MR-guided Online Adaptive Stereotactic Body Radiotherapy (MRgSBRT) of Primary Lung Tumors and Lung Oligometastases

Overview

Journal Strahlenther Onkol

Specialties Oncology
Radiology

Date 2024 Dec 2

PMID 39622976

Authors

Gamze Ugurluer

Neris Dincer

Teuta Zoto Mustafayev

Gorkem Gungor

Mehmet Ufuk Abacioglu

Meric Sengoz

Enis Ozyar

Banu Atalar

Affiliations

Soon will be listed here.

Abstract

Purpose: Stereotactic body radiotherapy is pivotal in the treatment of lung tumors, demonstrating effective local control. However, challenges persist with intra-fractional anatomical changes and organs at risk during delivery. Magnetic resonance-guided online adaptive stereotactic body radiotherapy (MRgSBRT) represents a novel technique promising to achieve safe delivery of ablative doses with improved outcomes for primary lung tumors or lung oligometastases.

Methods: In this single-institution retrospective analysis, we evaluated 64 patients (92 lesions) with primary lung cancer or lung oligometastases treated with MRgSBRT. Using Kaplan-Meier method and log-rank test; we estimated local control (LC), local progression-free survival (LPFS), distant progression-free survival (DPFS), and overall survival (OS).

Results: A total of 64 patients (92 lesions) treated with MRgSBRT were included comprising 14.1% primary lung cancer lesions and 85.9% lung oligometastases. Median total dose, fraction number, fraction dose and BED were 50 Gy (range, 21-70 Gy), 5 (range, 1-10), 10 Gy (range, 6-34 Gy), 100 Gy (range, 48-180.0 Gy) respectively. Of the 420 fractions administered, 88.6% (n = 372) involved on-table adapted plans. Median LPFS was not reached and the 1‑ and 3‑year LPFS rates were 96.3% (95% CI 92.4-100.0%) and 86.4% (95% CI 76.9-95.9%), respectively. No local recurrences were observed post-treatment with a total dose of > 50 Gy, BED10 > 100 Gy, fractional dose of > 10 Gy or a CCI > 0.96.

Conclusion: Our study of MRgSBRT in 92 lung lesions revealed a 1-year and 3‑year LPFS rates of 96.3 and 86.4%, respectively without ≥ grade 3 toxicity. Future prospective studies evaluating lung MRgSBRT are awaited.

References

Amini A, Yeh N, Gaspar L, Kavanagh B, Karam S . Stereotactic body radiation therapy (SBRT) for lung cancer patients previously treated with conventional radiotherapy: a review. Radiat Oncol. 2014; 9:210. PMC: 4261522. DOI: 10.1186/1748-717X-9-210. View

Palma D, Olson R, Harrow S, Gaede S, Louie A, Haasbeek C . Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): a randomised, phase 2, open-label trial. Lancet. 2019; 393(10185):2051-2058. DOI: 10.1016/S0140-6736(18)32487-5. View

Postmus P, Kerr K, Oudkerk M, Senan S, Waller D, Vansteenkiste J . Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017; 28(suppl_4):iv1-iv21. DOI: 10.1093/annonc/mdx222. View

Chargari C, Magne N, Guy J, Rancoule C, Levy A, Goodman K . Optimize and refine therapeutic index in radiation therapy: Overview of a century. Cancer Treat Rev. 2016; 45:58-67. DOI: 10.1016/j.ctrv.2016.03.001. View

Timmerman R, Papiez L, McGarry R, Likes L, DesRosiers C, Frost S . Extracranial stereotactic radioablation: results of a phase I study in medically inoperable stage I non-small cell lung cancer. Chest. 2003; 124(5):1946-55. DOI: 10.1378/chest.124.5.1946. View

Wulf J, Baier K, Mueller G, Flentje M . Dose-response in stereotactic irradiation of lung tumors. Radiother Oncol. 2005; 77(1):83-7. DOI: 10.1016/j.radonc.2005.09.003. View

Onishi H, Shirato H, Nagata Y, Hiraoka M, Fujino M, Gomi K . Hypofractionated stereotactic radiotherapy (HypoFXSRT) for stage I non-small cell lung cancer: updated results of 257 patients in a Japanese multi-institutional study. J Thorac Oncol. 2007; 2(7 Suppl 3):S94-100. DOI: 10.1097/JTO.0b013e318074de34. View

Haseltine J, Rimner A, Gelblum D, Modh A, Rosenzweig K, Jackson A . Fatal complications after stereotactic body radiation therapy for central lung tumors abutting the proximal bronchial tree. Pract Radiat Oncol. 2015; 6(2):e27-33. PMC: 4973477. DOI: 10.1016/j.prro.2015.09.012. View

Landry G, Corradini S, Belka C . Magnetic resonance-guided radiation therapy: the beginning of a new era. Radiat Oncol. 2020; 15(1):163. PMC: 7346330. DOI: 10.1186/s13014-020-01599-z. View

10.

Corradini S, Alongi F, Andratschke N, Belka C, Boldrini L, Cellini F . MR-guidance in clinical reality: current treatment challenges and future perspectives. Radiat Oncol. 2019; 14(1):92. PMC: 6551911. DOI: 10.1186/s13014-019-1308-y. View

11.

Cusumano D, Dhont J, Boldrini L, Chiloiro G, Teodoli S, Massaccesi M . Predicting tumour motion during the whole radiotherapy treatment: a systematic approach for thoracic and abdominal lesions based on real time MR. Radiother Oncol. 2018; 129(3):456-462. DOI: 10.1016/j.radonc.2018.07.025. View

12.

Chin S, Eccles C, McWilliam A, Chuter R, Walker E, Whitehurst P . Magnetic resonance-guided radiation therapy: A review. J Med Imaging Radiat Oncol. 2019; 64(1):163-177. DOI: 10.1111/1754-9485.12968. View

13.

Noel C, Parikh P, Spencer C, Green O, Hu Y, Mutic S . Comparison of onboard low-field magnetic resonance imaging versus onboard computed tomography for anatomy visualization in radiotherapy. Acta Oncol. 2015; 54(9):1474-82. DOI: 10.3109/0284186X.2015.1062541. View

14.

Benedict S, Yenice K, Followill D, Galvin J, Hinson W, Kavanagh B . Stereotactic body radiation therapy: the report of AAPM Task Group 101. Med Phys. 2010; 37(8):4078-101. DOI: 10.1118/1.3438081. View

15.

Bezjak A, Paulus R, Gaspar L, Timmerman R, Straube W, Ryan W . Safety and Efficacy of a Five-Fraction Stereotactic Body Radiotherapy Schedule for Centrally Located Non-Small-Cell Lung Cancer: NRG Oncology/RTOG 0813 Trial. J Clin Oncol. 2019; 37(15):1316-1325. PMC: 6524984. DOI: 10.1200/JCO.18.00622. View

16.

Gungor G, Serbez I, Temur B, Gur G, Kayalilar N, Mustafayev T . Time Analysis of Online Adaptive Magnetic Resonance-Guided Radiation Therapy Workflow According to Anatomical Sites. Pract Radiat Oncol. 2020; 11(1):e11-e21. DOI: 10.1016/j.prro.2020.07.003. View

17.

Finazzi T, Palacios M, Haasbeek C, Admiraal M, Spoelstra F, Bruynzeel A . Stereotactic MR-guided adaptive radiation therapy for peripheral lung tumors. Radiother Oncol. 2019; 144:46-52. DOI: 10.1016/j.radonc.2019.10.013. View

18.

Dunlap N, Cai J, Biedermann G, Yang W, Benedict S, Sheng K . Chest wall volume receiving >30 Gy predicts risk of severe pain and/or rib fracture after lung stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys. 2009; 76(3):796-801. DOI: 10.1016/j.ijrobp.2009.02.027. View

19.

Finazzi T, Haasbeek C, Spoelstra F, Palacios M, Admiraal M, Bruynzeel A . Clinical Outcomes of Stereotactic MR-Guided Adaptive Radiation Therapy for High-Risk Lung Tumors. Int J Radiat Oncol Biol Phys. 2020; 107(2):270-278. DOI: 10.1016/j.ijrobp.2020.02.025. View

20.

Finazzi T, Palacios M, Spoelstra F, Haasbeek C, Bruynzeel A, Slotman B . Role of On-Table Plan Adaptation in MR-Guided Ablative Radiation Therapy for Central Lung Tumors. Int J Radiat Oncol Biol Phys. 2019; 104(4):933-941. DOI: 10.1016/j.ijrobp.2019.03.035. View