TY - JOUR
T1 - Safety and Tolerability of Online Adaptive High-Field Magnetic Resonance-Guided Radiotherapy
AU - Westerhoff, Jasmijn M.
AU - Daamen, Lois A.
AU - Christodouleas, John P.
AU - Blezer, Erwin L.A.
AU - Choudhury, Ananya
AU - Westley, Rosalyne L.
AU - Erickson, Beth A.
AU - Fuller, Clifton D.
AU - Hafeez, Shaista
AU - Van Der Heide, Uulke A.
AU - Intven, Martijn P.W.
AU - Kirby, Anna M.
AU - Lalondrelle, Susan
AU - Minsky, Bruce D.
AU - Mook, Stella
AU - Nowee, Marlies E.
AU - Marijnen, Corrie A.M.
AU - Orrling, Kristina M.
AU - Sahgal, Arjun
AU - Schultz, Christopher J.
AU - Faivre-Finn, Corinne
AU - Tersteeg, Robbert J.H.A.
AU - Tree, Alison C.
AU - Tseng, Chia-Lin
AU - Schytte, Tine
AU - Silk, Dustin M.
AU - Eggert, Dave
AU - Luzzara, Marco
AU - Van Der Voort Van Zyp, Jochem R.N.
AU - Verkooijen, Helena M.
AU - Hall, William A.
N1 - Publisher Copyright:
© 2024 American Medical Association. All rights reserved.
PY - 2024/5/1
Y1 - 2024/5/1
N2 - Importance: In 2018, the first online adaptive magnetic resonance (MR)-guided radiotherapy (MRgRT) system using a 1.5-T MR-equipped linear accelerator (1.5-T MR-Linac) was clinically introduced. This system enables online adaptive radiotherapy, in which the radiation plan is adapted to size and shape changes of targets at each treatment session based on daily MR-visualized anatomy. Objective: To evaluate safety, tolerability, and technical feasibility of treatment with a 1.5-T MR-Linac, specifically focusing on the subset of patients treated with an online adaptive strategy (ie, the adapt-to-shape [ATS] approach). Design, Setting, and Participants: This cohort study included adults with solid tumors treated with a 1.5-T MR-Linac enrolled in Multi Outcome Evaluation for Radiation Therapy Using the MR-Linac (MOMENTUM), a large prospective international study of MRgRT between February 2019 and October 2021. Included were adults with solid tumors treated with a 1.5-T MR-Linac. Data were collected in Canada, Denmark, The Netherlands, United Kingdom, and the US. Data were analyzed in August 2023. Exposure: All patients underwent MRgRT using a 1.5-T MR-Linac. Radiation prescriptions were consistent with institutional standards of care. Main Outcomes and Measures: Patterns of care, tolerability, and technical feasibility (ie, treatment completed as planned). Acute high-grade radiotherapy-related toxic effects (ie, grade 3 or higher toxic effects according to Common Terminology Criteria for Adverse Events version 5.0) occurring within the first 3 months after treatment delivery. Results: In total, 1793 treatment courses (1772 patients) were included (median patient age, 69 years [range, 22-91 years]; 1384 male [77.2%]). Among 41 different treatment sites, common sites were prostate (745 [41.6%]), metastatic lymph nodes (233 [13.0%]), and brain (189 [10.5%]). ATS was used in 1050 courses (58.6%). MRgRT was completed as planned in 1720 treatment courses (95.9%). Patient withdrawal caused 5 patients (0.3%) to discontinue treatment. The incidence of radiotherapy-related grade 3 toxic effects was 1.4% (95% CI, 0.9%-2.0%) in the entire cohort and 0.4% (95% CI, 0.1%-1.0%) in the subset of patients treated with ATS. There were no radiotherapy-related grade 4 or 5 toxic effects. Conclusions and Relevance: In this cohort study of patients treated on a 1.5-T MR-Linac, radiotherapy was safe and well tolerated. Online adaptation of the radiation plan at each treatment session to account for anatomic variations was associated with a low risk of acute grade 3 toxic effects..
AB - Importance: In 2018, the first online adaptive magnetic resonance (MR)-guided radiotherapy (MRgRT) system using a 1.5-T MR-equipped linear accelerator (1.5-T MR-Linac) was clinically introduced. This system enables online adaptive radiotherapy, in which the radiation plan is adapted to size and shape changes of targets at each treatment session based on daily MR-visualized anatomy. Objective: To evaluate safety, tolerability, and technical feasibility of treatment with a 1.5-T MR-Linac, specifically focusing on the subset of patients treated with an online adaptive strategy (ie, the adapt-to-shape [ATS] approach). Design, Setting, and Participants: This cohort study included adults with solid tumors treated with a 1.5-T MR-Linac enrolled in Multi Outcome Evaluation for Radiation Therapy Using the MR-Linac (MOMENTUM), a large prospective international study of MRgRT between February 2019 and October 2021. Included were adults with solid tumors treated with a 1.5-T MR-Linac. Data were collected in Canada, Denmark, The Netherlands, United Kingdom, and the US. Data were analyzed in August 2023. Exposure: All patients underwent MRgRT using a 1.5-T MR-Linac. Radiation prescriptions were consistent with institutional standards of care. Main Outcomes and Measures: Patterns of care, tolerability, and technical feasibility (ie, treatment completed as planned). Acute high-grade radiotherapy-related toxic effects (ie, grade 3 or higher toxic effects according to Common Terminology Criteria for Adverse Events version 5.0) occurring within the first 3 months after treatment delivery. Results: In total, 1793 treatment courses (1772 patients) were included (median patient age, 69 years [range, 22-91 years]; 1384 male [77.2%]). Among 41 different treatment sites, common sites were prostate (745 [41.6%]), metastatic lymph nodes (233 [13.0%]), and brain (189 [10.5%]). ATS was used in 1050 courses (58.6%). MRgRT was completed as planned in 1720 treatment courses (95.9%). Patient withdrawal caused 5 patients (0.3%) to discontinue treatment. The incidence of radiotherapy-related grade 3 toxic effects was 1.4% (95% CI, 0.9%-2.0%) in the entire cohort and 0.4% (95% CI, 0.1%-1.0%) in the subset of patients treated with ATS. There were no radiotherapy-related grade 4 or 5 toxic effects. Conclusions and Relevance: In this cohort study of patients treated on a 1.5-T MR-Linac, radiotherapy was safe and well tolerated. Online adaptation of the radiation plan at each treatment session to account for anatomic variations was associated with a low risk of acute grade 3 toxic effects..
KW - Humans
KW - Radiotherapy, Image-Guided/methods
KW - Male
KW - Female
KW - Middle Aged
KW - Aged
KW - Neoplasms/radiotherapy
KW - Adult
KW - Prospective Studies
KW - Magnetic Resonance Imaging/methods
KW - Feasibility Studies
KW - Cohort Studies
KW - Aged, 80 and over
UR - http://www.scopus.com/inward/record.url?scp=85192045091&partnerID=8YFLogxK
U2 - 10.1001/jamanetworkopen.2024.10819
DO - 10.1001/jamanetworkopen.2024.10819
M3 - Article
C2 - 38691356
SN - 2574-3805
VL - 7
JO - JAMA network open
JF - JAMA network open
IS - 5
M1 - E2410819
ER -