Patient-reported Outcome Measurements on the Tolerance of Magnetic Resonance Imaging-guided Radiation Therapy

Abstract

PurposeMagnetic resonance imaging-guided radiation therapy (MRgRT) requires patient positioning within the MR bore and prolonged MR imaging during delivery, both of which are new in radiation oncology. Patient tolerance of MRgRT was prospectively evaluated using patient-reported outcome questionnaires (PRO-Q).MethodsOur MRgRT procedure involves daily high-resolution MR scanning, limited re-contouring, daily plan re-optimization, quality assurance (QA), and gated delivery. Patients with claustrophobia are excluded. Mean fraction duration was 45 and 60 minutes for stereotactic treatments during free-breathing and breath-hold, respectively. Patient-controlled video-feedback was used for breath-hold delivery. PRO-Qs collected in the first 150 patients treated included questions on MR-related complaints and also evaluated aspects of active participation.ResultsAlmost one-third of patients (29%) scored at least one PRO-Q item on MR-related complaints as ‘moderate’ or ‘very much’, with noise, feeling cold, and paresthesia being the most frequently scored in this way. Considerable anxiety was reported by 5%, but no medication was required for this in any patient. Patient participation in video feedback for breath-hold delivery was appreciated by the majority of patients, all of whom completed the procedure. Only 5% of patients considered treatment duration to be unacceptably long.ConclusionDespite the lengthy MRgRT procedure, outcomes of PRO-Q indicate that it was well-tolerated by patients.

First prospective clinical evaluation of feasibility and patient acceptance of magnetic resonance-guided radiotherapy in Germany

“…In our cohort, all fractions could be administered safely, without patient-induced early terminations, and, as expected, without any treatment-related severe toxicities. The PRO-Q results shown in this manuscript confirm that treatment at the MR-Linac is generally well tolerated by patients, which is in accordance with results previously published by Tetar et al [26]. Compared to their rate of MR-related patient complaints of 29%, the value of 65% in our study is considerably higher, while, on the other hand, none of our patients reported considerable anxiety.…”

“…We have shown that MR-guided respiratory gating in breath-hold is feasible and, combined with a real-time au-diovisual feedback system, was very well tolerated and appreciated by patients. This confirms the positive results of Tetar et al [26]. Cine-MR-enabled gating in breath-hold is also effective; we observed a mean gating duty cycle of 72%, similar to the range of 67% to 87% published by van Sörnsen de Koste et al [17] using a predecessor of the MRIdian Linac system [12].…”

MR‐linac is the best modality for lung SBRT

“…Video feedback for breath-hold delivery has been positively viewed by patients treated on the MR-linac. 9 Commonly no immobilization is necessary, with the patient arranged comfortably on the couch. No implanted fiducials are required either, making for a safer and noninvasive treatment.…”

Protocol of a study investigating breath-hold techniques for upper-abdominal radiation therapy (BURDIE): addressing the challenge of a moving target

“…There is limited literature available to describe patients’ experience of BH. A recent study evaluated 150 patients’ experiences of voluntary BH using MR-guided RT using an un-validated questionnaire [ 11 ]. Considerable difficulty controlling their tumor position in voluntary BH was reported by 12.5% of patients [ 11 ].…”

“…A recent study evaluated 150 patients’ experiences of voluntary BH using MR-guided RT using an un-validated questionnaire [ 11 ]. Considerable difficulty controlling their tumor position in voluntary BH was reported by 12.5% of patients [ 11 ]. Another study investigated the patient experience of DIBH, in 41 patients receiving breast RT [ 12 ].…”