%), and 17 (21.25%) lesions, respectively. Furthermore, CB was evaluated at a rate of 67.5% with an ORR of 46.25%. Median follow-up time was 14 months (range: 3–46 months). The 12-month LPFS and PFS rates were 70% and 23%, while 24-month OS rate was 93%. No acute toxicity was reported, whereas late pulmonary fibrosis G 1 was observed in 9 patients (15.25%). Conclusion MRgSBRT was well tolerated by patients with reported low toxicity levels and a satisfying CB. Supplementary Information The online version contains supplementary material available at 10.1007/s11547-023-01627-4.

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Section: Discussionmentioning

confidence: 99%

Magnetic resonance-guided stereotactic body radiation therapy (MRgSBRT) for oligometastatic patients: a single-center experience

et al. 2023

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“…To highlight the value of dose escalation facilitated with MRgRT, 2-year LC was 96% for lesions that were treated with BED ≥ 100 versus 69% for BED < 100 (p = 0.02). PFS was significantly improved in patients with locally controlled tumors (2-year PFS 21 vs. 8%, p = 0.03) Of course, MRgRT is not limited to metastases in these locations and also has shown utility in a number of other sites including breast, adrenal glands, brain, spine, and pediatric patients [41]. Any tumor with close proximity to critical organs, with significant motion or without clear borders on CT, stands to benefit from MRgRT by ensuring that ablative doses required to improve PFS and OS can be delivered.…”

Section: Oligometastasesmentioning

confidence: 98%

“…The role of MRgRT in pancreatic cancer was investigated as part of a multi-institutional study by Rudra et al [18]. In this study of 44 patients with inoperable pancreatic cancer, 13 patients received conventional fractionation (40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55) Gy in 25-28 fractions), 9 received hypofractionation (50-67.5 Gy in 10-15 fractions), 6 received conventional SBRT (30)(31)(32)(33)(34)(35) Gy in 5 fractions), and 16 received high-dose SBRT (40-52 Gy in 5 fractions). Adaptive replanning was used for treatment courses of 15 or fewer fractions, with OAR doses prioritized and dose escalation permitted if normal tissue constraints could be met.…”

Section: Pancreasmentioning

confidence: 99%

Clinical Applications of Magnetic Resonance-Guided Radiotherapy: A Narrative Review

Ladbury

Amini

Schwer

et al. 2023

Cancers

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Magnetic resonance-guided radiotherapy (MRgRT) represents a promising new image guidance technology for radiation treatment delivery combining an onboard MRI scanner with radiation delivery technology. By enabling real-time low-field or high-field MRI acquisition, it facilitates improved soft tissue delineation, adaptive treatment, and motion management. Now that MRgRT has been available for nearly a decade, research has shown the technology can be used to effectively shrink treatment margins to either decrease toxicity (in breast, prostate cancer, and pancreatic cancer) or facilitate dose-escalation and improved oncologic outcomes (in pancreatic and liver cancer), as well as enabling indications that require clear soft tissue delineation and gating (lung and cardiac ablation). In doing so, the use of MRgRT has the potential to significantly improve the outcomes and quality of life of the patients it treats. The present narrative review aims to describe the rationale for MRgRT, the current and forthcoming state of technology, existing studies, and future directions for the advancement of MRgRT, including associated challenges.

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“…In recent years, there has been rapid technological development of MRI-guided radiotherapy (MRgRT) and MRI simulations (MR sim) that are paving the way for MR-only radiotherapy. MRgRT delivered with linear accelerators with on-board MRI scanners (MR-Linac) has demonstrated early promising indications of safety and effectiveness in many tumor types [9] , [10] . Furthermore, synthetic CT (sCT) generation from MR sim images using deep learning and convoluational neural networks can be used for electron density estimation and dose calculation in treatment planning.…”

Section: Introductionmentioning

confidence: 99%

Incidental findings and safety events from magnetic resonance imaging simulation for head and neck radiation treatment planning: A single institution experience

Massachi,

Singer,

Glastonbury

et al. 2024

Technical Innovations & Patient Support in Radiation Oncolo

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MRI-guided Radiotherapy (MRgRT) for Treatment of Oligometastases: Review of Clinical Applications and Challenges

Cited by 14 publications

References 170 publications

Magnetic resonance-guided stereotactic body radiation therapy (MRgSBRT) for oligometastatic patients: a single-center experience

Magnetic resonance-guided stereotactic body radiation therapy (MRgSBRT) for oligometastatic patients: a single-center experience

Clinical Applications of Magnetic Resonance-Guided Radiotherapy: A Narrative Review

Incidental findings and safety events from magnetic resonance imaging simulation for head and neck radiation treatment planning: A single institution experience

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