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Journal articles on the topic 'MR-guided radiotherapy'

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Author: Grafiati

Published: 10 December 2022

Last updated: 29 January 2023

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1

Slotman, B., and C. Gani. "Online MR-guided radiotherapy – A new era in radiotherapy." Clinical and Translational Radiation Oncology 18 (September 2019): 102–3. http://dx.doi.org/10.1016/j.ctro.2019.04.011.

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2

Jonsson, J. "SP-0006: Challenges in MR guided radiotherapy." Radiotherapy and Oncology 119 (April 2016): S2—S3. http://dx.doi.org/10.1016/s0167-8140(16)31255-5.

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3

van den Berg, Cornelius. "[I186] New technologies for MR guided radiotherapy." Physica Medica 52 (August 2018): 71. http://dx.doi.org/10.1016/j.ejmp.2018.06.258.

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4

Pollard, Julianne M., Zhifei Wen, Ramaswamy Sadagopan, Jihong Wang, and Geoffrey S. Ibbott. "The future of image-guided radiotherapy will be MR guided." British Journal of Radiology 90, no. 1073 (May 2017): 20160667. http://dx.doi.org/10.1259/bjr.20160667.

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5

Palacios, M. A., O. Bohoudi, S. Senan, B. Slotman, A. Bruynzeel, and F. J. Lagerwaard. "1. MR-guided adaptive stereotactic radiotherapy: A new paradigm in radiotherapy." Physica Medica 44 (December 2017): 1. http://dx.doi.org/10.1016/j.ejmp.2017.10.026.

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6

Jaffray, D. "SP-0395: Challenges associated with MR guided radiotherapy." Radiotherapy and Oncology 123 (May 2017): S211. http://dx.doi.org/10.1016/s0167-8140(17)30837-x.

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7

Rodriguez, Lori L., Rupesh Kotecha, Martin C. Tom, Michael D. Chuong, Jessika A. Contreras, Tino Romaguera, Diane Alvarez, et al. "CT-guided versus MR-guided radiotherapy: Impact on gastrointestinal sparing in adrenal stereotactic body radiotherapy." Radiotherapy and Oncology 166 (January 2022): 101–9. http://dx.doi.org/10.1016/j.radonc.2021.11.024.

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8

Song, Yajun, Zhenjiang Li, Huadong Wang, Yun Zhang, and Jinbo Yue. "MR-LINAC-Guided Adaptive Radiotherapy for Gastric MALT: Two Case Reports and a Literature Review." Radiation 2, no. 3 (July 13, 2022): 259–67. http://dx.doi.org/10.3390/radiation2030019.

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It is still very challenging to use conventional radiation therapy techniques to treat stomach tumors, although image-guided radiotherapy, mainly by kV X-ray imaging techniques, has become routine in the clinic. This is because the stomach is one of the most deformable organs, and thus it is vulnerable to respiratory motions, daily diet, and body position changes. In addition, X-ray radiographs and CT volumetric images have low contrast in soft tissues. In contrast, magnetic resonance imaging (MRI) techniques provide good contrast in images of soft tissues. The emerging MR-guided radiotherapy, based on the MR-LINAC system, may have the potential to solve the above difficulties due to its unique advantages. The real-time imaging feature and the high-contrast of soft tissues MR images provided by the MR-LINAC system have facilitated the therapeutic adaptive planning. Online learning capabilities could be used to optimize the automatic delineation of the target organ or tissue prior to each radiotherapy session. This could greatly improve the accuracy and efficiency of the target delineation in adaptive planning. In this clinical case report, we elaborated a workflow for the diagnosis and treatment of two patients with gastric mucosa-associated lymphoid tissue (MALT) lymphoma. One patient underwent MR-guided daily adaptive radiotherapy based on daily automated segmentation using the novel artificial intelligence (AI) technique for gastric delineation.

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9

Fahad, H. M., S. Dorsch, M. Zaiß, and C. P. Karger. "PO-1638 Multiparametric optimization of MR imaging sequences for MR guided radiotherapy." Radiotherapy and Oncology 170 (May 2022): S1433—S1434. http://dx.doi.org/10.1016/s0167-8140(22)03602-7.

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10

Schumacher, Leif-Erik D., Alan Dal Pra, Sarah E. Hoffe, and Eric A. Mellon. "Toxicity reduction required for MRI-guided radiotherapy to be cost-effective in the treatment of localized prostate cancer." British Journal of Radiology 93, no. 1114 (October 1, 2020): 20200028. http://dx.doi.org/10.1259/bjr.20200028.

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Objective: To determine the toxicity reduction required to justify the added costs of MRI-guided radiotherapy (MR-IGRT) over CT-based image guided radiotherapy (CT-IGRT) for the treatment of localized prostate cancer. Methods: The costs of delivering prostate cancer radiotherapy with MR-IGRT and CT-IGRT in conventional 39 fractions and stereotactic body radiotherapy (SBRT) 5 fractions schedules were determined using literature values and cost accounting from two institutions. Gastrointestinal and genitourinary toxicity rates associated with CT-IGRT were summarized from 20 studies. Toxicity-related costs and utilities were obtained from literature values and cost databases. Markov modeling was used to determine the savings per patient for every 1% relative reduction in acute and chronic toxicities by MR-IGRT over 15 years. The costs and quality adjusted life years (QALYs) saved with toxicity reduction were juxtaposed with the cost increase of MR-IGRT to determine toxicity reduction thresholds for cost-effectiveness. One way sensitivity analyses were performed. Standard $100,000 and $50,000 per QALY ratios were used. Results: The added cost of MR-IGRT was $1,459 per course of SBRT and $10,129 per course of conventionally fractionated radiotherapy. Relative toxicity reductions of 7 and 14% are required for SBRT to be cost-effective using $100,000 and $50,000 per QALY, respectively. Conventional radiotherapy requires relative toxicity reductions of 50 and 94% to be cost-effective. Conclusion: From a healthcare perspective, MR-IGRT can reasonably be expected to be cost-effective. Hypofractionated schedules, such a five fraction SBRT, are most likely to be cost-effective as they require only slight reductions in toxicity (7–14%). Advances in knowledge: This is the first detailed economic assessment of MR-IGRT, and it suggests that MR-IGRT can be cost-effective for prostate cancer treatment through toxicity reduction alone.

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11

O’Dwyer, D. "SP-0150 Advanced motion management in MR guided radiotherapy." Radiotherapy and Oncology 161 (August 2021): S93. http://dx.doi.org/10.1016/s0167-8140(21)08510-8.

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12

van Dams, Ritchell, Ann C. Raldow, and Percy Lee. "Role of MR-guided Radiotherapy (MRgRT) in Colorectal Cancer." Current Colorectal Cancer Reports 17, no. 5 (September 4, 2021): 69–76. http://dx.doi.org/10.1007/s11888-021-00467-6.

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13

Tree, A. "SP-0643 MR-guided radiotherapy in the pelvic region." Radiotherapy and Oncology 133 (April 2019): S342. http://dx.doi.org/10.1016/s0167-8140(19)31063-1.

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14

Gani, C., L. Boldrini, and V. Valentini. "Online MR guided radiotherapy for rectal cancer. New opportunities." Clinical and Translational Radiation Oncology 18 (September 2019): 66–67. http://dx.doi.org/10.1016/j.ctro.2019.04.005.

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15

Sritharan, Kobika, Alex Dunlop, Adam Mitchell, Jonathan Mohajer, Gillian Smith, and Alison Tree. "Analysis of rectal dose during prostate stereotactic body radiotherapy in MR-guided radiotherapy." Journal of Clinical Oncology 39, no. 6_suppl (February 20, 2021): 242. http://dx.doi.org/10.1200/jco.2021.39.6_suppl.242.

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242 Background: The Unity MR-Linac combines a 7-MV Linac with 1.5T magnetic resonance (MR) imaging capability and it enables adaptive radiotherapy, whereby the target and organs at risk are recontoured and a plan is optimised daily. During treatment a session MR image is taken first, on which the target and organs-at-risk are contoured, and a plan created. A verification image is taken prior to dose delivery to identify intra-fractional changes. If present, the daily treatment plan is shifted to reflect the anatomy. A post-treatment image is acquired at the end of treatment. This study evaluates the dosimetric changes to the rectum caused by intra-fractional changes during treatment delivery for prostate stereotactic body radiotherapy (SBRT) calculated on the verification and post-treatment images. Methods: The first five patients treated on the MR-Linac with 5-fraction SBRT to the prostate are included in this study. For each patient, the rectum was contoured on the verification and post-treatment MR images for each of the five fractions. The dose delivered to the rectum with the original treatment plan was then calculated on each image and the V36Gy rectal dose constraint was noted. Results: Out of the 25 fractions, a post treatment image was not performed in one fraction; 24 fractions were therefore analysed in total. The rectal V36Gy dose constraint exceeded the mandatory target of 2cc on 50% of the verification images and 46% of the post-treatment images. In 6 fractions the rectal V36Gy was greater than 2cc on both the verification and post-treatment images suggesting this rectal constraint was exceeded throughout treatment. In 17% of patients, the volume of rectum receiving 36Gy increased at each timepoint an image was taken during the treatment workflow. Conclusions: The rectal V36Gy dose constraint is susceptible to minor changes in rectal filling, which may often lead to higher than the accepted dose constraint. Thus, a single planning CT scan is unlikely to be representative of dose delivered. Adaptive radiotherapy can reduce this uncertainty somewhat, but intra-fraction dose re-optimisation would be required to ensure the rectal V36Gy remains acceptable at all times.

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16

Westerhoff, J., S. de Mol van Otterloo, T. Leer, L. Daamen, R. Rutgers, L. Meijers, M. Intven, and H. Verkooijen. "OC-0133 Patient Experience of MR-guided Radiotherapy using a 1.5T MR-Linac." Radiotherapy and Oncology 170 (May 2022): S109—S110. http://dx.doi.org/10.1016/s0167-8140(22)02509-9.

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17

Gharzai, Laila A., Benjamin S. Rosen, Bharat Mittal, Michelle L. Mierzwa, and Poonam Yadav. "Magnetic Resonance Guided Radiotherapy for Head and Neck Cancers." Journal of Clinical Medicine 11, no. 5 (March 3, 2022): 1388. http://dx.doi.org/10.3390/jcm11051388.

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Radiotherapy is an integral component of head/neck squamous cell carcinomas (HNSCCs) treatment, and technological developments including advances in image-guided radiotherapy over the past decades have offered improvements in the technical treatment of these cancers. Integration of magnetic resonance imaging (MRI) into image guidance through the development of MR-guided radiotherapy (MRgRT) offers further potential for refinement of the techniques by which HNSCCs are treated. This article provides an overview of the literature supporting the current use of MRgRT for HNSCC, challenges with its use, and developing research areas.

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18

Ridder, Mischa de, Cornelis P. J. Raaijmakers, Frank A. Pameijer, Remco de Bree, Floris C. J. Reinders, Patricia A. H. Doornaert, Chris H. J. Terhaard, and Marielle E. P. Philippens. "Target Definition in MR-Guided Adaptive Radiotherapy for Head and Neck Cancer." Cancers 14, no. 12 (June 20, 2022): 3027. http://dx.doi.org/10.3390/cancers14123027.

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In recent years, MRI-guided radiotherapy (MRgRT) has taken an increasingly important position in image-guided radiotherapy (IGRT). Magnetic resonance imaging (MRI) offers superior soft tissue contrast in anatomical imaging compared to computed tomography (CT), but also provides functional and dynamic information with selected sequences. Due to these benefits, in current clinical practice, MRI is already used for target delineation and response assessment in patients with head and neck squamous cell carcinoma (HNSCC). Because of the close proximity of target areas and radiosensitive organs at risk (OARs) during HNSCC treatment, MRgRT could provide a more accurate treatment in which OARs receive less radiation dose. With the introduction of several new radiotherapy techniques (i.e., adaptive MRgRT, proton therapy, adaptive cone beam computed tomography (CBCT) RT, (daily) adaptive radiotherapy ensures radiation dose is accurately delivered to the target areas. With the integration of a daily adaptive workflow, interfraction changes have become visible, which allows regular and fast adaptation of target areas. In proton therapy, adaptation is even more important in order to obtain high quality dosimetry, due to its susceptibility for density differences in relation to the range uncertainty of the protons. The question is which adaptations during radiotherapy treatment are oncology safe and at the same time provide better sparing of OARs. For an optimal use of all these new tools there is an urgent need for an update of the target definitions in case of adaptive treatment for HNSCC. This review will provide current state of evidence regarding adaptive target definition using MR during radiotherapy for HNSCC. Additionally, future perspectives for adaptive MR-guided radiotherapy will be discussed.

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19

Rodgers, John, Rosie Hales, Lee Whiteside, Jacqui Parker, Louise McHugh, Anthea Cree, Marcel van Herk, et al. "Comparison of radiographer interobserver image registration variability using cone beam CT and MR for cervix radiotherapy." British Journal of Radiology 93, no. 1112 (August 2020): 20200169. http://dx.doi.org/10.1259/bjr.20200169.

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Objectives: The aim of this study was to assess the consistency of therapy radiographers performing image registration using cone beam computed tomography (CBCT)-CT, magnetic resonance (MR)-CT, and MR-MR image guidance for cervix cancer radiotherapy and to assess that MR-based image guidance is not inferior to CBCT standard practice. Methods: 10 patients receiving cervix radiation therapy underwent daily CBCT guidance and magnetic resonance (MR) imaging weekly during treatment. Offline registration of each MR image, and corresponding CBCT, to planning CT was performed by five radiographers. MR images were also registered to the earliest MR interobserver variation was assessed using modified Bland–Altman analysis with clinically acceptable 95% limits of agreement (LoA) defined as ±5.0 mm. Results: 30 CBCT-CT, 30 MR-CT and 20 MR–MR registrations were performed by each observer. Registration variations between CBCT-CT and MR-CT were minor and both strategies resulted in 95% LoA over the clinical threshold in the anteroposterior direction (CBCT-CT ±5.8 mm, MR-CT ±5.4 mm). MR–MR registrations achieved a significantly improved 95% LoA in the anteroposterior direction (±4.3 mm). All strategies demonstrated similar results in lateral and longitudinal directions. Conclusion: The magnitude of interobserver variations between CBCT-CT and MR-CT were similar, confirming that MR-CT radiotherapy workflows are comparable to CBCT-CT image-guided radiotherapy. Our results suggest MR–MR radiotherapy workflows may be a superior registration strategy. Advances in knowledge: This is the first publication quantifying interobserver registration of multimodality image registration strategies for cervix radical radiotherapy patients.

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20

Saxby, H. "SP-0484 Implementation of MR-guided radiotherapy to treat oligometastases." Radiotherapy and Oncology 161 (August 2021): S372. http://dx.doi.org/10.1016/s0167-8140(21)08606-0.

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21

Spoelstra, F., P. Cobussen, M. Palacios, A. Bruynzeel, F. Lagerwaard, B. Slotman, and S. Senan. "OC-0068 MR-guided adaptive radiotherapy for intra-abdominal lymphoma." Radiotherapy and Oncology 133 (April 2019): S30—S31. http://dx.doi.org/10.1016/s0167-8140(19)30488-8.

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22

Van den Wollenberg, W., C. Carbaat, P. De Ruiter, P. Remeijer, T. Janssen, and J. Sonke. "EP-2004 Online rotation correction for MR-guided prostate radiotherapy." Radiotherapy and Oncology 133 (April 2019): S1096—S1097. http://dx.doi.org/10.1016/s0167-8140(19)32424-7.

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23

Valentini, V. "SP-0396: Can we perform RCTs evaluating MR guided radiotherapy?" Radiotherapy and Oncology 123 (May 2017): S211. http://dx.doi.org/10.1016/s0167-8140(17)30838-1.

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24

Randall, James W., Nikhil Rammohan, Indra J. Das, and Poonam Yadav. "Towards Accurate and Precise Image-Guided Radiotherapy: Clinical Applications of the MR-Linac." Journal of Clinical Medicine 11, no. 14 (July 13, 2022): 4044. http://dx.doi.org/10.3390/jcm11144044.

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Advances in image-guided radiotherapy have brought about improved oncologic outcomes and reduced toxicity. The next generation of image guidance in the form of magnetic resonance imaging (MRI) will improve visualization of tumors and make radiation treatment adaptation possible. In this review, we discuss the role that MRI plays in radiotherapy, with a focus on the integration of MRI with the linear accelerator. The MR linear accelerator (MR-Linac) will provide real-time imaging, help assess motion management, and provide online adaptive therapy. Potential advantages and the current state of these MR-Linacs are highlighted, with a discussion of six different clinical scenarios, leading into a discussion on the future role of these machines in clinical workflows.

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25

de Muinck Keizer, D. M., L. G. W. Kerkmeijer, M. Maspero, A. Andreychenko, J. R. N. van der Voort van Zyp, C. A. T. van den Berg, B. W. Raaymakers, J. J. W. Lagendijk, and J. C. J. de Boer. "Soft-tissue prostate intrafraction motion tracking in 3D cine-MR for MR-guided radiotherapy." Physics in Medicine & Biology 64, no. 23 (December 5, 2019): 235008. http://dx.doi.org/10.1088/1361-6560/ab5539.

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26

Liu, Feng, Shengnan Fu, Yanzhu Chen, Ouying Yan, Lili He, Cuihong Jiang, Xiangwei Wu, Yaqian Han, and Hui Wang. "A randomized phase II trial of diffusion-weighted MR imaging-guided radiotherapy plus chemotherapy versus standard chemoradiotherapy in locoregional advanced nasopharyngeal carcinoma." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): 6018. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.6018.

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6018 Background: We hypothesized that diffusion-weighted MR imaging (DWI) guided dose-painting radiotherapy (DP-RT) was associated with improved tumor control and survival compared with standard CT-based radiotherapy in locoregionally advanced nasopharyngeal carcinoma (NPC). The purpose of this randomized phase II trial was to compare the efficacy and toxicity of DWI guided DP-RT plus chemotherapy versus standard CT-based radiotherapy plus chemotherapy in locoregionally advanced NPC. Methods: Two hundred and fifty-six patients with stage III-IVa (8th AJCC) NPC were randomly assigned to receive DWI-guided dose-painting radiotherapy plus chemotherapy (DP-RT group, n = 128) or standard CT-based radiotherapy plus chemotherapy (CT-based RT group, n = 128). Patients in both groups received 3 cycles of induction chemotherapy followed by cisplatin-based concurrent chemoradiotherapy. In DP-RT group, subvolume GTVnx-DWI (gross tumor volume of nasopharynx in DWI) was defined as the areas within the GTVnx (gross tumor volume of nasopharynx) with an apparent diffusion coefficient (ADC) below the mean ADC (ADC < mean). The dose to GTVnx-DWI was escalated to DT 75.2 Gy/32 Fx in patients with T1-2 disease, and DT 77.55 Gy/33 Fx in those with T3-4 disease, in 2.35 Gy per fraction. In CT-based RT group (n = 128), PGTVnx was irradiated at DT 70.4-72.6 Gy/32-33 Fx in 2.2 Gy per fraction. This trial is registered with chictr.org.cn, number ChiCTR1800015779. Results: Compared with standard CT-based radiotherapy, DWI-guided DP-RT significantly improved 2-year local recurrence-free survival (LRFS, 100% vs. 95.4%; P = 0.024), distant metastasis-free survival (DMFS, 97.9% vs. 90.6%; P = 0.006), disease free survival (DFS, 93.2% vs. 86.8%; P = 0.021), and overall survival (OS, 100% vs. 95.2%; P = 0.038). No statistically significant differences in acute and late toxic effects were observed. Multivariate analysis showed that dose painting (DWI-guided DP-RT vs CT-based RT without DP) was a significant independent prognostic factor for DMFS and DFS (P = 0.021 and P = 0.020, respectively). Conclusions: Diffusion-weighted MR imaging guided dose-painting radiotherapy plus chemotherapy is associated with a considerable survival benefit, without increasing toxicity, as compared with standard CT-based radiotherapy plus chemotherapy, among patients with locoregionally advanced nasopharyngeal carcinoma. Clinical trial information: ChiCTR1800015779.

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27

Rammohan, Nikhil, James W. Randall, and Poonam Yadav. "History of Technological Advancements towards MR-Linac: The Future of Image-Guided Radiotherapy." Journal of Clinical Medicine 11, no. 16 (August 12, 2022): 4730. http://dx.doi.org/10.3390/jcm11164730.

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Image-guided radiotherapy (IGRT) enables optimal tumor targeting and sparing of organs-at-risk, which ultimately results in improved outcomes for patients. Magnetic resonance imaging (MRI) revolutionized diagnostic imaging with its superior soft tissue contrast, high spatiotemporal resolution, and freedom from ionizing radiation exposure. Over the past few years there has been burgeoning interest in MR-guided radiotherapy (MRgRT) to overcome current challenges in X-ray-based IGRT, including but not limited to, suboptimal soft tissue contrast, lack of efficient daily adaptation, and incremental exposure to ionizing radiation. In this review, we present an overview of the technologic advancements in IGRT that led to MRI-linear accelerator (MRL) integration. Our report is organized in three parts: (1) a historical timeline tracing the origins of radiotherapy and evolution of IGRT, (2) currently available MRL technology, and (3) future directions and aspirations for MRL applications.

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28

Bhide, S. "SP-0769: Online MR-guided radiotherapy - Adaptation by size or function." Radiotherapy and Oncology 152 (November 2020): S422. http://dx.doi.org/10.1016/s0167-8140(21)00791-x.

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29

Benson, Rebecca, Athanasios Sideris, Lisa McDaid, Robert Chuter, Robin Portner, Linnéa Freear, Abigael Clough, et al. "The Role of MR Guided Radiotherapy In Rapid Response Palliative Treatment." Journal of Medical Imaging and Radiation Sciences 53, no. 2 (June 2022): S13—S14. http://dx.doi.org/10.1016/j.jmir.2022.04.037.

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30

Couwenberg, Alice, Uulke van der Heide, Tomas Janssen, Baukelien van Triest, Peter Remeijer, Corrie Marijnen, Jan-Jakob Sonke, and Marlies Nowee. "Master protocol trial design for technical feasibility of MR-guided radiotherapy." Radiotherapy and Oncology 166 (January 2022): 33–36. http://dx.doi.org/10.1016/j.radonc.2021.11.009.

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31

Hoffmans, Daan, Nina Niebuhr, Omar Bohoudi, Asja Pfaffenberger, and Miguel Palacios. "An end-to-end test for MR-guided online adaptive radiotherapy." Physics in Medicine & Biology 65, no. 12 (June 22, 2020): 125012. http://dx.doi.org/10.1088/1361-6560/ab8955.

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32

Raaijmakers, AJE, BW Raaymakers, and JJW Lagendijk. "SU-GG-T-530: MR-Guided Radiotherapy: Magnetic Field Dose Effects." Medical Physics 35, no. 6Part17 (June 2008): 2846–47. http://dx.doi.org/10.1118/1.2962279.

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33

Wolthaus, J. W. H. "46. Real-time MR image guided radiotherapy: The time is near!" Physica Medica 32 (December 2016): 363. http://dx.doi.org/10.1016/j.ejmp.2016.11.098.

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34

Kamp, Florian, Sebastian Neppl, Moritz Rabe, Lukas Nierer, Christopher Kurz, Michael Reiner, and Claus Belka. "[I093] Mr-guided radiotherapy at the LMU in Munich: Preliminary studies." Physica Medica 52 (August 2018): 36–37. http://dx.doi.org/10.1016/j.ejmp.2018.06.165.

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35

Mustafayev, T. Z., B. Atalar, G. Gungor, M. Sengoz, U. Abacioglu, and E. Ozyar. "Feasibility of Stereotactic MR-Guided Adaptive Radiotherapy in Localized Prostate Cancer." International Journal of Radiation Oncology*Biology*Physics 108, no. 3 (November 2020): e916. http://dx.doi.org/10.1016/j.ijrobp.2020.07.552.

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36

Pathmanathan, Angela U., Helen A. McNair, Maria A. Schmidt, Douglas H. Brand, Louise Delacroix, Cynthia L. Eccles, Alexandra Gordon, et al. "Comparison of prostate delineation on multimodality imaging for MR-guided radiotherapy." British Journal of Radiology 92, no. 1096 (April 2019): 20180948. http://dx.doi.org/10.1259/bjr.20180948.

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37

Michalet, Morgan, Ons Bettaïeb, Samia Khalfi, Asma Ghorbel, Simon Valdenaire, Pierre Debuire, Norbert Aillères, et al. "Stereotactic MR-Guided Radiotherapy for Adrenal Gland Metastases: First Clinical Results." Journal of Clinical Medicine 12, no. 1 (December 30, 2022): 291. http://dx.doi.org/10.3390/jcm12010291.

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Stereotactic MR-guided Radiotherapy (MRgRT) is an interesting treatment option for adrenal gland metastases (AGM). We reviewed data from 12 consecutive patients treated with MRgRT for an AGM in our center between 14 November 2019 and 17 August 2021. Endpoints were tolerance assessment, the impact of adaptive treatment on target volume coverage and organs at risk (OAR) sparing, local control (LC), and overall survival (OS). The majority of patients were oligometastatic (58.3%), with 6 right AGM, 5 left AGM and 1 left and right AGM. The prescribed dose was 35 to 50 Gy in 3 to 5 fractions. The median PTV V95% on the initial plan was 95.74%. The median V95% of the PTVoptimized (PTVopt) on the initial plan was 95.26%. Thirty-eight (69%) fractions were adapted. The PTV coverage was significantly improved for adapted plans compared to predicted plans (median PTV V95% increased from 89.85% to 91.17%, p = 0.0478). The plan adaptation also significantly reduced Dmax for the stomach and small intestine. The treatment was well tolerated with no grade > 2 toxicities. With a median follow-up of 15.5 months, the 1–year LC and OS rate were 100% and 91.7%. Six patients (50%) presented a metastatic progression, and one patient (8.3%) died of metastatic evolution during the follow-up. Adaptation of the treatment plan improved the overall dosimetric quality of MRI-guided radiotherapy. A longer follow-up is required to assess late toxicities and clinical results.

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38

Mulder, Samuel L., Jolien Heukelom, Brigid A. McDonald, Lisanne Van Dijk, Kareem A. Wahid, Keith Sanders, Travis C. Salzillo, Mehdi Hemmati, Andrew Schaefer, and Clifton D. Fuller. "MR-Guided Adaptive Radiotherapy for OAR Sparing in Head and Neck Cancers." Cancers 14, no. 8 (April 10, 2022): 1909. http://dx.doi.org/10.3390/cancers14081909.

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MR-linac devices offer the potential for advancements in radiotherapy (RT) treatment of head and neck cancer (HNC) by using daily MR imaging performed at the time and setup of treatment delivery. This article aims to present a review of current adaptive RT (ART) methods on MR-Linac devices directed towards the sparing of organs at risk (OAR) and a view of future adaptive techniques seeking to improve the therapeutic ratio. This ratio expresses the relationship between the probability of tumor control and the probability of normal tissue damage and is thus an important conceptual metric of success in the sparing of OARs. Increasing spatial conformity of dose distributions to target volume and OARs is an initial step in achieving therapeutic improvements, followed by the use of imaging and clinical biomarkers to inform the clinical decision-making process in an ART paradigm. Pre-clinical and clinical findings support the incorporation of biomarkers into ART protocols and investment into further research to explore imaging biomarkers by taking advantage of the daily MR imaging workflow. A coherent understanding of this road map for RT in HNC is critical for directing future research efforts related to sparing OARs using image-guided radiotherapy (IGRT).

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Castelluccia, Alessandra, Pierpaolo Mincarone, Maria Rosaria Tumolo, Saverio Sabina, Riccardo Colella, Antonella Bodini, Francesco Tramacere, Maurizio Portaluri, and Carlo Giacomo Leo. "Economic Evaluations of Magnetic Resonance Image-Guided Radiotherapy (MRIgRT): A Systematic Review." International Journal of Environmental Research and Public Health 19, no. 17 (August 30, 2022): 10800. http://dx.doi.org/10.3390/ijerph191710800.

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Objectives: This review systematically summarizes the evidence on the economic impact of magnetic resonance image-guided RT (MRIgRT). Methods: We systematically searched INAHTA, MEDLINE, and Scopus up to March 2022 to retrieve health economic studies. Relevant data were extracted on study type, model inputs, modeling methods and economic results. Results: Five studies were included. Two studies performed a full economic assessment to compare the cost-effectiveness of MRIgRT with other forms of image-guided radiation therapy. One study performed a cost minimization analysis and two studies performed an activity-based costing, all comparing MRIgRT with X-ray computed tomography image-guided radiation therapy (CTIgRT). Prostate cancer was the target condition in four studies and hepatocellular carcinoma in one. Considering the studies with a full economic assessment, MR-guided stereotactic body radiation therapy was found to be cost effective with respect to CTIgRT or conventional or moderate hypofractionated RT, even with a low reduction in toxicity. Conversely, a greater reduction in toxicity is required to compete with extreme hypofractionated RT without MR guidance. Conclusions: This review highlights the great potential of MRIgRT but also the need for further evidence, especially for late toxicity, whose reduction is expected to be the real added value of this technology.

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Romesser, Paul B., Neelam Tyagi, and Christopher H. Crane. "Magnetic Resonance Imaging-Guided Adaptive Radiotherapy for Colorectal Liver Metastases." Cancers 13, no. 7 (April 1, 2021): 1636. http://dx.doi.org/10.3390/cancers13071636.

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Technological advances have enabled well tolerated and effective radiation treatment for small liver metastases. Stereotactic ablative radiation therapy (SABR) refers to ablative dose delivery (>100 Gy BED) in five fractions or fewer. For larger tumors, the safe delivery of SABR can be challenging due to a more limited volume of healthy normal liver parenchyma and the proximity of the tumor to radiosensitive organs such as the stomach, duodenum, and large intestine. In addition to stereotactic treatment delivery, controlling respiratory motion, the use of image guidance, adaptive planning and increasing the number of radiation fractions are sometimes necessary for the safe delivery of SABR in these situations. Magnetic Resonance (MR) image-guided adaptive radiation therapy (MRgART) is a new and rapidly evolving treatment paradigm. MR imaging before, during and after treatment delivery facilitates direct visualization of both the tumor target and the adjacent normal healthy organs as well as potential intrafraction motion. Real time MR imaging facilitates non-invasive tumor tracking and treatment gating. While daily adaptive re-planning permits treatment plans to be adjusted based on the anatomy of the day. MRgART therapy is a promising radiation technology advance that can overcome many of the challenges of liver SABR and may facilitate the safe tumor dose escalation of colorectal liver metastases.

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Valdes Santurio, G., J. Edmund, and K. I. Nousiainen. "OC-0775 Dosimetric consistency between MR-only and deformed CT for MR-guided online adaptive radiotherapy." Radiotherapy and Oncology 170 (May 2022): S693—S694. http://dx.doi.org/10.1016/s0167-8140(22)02681-0.

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Kang, Seung Kwan, Hyun Joon An, Hyeongmin Jin, Jung-in Kim, Eui Kyu Chie, Jong Min Park, and Jae Sung Lee. "Synthetic CT generation from weakly paired MR images using cycle-consistent GAN for MR-guided radiotherapy." Biomedical Engineering Letters 11, no. 3 (June 19, 2021): 263–71. http://dx.doi.org/10.1007/s13534-021-00195-8.

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Fallone, B. "WE-D-BRC-03: Real-Time MR-Guided Radiotherapy: Integration of a Low-Field MR System." Medical Physics 36, no. 6Part25 (June 2009): 2774–75. http://dx.doi.org/10.1118/1.3182526.

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Yaromina, A., and D. Zips. "Bio-IGRT." Nuklearmedizin 49, S 01 (2010): S50—S52. http://dx.doi.org/10.1055/s-0038-1626528.

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SummaryImage-guided radiotherapy (IGRT) represents a novel method to precisely deliver radiation to tumours while sparing surrounding normal tissues. Integration of biological imaging using PET or MRI appears to be a promising concept to improve radiotherapy (Bio-IGRT). For this it is essential that biological imaging provides radiobiologically relevant information. Preclinical and clinical investigations into validation of PET tracers and MR methods in the context of curative radiotherapy and of concepts for biology-based escalation of radiation dose as well as other therapeutic interventions are an important task for further cancer research.

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Nethercott, Laura, Farshad Foroudi, Greg Jack, Stephen Chin, Daryl Lim Joon, Michael Chao, and Sweet Ping Ng. "Potential for focal magnetic resonance-guided stereotactic body radiotherapy for prostate cancer: A review." International Journal of Radiology & Radiation Therapy 8, no. 3 (August 13, 2021): 128–32. http://dx.doi.org/10.15406/ijrrt.2021.08.00304.

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Prostate cancer is the most commonly diagnosed cancer among Australian men. Current whole gland radiotherapy treatment regimens are associated with known toxicities. The MR-Linac has the capability to deliver real-time visually guided radiation to enable focal therapy and reduce toxicity through decreasing radiation doses to organs at risk. This review article discusses the rationale, potential benefits and limitations of the MR-Linac in focal prostate stereotactic body radiotherapy (SBRT), in an effort to reduce toxicity-related side effects for men with low to favourable-intermediate risk prostate cancer. Pubmed was systemically for all published and ongoing trials using the search terms ‘Prostate’ and ‘MRI Linac or MR Linac’. 8 articles were reviewed, of those 1 was deemed relevant, additions were made and expert opinions in the field were sought regarding the most relevant research. Real-time MRI imaging during the delivery of each fraction with daily plan adaption is now a reality due to the development of the MR-Linac system. It is hoped that with improved real-time imaging, treatment accuracy can be improved, increasing the percentage of the planning target volume receiving the prescribed dose while reducing radiation to the surrounding organs at risk. Early results of prostate SBRT are promising but further research is needed into long term survival benefits and toxicity related outcomes. Focal stereotactic radiotherapy for low-risk intermediate prostate cancer using the MR-Linac has the potential to provide adequate tumour control while decreasing the toxicity and quality of life impact of whole gland treatment for men with localised prostate cancer.

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Kong, Vickie, Jennifer Dang, Winnie Li, Alejandro Berlin, Inmaculada Navarro, Jerusha Padayachee, Srinivas Raman, Victor Malkov, Jeff Winter, and Peter Chung. "Dosimetry Between CBCT-Guided Translational Correction vs MR-Guided Online Adaptation for Prostate Ultra-Hypofractionated Radiotherapy." Journal of Medical Imaging and Radiation Sciences 53, no. 2 (June 2022): S12—S13. http://dx.doi.org/10.1016/j.jmir.2022.04.035.

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Driever, T., A. Van der Horst, J. Teuwen, M. Fast, and J. Sonke. "PH-0127: Quantifying intra-fractional gastric wall motion for MR-guided radiotherapy." Radiotherapy and Oncology 152 (November 2020): S65—S66. http://dx.doi.org/10.1016/s0167-8140(21)00154-7.

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Ding, Shouliang, Hongdong Liu, Yongbao Li, Bin Wang, Rui Li, Biaoshui Liu, Yi Ouyang, Dehua Wu, and Xiaoyan Huang. "Assessment of dose accuracy for online MR-guided radiotherapy for cervical carcinoma." Journal of Radiation Research and Applied Sciences 14, no. 1 (January 1, 2021): 159–70. http://dx.doi.org/10.1080/16878507.2021.1888243.

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Sandoval, Maria L., Irini Youssef, Kujtim Latifi, G. Daniel Grass, Javier Torres-Roca, Stephen Rosenberg, Kosj Yamoah, and Peter A. Johnstone. "Non-Adaptive MR-Guided Radiotherapy for Prostate SBRT: Less Time, Equal Results." Journal of Clinical Medicine 10, no. 15 (July 30, 2021): 3396. http://dx.doi.org/10.3390/jcm10153396.

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Background: The use of stereotactic body radiation therapy (SBRT) is widely utilized for treatment of localized prostate cancer. Magnetic-resonance-guided radiotherapy (MRgRT) was introduced in 2014 and has recently been implemented in SBRT for prostate cancer as it provides an opportunity for smaller margins and adaptive daily planning. Currently, the only publications of MRgRT for prostate SBRT describe European clinical experiences which utilized adaptive planning. However, adaptive planning adds significantly to the time required for daily treatment. Objectives: Since prostate SBRT has demonstrated acceptable toxicity for several years, we did not consider daily adaptation critical to the process of prostate SBRT. After Institutional Review Board approval, we analyzed and now report our experience using MRgRT without adaptation. Methods: Between 25 September 2019 and 21 December 2020, 35 consecutive patients were treated with MRgRT prostate SBRT at our center. Patients treated with MRgRT included favorable intermediate risk (43%) and unfavorable intermediate risk (54%), and only one patient had low-risk prostate cancer. Nine patients (25%) received adjuvant leuprolide for a median of 4.5 months (range 4–6 m). Our clinical pathway allows for a maximum prostate gland volume of 60 cc; median prostate volume of this cohort was 35.0 cc (range 17–58.4 cc). Median pre-treatment PSA was 6.30 (range 2.55–16.77). Each patient was treated with 36.25 Gy delivered in five fractions over 2 weeks with urethral sparing to a maximal dose of 35 Gy. Target volumes included the prostate gland and proximal seminal vesicles with a 3 mm margin. Results: Median follow-up as of 26 May 2021 was 11.97 months (range 4.37–19.80). First follow-up data are available for all patients, with a median of 1.10 month from completion of treatment (0.63–3.40). The median PSA at first visit was 2.75 (range 0.02–9.00) with a median AUA symptom score of 9 (range 1–24). Second follow-up data are available for 34 patients at a median of 4.45 months (range 2.57–8.90). At second follow-up, the median PSA was 1.60 (range 0.02–5.40) with a median AUA symptom score of 6 (range 1–33). Seventeen patients had third follow-up data with a median of 9.77 months (range 4.70–12.33) after SBRT. The median PSA was 1.13 (range 0.02–4.73) with an AUA score of 9 (2–22) at the third follow-up. We observed a statistically significant decrease in PSA between pre-treatment and at first follow-up (p < 0.005). The most common toxicity was grade 2 urethritis, managed in all cases by tamsulosin. One patient developed grade 2 tenesmus relieved by topical steroids. No cases of grade ≥ 3 toxicity were seen in our patient population. Conclusions: By avoiding the extra time required for plan adaptation, MRgRT without daily adaptation allows for successful prostate SBRT with manageable toxicity. We continue to reserve our limited adaptive treatment slots for preoperative pancreatic and ultra-central lung SBRT patients, which require time-intensive respiratory gating and adaptive planning.

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Neylon, John, Kiri A. Cook, Yingli Yang, Dongsu Du, Ke Sheng, Robert K. Chin, Amar U. Kishan, James M. Lamb, Daniel A. Low, and Minsong Cao. "Clinical assessment of geometric distortion for a 0.35T MR‐guided radiotherapy system." Journal of Applied Clinical Medical Physics 22, no. 8 (July 7, 2021): 303–9. http://dx.doi.org/10.1002/acm2.13340.

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