Patterns of Care, Tolerability, and Safety of the First Cohort of Patients Treated on a Novel High-Field MR-Linac Within the MOMENTUM Study: Initial Results From a Prospective Multi-Institutional Registry

Otterloo, Sophie R de Mol van; Christodouleas, John P.; Blezer, Erwin L. A.; Akhiat, Hafid; Brown, Kevin; Choudhury, Ananya; Eggert, Dave; Erickson, Beth; Daamen, Lois A; Faivre-Finn, Corinne; Fuller, Clifton D.; Goldwein, Joel W.; Hafeez, S.; Hall, Emma; Harrington, Kevin; Heide, Uulke A. van der; Huddart, Robert; Intven, Martijn; Kirby, Anna M.; Lalondrelle, Susan; McCann, Claire; Minsky, Bruce D.; Mook, Stella; Nowee, Marlies E.; Oelfke, Uwe; Orrling, Kristina M.; Philippens, M.E.P.; Sahgal, Arjun; Schultz, Christopher J.; Tersteeg, Robbert J.H.A.; Tijssen, Rob H N; Tree, A.; Triest, Baukelien van; Tseng, Chia‐Lin; Hall, William A.; Verkooijen, Helena M.

doi:10.1016/j.ijrobp.2021.07.003

Cited by 44 publications

(33 citation statements)

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“…Prostate cancer (PC) is one of the major diseases thought to be greatly benefited by oMRgART (Pathmanathan et al 2018 ; Cuccia et al 2021 ; Tocco et al 2020 ). It is also one of the most treated targets by both 0.35T and 1.5T MRgRT, particularly in the form of ultrahypofractionation, also known as stereotactic body radiotherapy (SBRT) (Ugurluer et al 2021 ; Tetar et al 2021 ; Bruynzeel et al 2019 ; Otterloo et al 2021 ). The recently published European Society for Radiotherapy and Oncology Advisory Committee for Radiation Oncology Practice (ESTRO ACROP) consensus guideline on the use of IMRT for localized PC prefers daily online adaptation for conventionally fractionated radiotherapy and recommends it in case of hypofractionated radiotherapy (Ghadjar et al 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Analysis of online plan adaptation for 1.5T magnetic resonance-guided stereotactic body radiotherapy (MRgSBRT) of prostate cancer

Poon

Yang

Geng

et al. 2022

J Cancer Res Clin Oncol

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Purpose To analyze and characterize the online plan adaptation of 1.5T magnetic resonance-guided stereotactic body radiotherapy (MRgSBRT) of prostate cancer (PC). Methods PC patients ( n = 107) who received adaptive 1.5 Tesla MRgSBRT were included. Online plan adaptation was implemented by either the adapt-to-position (ATP) or adapt-to-shape (ATS) methods. Patients were assigned to the ATS group if they underwent ≥ 1 ATS fraction ( n = 51); the remainder were assigned to the ATP group ( n = 56). The online plan adaptation records of 535 (107 × 5) fractions were retrospectively reviewed. Rationales for ATS decision-making were determined and analyzed using predefined criteria. Statistics of ATS fractions were summarized. Associations of patient characteristics and clinical factors with ATS utilization were investigated. Results There were 87 (16.3%) ATS fractions and 448 ATP fractions (83.7%). The numbers of ATS adoptions in fractions 1–5 were 29 (29/107, 27.1%), 18 (16.8%), 15 (14.0%), 16 (15.0%), and 9 (8.4%), respectively, with significant differences in adoption frequency between fractions ( p = 0.007). Other baseline patient characteristics and clinical factors were not significantly associated with ATS classification (all p > 0.05). Underlying criteria for the determination of ATS implementation comprised anatomical changes (77 fractions in 50 patients) and discrete multiple targets (15 fractions in 3 patients). No ATS utilization was determined using dosimetric or online quality assurance criteria. Conclusions This study contributes to facilitating the establishment of a standardized protocol for online MR-guided adaptive radiotherapy in PC.

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Section: Introductionmentioning

confidence: 99%

Analysis of online plan adaptation for 1.5T magnetic resonance-guided stereotactic body radiotherapy (MRgSBRT) of prostate cancer

Poon

Yang

Geng

et al. 2022

J Cancer Res Clin Oncol

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“…However, they did not report the results of follow-up outcomes [23]. The researchers from the same group also reported the preliminary outcome results of 1.5T MRgSBRT for oligometastatic castration-sensitive prostate cancer [24,25].…”

Section: Discussionmentioning

confidence: 99%

“…Besides the above-mentioned single-center studies, the initial experience within the MOMENTUM Study (NCT04075305), a prospective international registry of the 1.5T MR-Linac Consortium, was recently reported [25]. The MOMENTUM Study represents the largest multi-center 1.5T MRgRT study so far, with a total patient number of 943, including 281 patients indicated for prostate MRgRT.…”

Section: Discussionmentioning

confidence: 99%

“…The MOMENTUM Study represents the largest multi-center 1.5T MRgRT study so far, with a total patient number of 943, including 281 patients indicated for prostate MRgRT. However, the clinical outcomes of the 281 patients set to receive prostate MRgRT have not yet been published by van Otterloo et al [25].…”

Section: Discussionmentioning

confidence: 99%

“…The PACE-B phase 3 trial suggested that SBRT (36. 25 Gy in 5 fractions) did not increase either gastrointestinal (GI) or genitourinary (GU) acute toxicity for up to 12 weeks after RT in low/intermediate-risk PC patients [11]. The HYPO-RT-PC phase 3 trial showed that ultra-hypofractionation (42.7 Gy in seven fractions, 3 days/week) was non-inferior to conventionally fractionated RT for intermediate/high-risk PC patients in terms of failurefree survival, although clinician-reported early side effects were more pronounced [10].…”

Section: Introductionmentioning

confidence: 99%

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1.5T Magnetic Resonance-Guided Stereotactic Body Radiotherapy for Localized Prostate Cancer: Preliminary Clinical Results of Clinician- and Patient-Reported Outcomes

Poon

Yuan

Wong

et al. 2021

Cancers

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Background: Magnetic resonance-guided stereotactic body radiotherapy (MRgSBRT) offers the potential for achieving better prostate cancer (PC) treatment outcomes. This study reports the preliminary clinical results of 1.5T MRgSBRT in localized PC, based on both clinician-reported outcome measurement (CROM) and patient-reported outcome measurement (PROM). Methods: Fifty-one consecutive localized PC patients were prospectively enrolled with a median follow-up of 199 days. MRgSBRT was delivered in five fractions of 7.25–8 Gy with daily online adaptation. Clinician-reported gastrointestinal (GI) and genitourinary (GU) adverse events based on the Common Terminology Criteria for Adverse Events (CTCAE) Scale v. 5.0 were assessed. The Expanded Prostate Cancer Index Composite Questionnaire was collected at baseline, 1 month, and every 3 months thereafter. Serial prostate-specific antigen measurements were longitudinally recorded. Results: The maximum cumulative clinician-reported grade ≥2 acute GU and GI toxicities were 11.8% (6/51) and 2.0% (1/51), respectively, while grade ≥2 subacute GU and GI toxicities were 2.3% (1/43) each. Patient-reported urinary, bowel, and hormonal domain summary scores were reduced at 1 month, then gradually returned to baseline levels, with the exception of the sexual domain. Domain-specific subscale scores showed similar longitudinal changes. All patients had early post-MRgSBRT biochemical responses. Conclusions: The finding of low toxicity supports the accumulation of clinical evidence for 1.5T MRgSBRT in localized PC.

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Safety and Tolerability of Online Adaptive High-Field Magnetic Resonance–Guided Radiotherapy

Westerhoff,

Daamen,

Christodouleas

et al. 2024

JAMA Netw Open

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ImportanceIn 2018, the first online adaptive magnetic resonance (MR)-guided radiotherapy (MRgRT) system using a 1.5-T MR–equipped linear accelerator (1.5-T MR-Linac) was clinically introduced. This system enables online adaptive radiotherapy, in which the radiation plan is adapted to size and shape changes of targets at each treatment session based on daily MR-visualized anatomy.ObjectiveTo evaluate safety, tolerability, and technical feasibility of treatment with a 1.5-T MR-Linac, specifically focusing on the subset of patients treated with an online adaptive strategy (ie, the adapt-to-shape [ATS] approach).Design, Setting, and ParticipantsThis cohort study included adults with solid tumors treated with a 1.5-T MR-Linac enrolled in Multi Outcome Evaluation for Radiation Therapy Using the MR-Linac (MOMENTUM), a large prospective international study of MRgRT between February 2019 and October 2021. Included were adults with solid tumors treated with a 1.5-T MR-Linac. Data were collected in Canada, Denmark, The Netherlands, United Kingdom, and the US. Data were analyzed in August 2023.ExposureAll patients underwent MRgRT using a 1.5-T MR-Linac. Radiation prescriptions were consistent with institutional standards of care.Main Outcomes and MeasuresPatterns of care, tolerability, and technical feasibility (ie, treatment completed as planned). Acute high-grade radiotherapy-related toxic effects (ie, grade 3 or higher toxic effects according to Common Terminology Criteria for Adverse Events version 5.0) occurring within the first 3 months after treatment delivery.ResultsIn total, 1793 treatment courses (1772 patients) were included (median patient age, 69 years [range, 22-91 years]; 1384 male [77.2%]). Among 41 different treatment sites, common sites were prostate (745 [41.6%]), metastatic lymph nodes (233 [13.0%]), and brain (189 [10.5%]). ATS was used in 1050 courses (58.6%). MRgRT was completed as planned in 1720 treatment courses (95.9%). Patient withdrawal caused 5 patients (0.3%) to discontinue treatment. The incidence of radiotherapy-related grade 3 toxic effects was 1.4% (95% CI, 0.9%-2.0%) in the entire cohort and 0.4% (95% CI, 0.1%-1.0%) in the subset of patients treated with ATS. There were no radiotherapy-related grade 4 or 5 toxic effects.Conclusions and RelevanceIn this cohort study of patients treated on a 1.5-T MR-Linac, radiotherapy was safe and well tolerated. Online adaptation of the radiation plan at each treatment session to account for anatomic variations was associated with a low risk of acute grade 3 toxic effects.

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Patterns of Care, Tolerability, and Safety of the First Cohort of Patients Treated on a Novel High-Field MR-Linac Within the MOMENTUM Study: Initial Results From a Prospective Multi-Institutional Registry

Cited by 44 publications

References 48 publications

Analysis of online plan adaptation for 1.5T magnetic resonance-guided stereotactic body radiotherapy (MRgSBRT) of prostate cancer

Analysis of online plan adaptation for 1.5T magnetic resonance-guided stereotactic body radiotherapy (MRgSBRT) of prostate cancer

1.5T Magnetic Resonance-Guided Stereotactic Body Radiotherapy for Localized Prostate Cancer: Preliminary Clinical Results of Clinician- and Patient-Reported Outcomes

Safety and Tolerability of Online Adaptive High-Field Magnetic Resonance–Guided Radiotherapy

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