TY - JOUR
T1 - Phase I trial of stereotactic MR-guided online adaptive radiation therapy (SMART) for the treatment of oligometastatic or unresectable primary malignancies of the abdomen
AU - Henke, Lauren
AU - Kashani, Rojano
AU - Robinson, Clifford
AU - Curcuru, Austen
AU - DeWees, Todd
AU - Bradley, Jeffrey
AU - Green, Olga
AU - Michalski, Jeff
AU - Mutic, Sasa
AU - Parikh, Parag
AU - Olsen, Jeffrey
N1 - Funding Information:
A. Curcuru, Dr. Michalski, Dr. DeWees report no conflicts of interest related to or outside the submitted work. Dr. Olsen reports grants, personal fees and non-financial support from ViewRay, Inc, during the conduct of the study. Dr. Henke reports grants from ViewRay, Inc., during the conduct of the study, and other from ViewRay, Inc. outside the submitted work. Dr. Kashani reports grants from ViewRay, Inc., during the conduct of the study. Dr. Green and Dr. Bradley report personal fees and other from ViewRay, Inc. outside the submitted work. Dr. Robinson reports grants, personal fees and non-financial support from Varian Medical Systems, personal fees and non-financial support from ViewRay, other from Radialogica, grants from Elekta, non-financial support from DFINE, outside the submitted work. Dr. Mutic reports grants and personal fees from ViewRay, Inc, grants and other from Varian Medical Systems, other from TreatSafely, LLC, other from Radialogica, LLC, outside the submitted work. Dr. Parikh reports grants from Philips Healthcare, grants and other from Varian Medical Systems, other from Holaira, Inc, other from Medtronic/Covidien, outside the submitted work.
Funding Information:
This publication was additionally supported by the Washington University Institute of Clinical and Translational Sciences grant UL1T2000448 from the National Center for Advancing Translational Sciences (NCATS). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Funding Information:
This study was funded by an industry research grant from ViewRay, Inc. The funding source had no role or involvement in study design, data collection, data analysis, interpretation of results, the writing of the manuscript, or the choice to submit the manuscript for publication. The content is solely the responsibility of the authors.
Publisher Copyright:
© 2017 The Authors
PY - 2018/3
Y1 - 2018/3
N2 - Purpose/objectives: SBRT is used to treat oligometastatic or unresectable primary abdominal malignancies, although ablative dose delivery is limited by proximity of organs-at-risk (OAR). Stereotactic, magnetic resonance (MR)-guided online-adaptive radiotherapy (SMART) may improve SBRT's therapeutic ratio. This prospective Phase I trial assessed feasibility and potential advantages of SMART to treat abdominal malignancies. Materials/methods: Twenty patients with oligometastatic or unresectable primary liver (n = 10) and non-liver (n = 10) abdominal malignancies underwent SMART. Initial plans prescribed 50 Gy/5 fractions (BED 100 Gy) with goal 95% PTV coverage by 95% of prescription, subject to hard OAR constraints. Daily real-time online-adaptive plans were created as needed, based on daily setup MR-image-set tumor/OAR “anatomy-of-the-day” to preserve hard OAR constraints, escalate PTV dose, or both. Treatment times, patient outcomes, and dosimetric comparisons between initial and adaptive plans were prospectively recorded. Results: Online adaptive plans were created at time of treatment for 81/97 fractions, due to initial plan violation of OAR constraints (61/97) or observed opportunity for PTV dose escalation (20/97). Plan adaptation increased PTV coverage in 64/97 fractions. Zero Grade ≥ 3 acute (<6 months) treatment-related toxicities were observed. Discussion: SMART is clinically deliverable and safe, allowing PTV dose escalation and/or simultaneous OAR sparing compared to non-adaptive abdominal SBRT.
AB - Purpose/objectives: SBRT is used to treat oligometastatic or unresectable primary abdominal malignancies, although ablative dose delivery is limited by proximity of organs-at-risk (OAR). Stereotactic, magnetic resonance (MR)-guided online-adaptive radiotherapy (SMART) may improve SBRT's therapeutic ratio. This prospective Phase I trial assessed feasibility and potential advantages of SMART to treat abdominal malignancies. Materials/methods: Twenty patients with oligometastatic or unresectable primary liver (n = 10) and non-liver (n = 10) abdominal malignancies underwent SMART. Initial plans prescribed 50 Gy/5 fractions (BED 100 Gy) with goal 95% PTV coverage by 95% of prescription, subject to hard OAR constraints. Daily real-time online-adaptive plans were created as needed, based on daily setup MR-image-set tumor/OAR “anatomy-of-the-day” to preserve hard OAR constraints, escalate PTV dose, or both. Treatment times, patient outcomes, and dosimetric comparisons between initial and adaptive plans were prospectively recorded. Results: Online adaptive plans were created at time of treatment for 81/97 fractions, due to initial plan violation of OAR constraints (61/97) or observed opportunity for PTV dose escalation (20/97). Plan adaptation increased PTV coverage in 64/97 fractions. Zero Grade ≥ 3 acute (<6 months) treatment-related toxicities were observed. Discussion: SMART is clinically deliverable and safe, allowing PTV dose escalation and/or simultaneous OAR sparing compared to non-adaptive abdominal SBRT.
KW - ART
KW - MR-IGRT
KW - MRI-guided radiation therapy
KW - Online-adaptive radiation therapy
KW - SBRT
KW - SMART
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U2 - 10.1016/j.radonc.2017.11.032
DO - 10.1016/j.radonc.2017.11.032
M3 - Article
C2 - 29277446
AN - SCOPUS:85038821694
SN - 0167-8140
VL - 126
SP - 519
EP - 526
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
IS - 3
ER -