TY - JOUR
T1 - Ablative 5-Fraction Stereotactic Magnetic Resonance–Guided Radiation Therapy With On-Table Adaptive Replanning and Elective Nodal Irradiation for Inoperable Pancreas Cancer
AU - Chuong, Michael D.
AU - Bryant, John
AU - Mittauer, Kathryn E.
AU - Hall, Matthew
AU - Kotecha, Rupesh
AU - Alvarez, Diane
AU - Romaguera, Tino
AU - Rubens, Muni
AU - Adamson, Sonia
AU - Godley, Andrew
AU - Mishra, Vivek
AU - Luciani, Gustavo
AU - Gutierrez, Alonso N.
N1 - Funding Information:
Sources of support: No financial support was provided for this research. Disclosures: Dr Chuong reports grants, personal fees and nonfinancial support from ViewRay, personal fees and nonfinancial support from Sirtex, personal fees and nonfinancial support from Accuray, outside the submitted work. Dr Gutierrez reports personal fees and nonfinancial support from ViewRay, outside the submitted work. Dr Kotecha reports personal fees and nonfinancial support from Elekta, other from Novocure, outside the submitted work. Dr Mittauer reports personal fees and nonfinancial support from ViewRay, other from MR Guidance, LLC, outside the submitted work.
Publisher Copyright:
© 2020 The Author(s)
PY - 2021/3/1
Y1 - 2021/3/1
N2 - Purpose: Radiation therapy dose escalation using stereotactic body radiation therapy may significantly improve both local control (LC) and overall survival (OS) for patients with inoperable pancreas cancer. However, ablative dose cannot be routinely offered because of the risk of causing severe injury to adjacent normal organs. Stereotactic magnetic resonance (MR)-guided adaptive radiation therapy (SMART) represents a novel technique that may achieve safe delivery of ablative dose and improve long-term outcomes. Methods and Materials: We performed a single institution retrospective analysis of 35 consecutive pancreatic cancer patients treated with SMART in mid-inspiration breath hold on an MR-linear accelerator. Most had locally advanced disease (80%) and received induction chemotherapy (91.4%) for a median 3.9 months before stereotactic body radiation therapy. All were prescribed 5 fractions delivered in consecutive days to a median total dose of 50 Gy (BED10 100 Gy10), typically with a 120% to 130% hotspot. Elective nodal irradiation was delivered to 20 (57.1%) patients. No patient had fiducial markers placed and all were treated with continuous intrafraction MR visualization and automatic beam triggering. Results: With median follow-up of 10.3 months from SMART, acute (2.9%) and late (2.9%) grade 3 toxicities were uncommon. One-year LC, distant metastasis-free survival, progression-free survival, cause-specific survival, and OS were 87.8%, 63.1%, 52.4%, 77.6%, and 58.9%, respectively. Conclusions: To our knowledge, this is the first report of 5-fraction pancreas SMART delivered on an MR-linear accelerator. We observed minimal severe treatment-related toxicity and encouraging early LC. Prospective confirmation of feasibility and long-term clinical outcomes of dose intensified SMART is warranted.
AB - Purpose: Radiation therapy dose escalation using stereotactic body radiation therapy may significantly improve both local control (LC) and overall survival (OS) for patients with inoperable pancreas cancer. However, ablative dose cannot be routinely offered because of the risk of causing severe injury to adjacent normal organs. Stereotactic magnetic resonance (MR)-guided adaptive radiation therapy (SMART) represents a novel technique that may achieve safe delivery of ablative dose and improve long-term outcomes. Methods and Materials: We performed a single institution retrospective analysis of 35 consecutive pancreatic cancer patients treated with SMART in mid-inspiration breath hold on an MR-linear accelerator. Most had locally advanced disease (80%) and received induction chemotherapy (91.4%) for a median 3.9 months before stereotactic body radiation therapy. All were prescribed 5 fractions delivered in consecutive days to a median total dose of 50 Gy (BED10 100 Gy10), typically with a 120% to 130% hotspot. Elective nodal irradiation was delivered to 20 (57.1%) patients. No patient had fiducial markers placed and all were treated with continuous intrafraction MR visualization and automatic beam triggering. Results: With median follow-up of 10.3 months from SMART, acute (2.9%) and late (2.9%) grade 3 toxicities were uncommon. One-year LC, distant metastasis-free survival, progression-free survival, cause-specific survival, and OS were 87.8%, 63.1%, 52.4%, 77.6%, and 58.9%, respectively. Conclusions: To our knowledge, this is the first report of 5-fraction pancreas SMART delivered on an MR-linear accelerator. We observed minimal severe treatment-related toxicity and encouraging early LC. Prospective confirmation of feasibility and long-term clinical outcomes of dose intensified SMART is warranted.
UR - http://www.scopus.com/inward/record.url?scp=85092513240&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85092513240&partnerID=8YFLogxK
U2 - 10.1016/j.prro.2020.09.005
DO - 10.1016/j.prro.2020.09.005
M3 - Article
C2 - 32947042
AN - SCOPUS:85092513240
SN - 1879-8500
VL - 11
SP - 134
EP - 147
JO - Practical Radiation Oncology
JF - Practical Radiation Oncology
IS - 2
ER -