Online adaptive MR-guided stereotactic radiotherapy for unresectable malignancies in the upper abdomen using a 1.5T MR-linac

Daamen, Lois A; Otterloo, Sophie R de Mol van; Goor, Iris W.J.M. van; Eijkelenkamp, H.; Erickson, Beth; Hall, William A.; Heerkens, H.D.; Meijer, G.J.; Molenaar, I.; Santvoort, Hjalmar C. van; Verkooijen, Helena M.; Intven, Martijn

doi:10.1080/0284186x.2021.2012593

Cited by 34 publications

(21 citation statements)

References 27 publications

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“…Data detailing the additional oART work and related time have been published by a number of institutions, generally finding that additional 20 to 30 min of time are spent in the oART workflow [22] , [23] , [39] , [40] , [41] , [42] , [43] . Similar reports have also been published for the 1.5 T MR-linac system, finding comparable additional times needed for oART [44] , [45] , [46] , [47] .…”

Section: Discussionsupporting

confidence: 80%

Patterns of utilization and clinical adoption of 0.35 Tesla MR-guided radiation therapy in the United States – Understanding the transition to adaptive, ultra-hypofractionated treatments

Chuong

Clark²,

Henke³

et al. 2023

Clinical and Translational Radiation Oncology

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Section: Discussionsupporting

confidence: 80%

Patterns of utilization and clinical adoption of 0.35 Tesla MR-guided radiation therapy in the United States – Understanding the transition to adaptive, ultra-hypofractionated treatments

Chuong

Clark²,

Henke³

et al. 2023

Clinical and Translational Radiation Oncology

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“…It was demonstrated that SBRT safely enables dose escalated radiotherapy to pancreatic lesions. In the Netherlands, the University Medical Center (UMC) Utrecht with the MR-linac, the Amsterdam UMC with the MRIdian and the Erasmus Medical Center (MC) with the Cyberknife all have extensive experience with delivering SBRT to the pancreatic region [43][44][45]. Early results of retrospective single-center studies suggest improved progression-free survival, which could be translated to longer overall survival [37,42,46].…”

Section: Background and Rationale {6a} Backgroundmentioning

confidence: 99%

A nationwide randomized controlled trial on additional treatment for isolated local pancreatic cancer recurrence using stereotactic body radiation therapy (ARCADE)

Goor

Daamen

Besselink

et al. 2022

Trials

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Background Disease recurrence is the main cause of mortality after resection of pancreatic ductal adenocarcinoma (PDAC). In 20–30% of resected patients, isolated local PDAC recurrence occurs. Retrospective studies have suggested that stereotactic body radiation therapy (SBRT) might lead to improved local control in these patients, potentially having a beneficial effect on both survival and quality of life. The “nationwide randomized controlled trial on additional treatment for isolated local pancreatic cancer recurrence using stereotactic body radiation therapy” (ARCADE) will investigate the value of SBRT in addition to standard of care in patients with isolated local PDAC recurrence compared to standard of care alone, regarding both survival and quality of life outcomes. Methods The ARCADE trial is nested within a prospective cohort (Dutch Pancreatic Cancer Project; PACAP) according to the ‘Trials within Cohorts’ design. All PACAP participants with isolated local PDAC recurrence after primary resection who provided informed consent for being randomized in future studies are eligible. Patients will be randomized for local therapy (5 fractions of 8 Gy SBRT) in addition to standard of care or standard of care alone. In total, 174 patients will be included. The main study endpoint is survival after recurrence. The most important secondary endpoint is quality of life. Discussion It is hypothesized that additional SBRT, compared to standard of care alone, improves survival and quality of life in patients with isolated local recurrence after PDAC resection. Trial registration ClinicalTrials.gov registration NCT04881487. Registered on May 11, 2021.

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“…Due to the high soft-tissue contrast, online MR-guided radiotherapy allows for the precise separation of the respective liver lesion and adjacent OAR. Through on-table adaptation the daily anatomy of both the tumor and the OAR can be accounted for [ 21 , 22 , 23 ]. Moreover, some MR-Linac systems offer gated dose delivery to compensate for respiratory motion and possibly allow to reduce safety margins [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

Dosimetric Benefit of Adaptive Magnetic Resonance-Guided Stereotactic Body Radiotherapy of Liver Metastases

Weykamp

Katsigiannopulos

Piskorski

et al. 2022

Cancers

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(1) Background: To assess dosimetry benefits of stereotactic magnetic resonance (MR)-guided online adaptive radiotherapy (SMART) of liver metastases. (2) Methods: This is a subgroup analysis of an ongoing prospective registry including patients with liver metastases. Patients were treated at the MRIdian Linac between February 2020 and April 2022. The baseline plan was recalculated based on the updated anatomy of the day to generate the predicted plan. This predicted plan could then be re-optimized to create an adapted plan. (3) Results: Twenty-three patients received 30 SMART treatment series of in total 36 liver metastases. Most common primary tumors were colorectal- and pancreatic carcinoma (26.1% respectively). Most frequent fractionation scheme (46.6%) was 50 Gy in five fractions. The adapted plan was significantly superior compared to the predicted plan in regard to planning-target-volume (PTV) coverage, PTV overdosing, and organs-at-risk (OAR) dose constraints violations (91.5 vs. 38.0%, 6 vs. 19% and 0.6 vs. 10.0%; each p < 0.001). Plan adaptation significantly increased median BEDD95 by 3.2 Gy (p < 0.001). Mean total duration of SMART was 72.4 min. (4) Conclusions: SMART offers individualized ablative irradiation of liver metastases tailored to the daily anatomy with significant superior tumor coverage and improved sparing of OAR.

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Online adaptive MR-guided stereotactic radiotherapy for unresectable malignancies in the upper abdomen using a 1.5T MR-linac

Cited by 34 publications

References 27 publications

Patterns of utilization and clinical adoption of 0.35 Tesla MR-guided radiation therapy in the United States – Understanding the transition to adaptive, ultra-hypofractionated treatments

Patterns of utilization and clinical adoption of 0.35 Tesla MR-guided radiation therapy in the United States – Understanding the transition to adaptive, ultra-hypofractionated treatments

A nationwide randomized controlled trial on additional treatment for isolated local pancreatic cancer recurrence using stereotactic body radiation therapy (ARCADE)

Dosimetric Benefit of Adaptive Magnetic Resonance-Guided Stereotactic Body Radiotherapy of Liver Metastases

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