Online adaptive MR-guided stereotactic radiotherapy for unresectable malignancies in the upper abdomen using a 1.5T MR-linac

Lois A Daamen; Sophie R de Mol van Otterloo; Iris W J M van Goor; Hidde Eijkelenkamp; Beth A Erickson; William A Hall; Hanne D Heerkens; Gert J Meijer; I Quintus Molenaar; Hjalmar C van Santvoort; Helena M Verkooijen; Martijn P W Intven

doi:10.1080/0284186X.2021.2012593

Online adaptive MR-guided stereotactic radiotherapy for unresectable malignancies in the upper abdomen using a 1.5T MR-linac

Lois A Daamen
, Sophie R de Mol van Otterloo
, Iris W J M van Goor
, Hidde Eijkelenkamp
, Beth A Erickson
, William A Hall
, Hanne D Heerkens
, Gert J Meijer
, I Quintus Molenaar
, Hjalmar C van Santvoort
, Helena M Verkooijen
, Martijn P W Intven

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

BACKGROUND: Introduction of online adaptive MR-guided radiotherapy enables stereotactic body radiation therapy (SBRT) of upper abdominal tumors. This study aimed to evaluate the feasibility of MR-guided SBRT on a 1.5 T MR-linac in patients with unresectable upper abdominal malignancies.

MATERIAL AND METHODS: Patients treated at the UMC Utrecht (April 2019 to December 2020) were identified in the prospective 'Multi-OutcoMe EvaluatioN of radiation Therapy Using the MR-linac' (MOMENTUM) study. Feasibility of treatment was arbitrarily defined as an on-table time interval of ≤60 min for >75% of delivered fractions and completion of >95% of fractions as scheduled, reflecting patient tolerability. Acute treatment-related toxicity was assessed at 3 months of follow-up and graded according to the National Cancer Institute Common Terminology Criteria of Adverse Events version 5.0.

RESULTS: Twenty-five consecutive patients with a median follow-up time of 8 (range 4-23) months were treated with 35 Gray (n = 4) and 40 Gray (n = 21) in five fractions over 2 weeks. For all fractions, contours were adapted based on the daily anatomy and delivered within 47 min/fraction (range 30-74). In 98/117 fractions (84%), adapted treatment was completed within 1 h. All patients received the scheduled irradiation dose as planned. No acute grade 3 toxicity or higher was reported. Treatment resulted in pain alleviation in 11/13 patients.

DISCUSSION: Online adaptive MR-guided SBRT on a 1.5 T MR-linac is feasible and well-tolerated in patients with unresectable upper abdominal malignancies. Dose escalation studies, followed by comparative studies, are needed to determine the optimal radiation dose for irradiation of upper abdominal malignancies.

Original language	English
Pages (from-to)	111-115
Number of pages	5
Journal	Acta Oncologica
Volume	61
Issue number	1
Early online date	8 Dec 2021
DOIs	https://doi.org/10.1080/0284186X.2021.2012593
Publication status	Published - Jan 2022

Keywords

MR-guided radiotherapy
MR-linac
radiation oncology
stereotactic body radiation therapy
upper abdominal malignancies

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10.1080/0284186X.2021.2012593Licence: CC BY-NC-ND

0284186X.2021Final published version, 1.22 MBLicence: CC BY-NC-ND

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Daamen, L. A., de Mol van Otterloo, S. R., van Goor, I. W. J. M., Eijkelenkamp, H., Erickson, B. A., Hall, W. A., Heerkens, H. D., Meijer, G. J., Molenaar, I. Q., van Santvoort, H. C., Verkooijen, H. M., & Intven, M. P. W. (2022). Online adaptive MR-guided stereotactic radiotherapy for unresectable malignancies in the upper abdomen using a 1.5T MR-linac. Acta Oncologica, 61(1), 111-115. https://doi.org/10.1080/0284186X.2021.2012593

@article{d32e63fb88294cab924ded9d4ff1c727,

title = "Online adaptive MR-guided stereotactic radiotherapy for unresectable malignancies in the upper abdomen using a 1.5T MR-linac",

abstract = "BACKGROUND: Introduction of online adaptive MR-guided radiotherapy enables stereotactic body radiation therapy (SBRT) of upper abdominal tumors. This study aimed to evaluate the feasibility of MR-guided SBRT on a 1.5 T MR-linac in patients with unresectable upper abdominal malignancies.MATERIAL AND METHODS: Patients treated at the UMC Utrecht (April 2019 to December 2020) were identified in the prospective 'Multi-OutcoMe EvaluatioN of radiation Therapy Using the MR-linac' (MOMENTUM) study. Feasibility of treatment was arbitrarily defined as an on-table time interval of ≤60 min for >75\% of delivered fractions and completion of >95\% of fractions as scheduled, reflecting patient tolerability. Acute treatment-related toxicity was assessed at 3 months of follow-up and graded according to the National Cancer Institute Common Terminology Criteria of Adverse Events version 5.0.RESULTS: Twenty-five consecutive patients with a median follow-up time of 8 (range 4-23) months were treated with 35 Gray (n = 4) and 40 Gray (n = 21) in five fractions over 2 weeks. For all fractions, contours were adapted based on the daily anatomy and delivered within 47 min/fraction (range 30-74). In 98/117 fractions (84\%), adapted treatment was completed within 1 h. All patients received the scheduled irradiation dose as planned. No acute grade 3 toxicity or higher was reported. Treatment resulted in pain alleviation in 11/13 patients.DISCUSSION: Online adaptive MR-guided SBRT on a 1.5 T MR-linac is feasible and well-tolerated in patients with unresectable upper abdominal malignancies. Dose escalation studies, followed by comparative studies, are needed to determine the optimal radiation dose for irradiation of upper abdominal malignancies.",

keywords = "MR-guided radiotherapy, MR-linac, radiation oncology, stereotactic body radiation therapy, upper abdominal malignancies",

author = "Daamen, \{Lois A\} and \{de Mol van Otterloo\}, \{Sophie R\} and \{van Goor\}, \{Iris W J M\} and Hidde Eijkelenkamp and Erickson, \{Beth A\} and Hall, \{William A\} and Heerkens, \{Hanne D\} and Meijer, \{Gert J\} and Molenaar, \{I Quintus\} and \{van Santvoort\}, \{Hjalmar C\} and Verkooijen, \{Helena M\} and Intven, \{Martijn P W\}",

note = "Publisher Copyright: {\textcopyright} 2021 The Author(s). Published by Informa UK Limited, trading as Taylor \& Francis Group.",

year = "2022",

month = jan,

doi = "10.1080/0284186X.2021.2012593",

language = "English",

volume = "61",

pages = "111--115",

journal = "Acta Oncologica",

issn = "0284-186X",

publisher = "Medical Journals Sweden AB",

number = "1",

}

Daamen, LA, de Mol van Otterloo, SR, van Goor, IWJM, Eijkelenkamp, H, Erickson, BA, Hall, WA, Heerkens, HD, Meijer, GJ , Molenaar, IQ , van Santvoort, HC , Verkooijen, HM & Intven, MPW 2022, 'Online adaptive MR-guided stereotactic radiotherapy for unresectable malignancies in the upper abdomen using a 1.5T MR-linac', Acta Oncologica, vol. 61, no. 1, pp. 111-115. https://doi.org/10.1080/0284186X.2021.2012593

TY - JOUR

T1 - Online adaptive MR-guided stereotactic radiotherapy for unresectable malignancies in the upper abdomen using a 1.5T MR-linac

AU - Daamen, Lois A

AU - de Mol van Otterloo, Sophie R

AU - van Goor, Iris W J M

AU - Eijkelenkamp, Hidde

AU - Erickson, Beth A

AU - Hall, William A

AU - Heerkens, Hanne D

AU - Meijer, Gert J

AU - Molenaar, I Quintus

AU - van Santvoort, Hjalmar C

AU - Verkooijen, Helena M

AU - Intven, Martijn P W

PY - 2022/1

Y1 - 2022/1

N2 - BACKGROUND: Introduction of online adaptive MR-guided radiotherapy enables stereotactic body radiation therapy (SBRT) of upper abdominal tumors. This study aimed to evaluate the feasibility of MR-guided SBRT on a 1.5 T MR-linac in patients with unresectable upper abdominal malignancies.MATERIAL AND METHODS: Patients treated at the UMC Utrecht (April 2019 to December 2020) were identified in the prospective 'Multi-OutcoMe EvaluatioN of radiation Therapy Using the MR-linac' (MOMENTUM) study. Feasibility of treatment was arbitrarily defined as an on-table time interval of ≤60 min for >75% of delivered fractions and completion of >95% of fractions as scheduled, reflecting patient tolerability. Acute treatment-related toxicity was assessed at 3 months of follow-up and graded according to the National Cancer Institute Common Terminology Criteria of Adverse Events version 5.0.RESULTS: Twenty-five consecutive patients with a median follow-up time of 8 (range 4-23) months were treated with 35 Gray (n = 4) and 40 Gray (n = 21) in five fractions over 2 weeks. For all fractions, contours were adapted based on the daily anatomy and delivered within 47 min/fraction (range 30-74). In 98/117 fractions (84%), adapted treatment was completed within 1 h. All patients received the scheduled irradiation dose as planned. No acute grade 3 toxicity or higher was reported. Treatment resulted in pain alleviation in 11/13 patients.DISCUSSION: Online adaptive MR-guided SBRT on a 1.5 T MR-linac is feasible and well-tolerated in patients with unresectable upper abdominal malignancies. Dose escalation studies, followed by comparative studies, are needed to determine the optimal radiation dose for irradiation of upper abdominal malignancies.

AB - BACKGROUND: Introduction of online adaptive MR-guided radiotherapy enables stereotactic body radiation therapy (SBRT) of upper abdominal tumors. This study aimed to evaluate the feasibility of MR-guided SBRT on a 1.5 T MR-linac in patients with unresectable upper abdominal malignancies.MATERIAL AND METHODS: Patients treated at the UMC Utrecht (April 2019 to December 2020) were identified in the prospective 'Multi-OutcoMe EvaluatioN of radiation Therapy Using the MR-linac' (MOMENTUM) study. Feasibility of treatment was arbitrarily defined as an on-table time interval of ≤60 min for >75% of delivered fractions and completion of >95% of fractions as scheduled, reflecting patient tolerability. Acute treatment-related toxicity was assessed at 3 months of follow-up and graded according to the National Cancer Institute Common Terminology Criteria of Adverse Events version 5.0.RESULTS: Twenty-five consecutive patients with a median follow-up time of 8 (range 4-23) months were treated with 35 Gray (n = 4) and 40 Gray (n = 21) in five fractions over 2 weeks. For all fractions, contours were adapted based on the daily anatomy and delivered within 47 min/fraction (range 30-74). In 98/117 fractions (84%), adapted treatment was completed within 1 h. All patients received the scheduled irradiation dose as planned. No acute grade 3 toxicity or higher was reported. Treatment resulted in pain alleviation in 11/13 patients.DISCUSSION: Online adaptive MR-guided SBRT on a 1.5 T MR-linac is feasible and well-tolerated in patients with unresectable upper abdominal malignancies. Dose escalation studies, followed by comparative studies, are needed to determine the optimal radiation dose for irradiation of upper abdominal malignancies.

KW - MR-guided radiotherapy

KW - MR-linac

KW - radiation oncology

KW - stereotactic body radiation therapy

KW - upper abdominal malignancies

UR - https://www.scopus.com/pages/publications/85121352408

U2 - 10.1080/0284186X.2021.2012593

DO - 10.1080/0284186X.2021.2012593

M3 - Article

C2 - 34879792

SN - 0284-186X

VL - 61

SP - 111

EP - 115

JO - Acta Oncologica

JF - Acta Oncologica

IS - 1

ER -

Online adaptive MR-guided stereotactic radiotherapy for unresectable malignancies in the upper abdomen using a 1.5T MR-linac

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