Simulated Online Adaptive Magnetic Resonance-Guided Stereotactic Body Radiation Therapy for the Treatment of Oligometastatic Disease of the Abdomen and Central Thorax: Characterization of Potential Advantages.
case_series · Level IV
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- Record sourced from PubMed, PMID 27742541.
- Also identified by DOI 10.1016/j.ijrobp.2016.08.036 and PMC identifier 5376349.
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Abstract
To characterize potential advantages of online-adaptive magnetic resonance (MR)-guided stereotactic body radiation therapy (SBRT) to treat oligometastatic disease of the non-liver abdomen and central thorax. Ten patients treated with RT for unresectable primary or oligometastatic disease of the non-liver abdomen (n=5) or central thorax (n=5) underwent imaging throughout treatment on a clinical MR image guided RT system. The SBRT plans were created on the basis of tumor/organ at risk (OAR) anatomy at initial computed tomography simulation (P<sub>I</sub>), and simulated adaptive plans were created on the basis of observed MR image set tumor/OAR "anatomy of the day" (P<sub>A</sub>). Each P<sub>A</sub> was planned under workflow constraints to simulate online-adaptive RT. Prescribed dose was 50 Gy/5 fractions, with goal coverage of 95% planning target volume (PTV) by 95% of the prescription, subject to hard OAR constraints. The P<sub>I</sub> was applied to each MR dataset and compared with P<sub>A</sub> to evaluate changes in dose delivered to tumor/OARs, with dose escalation when possible. Hard OAR constraints were met for all P<sub>Is</sub> based on anatomy from initial computed tomography simulation, and all P<sub>As</sub> based on anatomy from each daily MR image set. Application of the P<sub>I</sub> to anatomy of the day caused OAR constraint violation in 19 of 30 cases. Adaptive planning increased PTV coverage in 21 of 30 cases, including 14 cases in which hard OAR constraints were violated by the nonadaptive plan. For 9 P<sub>A</sub> cases, decreased PTV coverage was required to meet hard OAR constraints that would have been violated in a nonadaptive setting. Online-adaptive MRI-guided SBRT may allow PTV dose escalation and/or simultaneous OAR sparing compared with nonadaptive SBRT. A prospective clinical trial is underway at our institution to evaluate clinical outcomes of this technique.
Medical subject headings
- Abdominal Neoplasms
- Magnetic Resonance Imaging, Interventional
- Radiosurgery
- Radiotherapy Planning, Computer-Assisted
- Thoracic Neoplasms