Stereotactic MR-Guided Adaptive Radiotherapy for Pancreatic Tumors: Updated Results of the Montpellier Prospective Registry Study

Bordeau, Karl; Michalet, Morgan; Keskes, Aïcha; Valdenaire, Simon; Debuire, P.; Cantaloube, Marie; Cabaillé, Morgane; Portalès, Fabienne; Draghici, Roxana; Ychou, Marc; Assenat, Éric; Mazard, Thibault; Samalin, Emmanuelle; Gauthier, Ludovic; Colombo, Pierre‐Emmanuel; Carrère, Sébastien; Souche, Régis; Aillères, N.; Fénoglietto, P.; Azria, D.; Riou, O.

doi:10.3390/cancers15010007

Cited by 16 publications

(9 citation statements)

References 21 publications

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“…Overall survival and oncologic outcomes were consistent with research reporting on comparable subgroups treated with MRgRT 20 or CTgRT, 17 , 21 , 22 , 23 , 24 which further supports the safety of this treatment approach. It should be acknowledged that MOMENTUM has broad inclusion criteria and therefore reports an unselected population of patients.…”

Section: Discussionsupporting

confidence: 85%

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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Section: Discussionsupporting

confidence: 85%

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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“…Based on the acquired images, a plan is created, taking into account the primary plan, which takes into account the anatomical conditions present at the time. Data presented by Bordeau et al indicate that significant adaptation was realised for each irradiation fraction [ 52 ]. The authors presented the results of treating 70 patients using SMART.…”

Section: Treatment Of Locally Advanced Pancreatic Cancermentioning

confidence: 99%

“…In six patients, the pancreatic lesions were secondary. Local recurrence was observed in three (8.6%) patients, including one in the tumour and two at the tumour margin [ 52 ]. No grade 3 or higher toxicity was observed, while 1yOS and 2yOS were 91% and 45.8%, respectively [ 52 ].…”

Section: Treatment Of Locally Advanced Pancreatic Cancermentioning

confidence: 99%

“…Local recurrence was observed in three (8.6%) patients, including one in the tumour and two at the tumour margin [ 52 ]. No grade 3 or higher toxicity was observed, while 1yOS and 2yOS were 91% and 45.8%, respectively [ 52 ]. Another retrospective analysis, presented by Chuong et al, presents the results of treatment with SMART in a group of 62 patients diagnosed with advanced pancreatic cancer, including 14 with BLRPC [ 53 ].…”

Section: Treatment Of Locally Advanced Pancreatic Cancermentioning

confidence: 99%

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Radiotherapy in Pancreatic Cancer: To Whom, When, and How?

Falco¹,

Masojć²,

Sulikowski

2023

Cancers

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The diagnosis rate of pancreatic cancer is steadily increasing. The average age of onset is close to 70 years. In most cases, the disease is diagnosed at an advanced stage. The indications for and techniques of radiotherapy are changing over time. The aim of this thesis is to present the role and possibilities of radiotherapy from the perspective of radiation oncologist. The most common cause of treatment failure in pancreatic cancer remains generalisation. The implementation of new systemic treatment regimens contributes to improved treatment outcomes regardless of the stage of the disease. With improved treatment outcomes in terms of the incidence of distant metastases, the impact of local curability on the length and quality of life of patients increases. Modern radiotherapy offers the opportunity to achieve high local cure rates. Postoperative radiotherapy in combination with chemotherapy seems justified in the group of postoperative pancreatic cancer patients with pT3 and pN+ features. In the group of patients with borderline resectable pancreatic cancer, the impact of radiotherapy in combination with the latest chemotherapy regimens is difficult to define clearly. In the setting of a diagnosis of advanced pancreatic cancer, radiotherapy, especially stereotactic radiotherapy, in combination with chemotherapy, contributes to improved local curability and allows to achieve a significantly reduced level of pain.

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“…In this frame, lung SBRT may benefit from modern techniques of respiratory gating and tumor tracking that permit the reduction of the total irradiated volume at high doses [ 14 ]. New radiotherapy devices may also offer new possibilities for expanding the use of SBRT; as an example, MRI linac-based and proton-based SBRT treatments are under investigation [ 15 , 16 , 17 , 18 ].…”

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confidence: 99%