Radiotherapy and Oncology· 2017Q1
Phase I trial of stereotactic MR-guided online adaptive radiation therapy (SMART) for the treatment of oligometastatic or unresectable primary malignancies of the abdomen
- 427citations
- Q1SCImago
- 2017year
Short summary
A Phase I trial found stereotactic MR-guided online-adaptive radiotherapy (SMART) to be feasible and safe for abdominal malignancies, enabling dose escalation or improved organ-at-risk sparing in 81% of fractions.
AI-generated from the title and abstract; the full text is not read.
Key points
- SMART radiation therapy was tested in 20 patients with abdominal malignancies.
- Online adaptive plans were created for 81% of treatment fractions.
- Adaptations were driven by organ-at-risk constraints (61%) or dose escalation opportunities (20%).
- No Grade ≥ 3 acute treatment-related toxicities were observed.
AI-generated from the title and abstract; the full text is not read.
Abstract
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.
The authors' abstract, as published at the source. Radiotherapy and Oncology, 2017 · DOI ↗
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Field: Radiation
RadiationPhysics and Astronomy