TY - JOUR
T1 - Clinical outcomes of stereotactic MR-guided adaptive radiation therapy for high-risk lung tumors
AU - Finazzi, Tobias
AU - Haasbeek, Cornelis J A
AU - Spoelstra, Femke O B
AU - Palacios, Miguel A
AU - Admiraal, Marjan A
AU - Bruynzeel, Anna M E
AU - Slotman, Berend J
AU - Lagerwaard, Frank J
AU - Senan, Suresh
N1 - Funding Information:
Disclosures: The Department of Radiation Oncology at the Amsterdam University Medical Centers (location VUmc) has institutional research agreements with ViewRay Inc and Varian Medical Systems. T.F. is supported by the Swiss Cancer Research Foundation (bursary grant; BIL KFS-4380-02-2018), the Swiss Cancer League section Basel (cancer research grant; KlbB-4468-03-2018), and the University Hospital Basel, Clinic of Radiotherapy and Radiation Oncology (departmental research support). C.J.A.H. and S.S. report personal fees from Varian Medical Systems, outside of the submitted work. M.A.P., A.M.E.B, and F.J.L. report personal fees from ViewRay, Inc, outside the submitted work. B.J.S. reports personal fees from ViewRay Inc and Varian Medical Systems, outside of the submitted work.
Publisher Copyright:
© 2020 Elsevier Inc.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/6/1
Y1 - 2020/6/1
N2 - Purpose: Magnetic resonance (MR)-guided SABR was performed for patients with lung tumors in whom treatment delivery was challenging owing to tumor location, motion, or pulmonary comorbidity. Because stereotactic MR-guided adaptive radiation therapy (SMART) is a novel approach, we studied clinical outcomes in these high-risk lung tumors. Methods and Materials: Fifty consecutive patients (54 lung tumors) underwent SMART between 2016 and 2018 for either a primary lung cancer (29 patients) or for lung metastases (21 patients). Eligible patients had risk factors that could predispose them to toxicity, including a central tumor location (n = 30), previous thoracic radiation therapy (n = 17), and interstitial lung disease (n = 7). A daily 17-second breath-hold MR scan was acquired in treatment position, and on-table plan adaptation was performed using the anatomy of the day. Gated SABR was delivered during repeated breath-holds under continuous MR guidance. Results: All but 1 patient completed the planned SMART schedule. With daily plan adaptation, a biologically effective dose ≥100 Gy to 95% of the planning target volume was delivered in 50 tumors (93%). Median follow-up was 21.7 months (95% confidence interval, 19.9-28.1). Local control and overall and disease-free survival rates at 12 months were 95.6%, 88.0%, and 63.6%, respectively. Local failures developed in 4 patients: in 2 after reirradiation for a recurrent lung cancer and in 2 patients with a colorectal metastasis. Overall rates of any grade ≥2 and ≥3 toxicity were 30% and 8%, respectively. Commonest toxicities were grade ≥2 radiation pneumonitis (12%) and chest wall pain (8%). No grade 4 or 5 toxicities were observed. Conclusions: Use of MR-guided SABR resulted in low rates of high-grade toxicity and encouraging early local control in a cohort of high-risk lung tumors. Additional studies are needed to identify patients who are most likely to benefit from the SMART approach.
AB - Purpose: Magnetic resonance (MR)-guided SABR was performed for patients with lung tumors in whom treatment delivery was challenging owing to tumor location, motion, or pulmonary comorbidity. Because stereotactic MR-guided adaptive radiation therapy (SMART) is a novel approach, we studied clinical outcomes in these high-risk lung tumors. Methods and Materials: Fifty consecutive patients (54 lung tumors) underwent SMART between 2016 and 2018 for either a primary lung cancer (29 patients) or for lung metastases (21 patients). Eligible patients had risk factors that could predispose them to toxicity, including a central tumor location (n = 30), previous thoracic radiation therapy (n = 17), and interstitial lung disease (n = 7). A daily 17-second breath-hold MR scan was acquired in treatment position, and on-table plan adaptation was performed using the anatomy of the day. Gated SABR was delivered during repeated breath-holds under continuous MR guidance. Results: All but 1 patient completed the planned SMART schedule. With daily plan adaptation, a biologically effective dose ≥100 Gy to 95% of the planning target volume was delivered in 50 tumors (93%). Median follow-up was 21.7 months (95% confidence interval, 19.9-28.1). Local control and overall and disease-free survival rates at 12 months were 95.6%, 88.0%, and 63.6%, respectively. Local failures developed in 4 patients: in 2 after reirradiation for a recurrent lung cancer and in 2 patients with a colorectal metastasis. Overall rates of any grade ≥2 and ≥3 toxicity were 30% and 8%, respectively. Commonest toxicities were grade ≥2 radiation pneumonitis (12%) and chest wall pain (8%). No grade 4 or 5 toxicities were observed. Conclusions: Use of MR-guided SABR resulted in low rates of high-grade toxicity and encouraging early local control in a cohort of high-risk lung tumors. Additional studies are needed to identify patients who are most likely to benefit from the SMART approach.
UR - http://www.scopus.com/inward/record.url?scp=85081656890&partnerID=8YFLogxK
U2 - 10.1016/j.ijrobp.2020.02.025
DO - 10.1016/j.ijrobp.2020.02.025
M3 - Article
C2 - 32105742
VL - 107
SP - 270
EP - 278
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
SN - 0360-3016
IS - 2
ER -