nach oben

Journal of Cancer Research and Clinical Oncology

Erschienen in:

30.08.2022 | Research

Application of real-time MRI-guided linear accelerator in stereotactic ablative body radiotherapy for non-small cell lung cancer: one step forward to precise targeting

verfasst von: Hye Jin Kang, Yoo-Kang Kwak, Myungsoo Kim, So Jung Lee

Erschienen in: Journal of Cancer Research and Clinical Oncology | Ausgabe 11/2022

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Tumor motion is a major challenge in stereotactic ablative body radiotherapy (SABR) for non-small cell lung cancer (NSCLC), causing excessive irradiation to compensate for this motion. Real-time tumor tracking with a magnetic resonance imaging-guided linear accelerator (MR-Linac) could address this problem. This study aimed to assess the effects and advantages of MR-Linac in SABR for the treatment of lung tumors.

Methods

Overall, 41 patients with NSCLC treated with SABR using MR-Linac between March 2019 and December 2021 were included. For comparison, 40 patients treated with SABR using computed tomography-based modalities were also enrolled. The SABR dose ranged from 48 to 60 Gy in 3–5 fractions. The primary endpoint was a lower radiation volume compared to CT-based SABR. The secondary endpoint was the local control rate of SABR using the MR-Linac.

Results

The median follow-up time was 19 months (range: 3–105 months). There was no significant difference in the gross tumor volume between the MR and CT groups (7.1 ± 9.3 cm³ vs 8.0 ± 6.8 cm³, p = 0.643), but the planning target volume was significantly smaller in the MR group (20.8 ± 18.8 cm³ vs 34.1 ± 22.9 cm³, p = 0.005). The 1-year local control rates for the MR and CT groups were 92.1 and 75.4%, respectively (p = 0.07), and the 1-year overall survival rates were 87.4 and 87.0%, respectively (p = 0.30).

Conclusion

Lung SABR with MR-Linac can reduce the radiation field without compromising the local control rate. Further follow-up is needed to assess the long-term effects.

Baumann P, Nyman J, Hoyer M et al (2009) Outcome in a prospective phase II trial of medically inoperable stage I non-small-cell lung cancer patients treated with stereotactic body radiotherapy. J Clin Oncol 27:3290–3296. https://doi.org/10.1200/JCO.2008.21.5681CrossRefPubMed

Brandner ED, Chetty IJ, Giaddui TG, Xiao Y, Huq MS (2017) Motion management strategies and technical issues associated with stereotactic body radiotherapy of thoracic and upper abdominal tumors: a review from NRG oncology. Med Phys 44:2595–2612. https://doi.org/10.1002/mp.12227CrossRefPubMed

Ehrbar S, Johl A, Tartas A et al (2017) ITV, mid-ventilation, gating or couch tracking - a comparison of respiratory motion-management techniques based on 4D dose calculations. Radiother Oncol 124:80–88. https://doi.org/10.1016/j.radonc.2017.05.016CrossRefPubMed

Giraud P, Houle A (2013) Respiratory gating for radiotherapy: main technical aspects and clinical benefits. ISRN Pulmonology 2013:519602. https://doi.org/10.1155/2013/519602CrossRef

Hanley J, Debois MM, Mah D et al (1999) Deep inspiration breath-hold technique for lung tumors: the potential value of target immobilization and reduced lung density in dose escalation. Int J Radiat Oncol Biol Phys 45:603–611. https://doi.org/10.1016/s0360-3016(99)00154-6CrossRefPubMed

Hof H, Muenter M, Oetzel D, Hoess A, Debus J, Herfarth K (2007) Stereotactic single-dose radiotherapy (radiosurgery) of early stage nonsmall-cell lung cancer (NSCLC). Cancer 110:148–155. https://doi.org/10.1002/cncr.22763CrossRefPubMed

Howington JA, Blum MG, Chang AC, Balekian AA, Murthy SC (2013) Treatment of stage I and II non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American college of chest physicians evidence-based clinical practice guidelines. Chest 143:e278S-e313S. https://doi.org/10.1378/chest.12-2359CrossRefPubMed

Kim J, Wu Q, Zhao B, Wen N, Ajlouni M, Movsas B, Chetty IJ (2016) To gate or not to gate - dosimetric evaluation comparing Gated vs. ITV-based methodologies in stereotactic ablative body radiotherapy (SABR) treatment of lung cancer. Radiat Oncol 11:125. https://doi.org/10.1186/s13014-016-0699-2CrossRefPubMedPubMedCentral

Koto M, Takai Y, Ogawa Y et al (2007) A phase II study on stereotactic body radiotherapy for stage I non-small cell lung cancer. Radiother Oncol 85:429–434. https://doi.org/10.1016/j.radonc.2007.10.017CrossRefPubMed

Lee P, Loo BW Jr, Biswas T et al (2021) Local control after stereotactic body radiation therapy for stage I non-small cell lung cancer. Int J Radiat Oncol Biol Phys 110:160–171. https://doi.org/10.1016/j.ijrobp.2019.03.045CrossRefPubMed

Matsuo Y, Shibuya K, Nakamura M et al (2012) Dose–volume metrics associated with radiation pneumonitis after stereotactic body radiation therapy for lung cancer. Int J Radiat Oncol Biol Phys 83:e545-549. https://doi.org/10.1016/j.ijrobp.2012.01.018CrossRefPubMed

Molitoris JK, Diwanji T, Snider JW 3rd et al (2018) Advances in the use of motion management and image guidance in radiation therapy treatment for lung cancer. J Thorac Dis 10:S2437–S2450. https://doi.org/10.21037/jtd.2018.01.155CrossRefPubMedPubMedCentral

Murray P, Franks K, Hanna GG (2017) A systematic review of outcomes following stereotactic ablative radiotherapy in the treatment of early-stage primary lung cancer. Br J Radiol 90:20160732. https://doi.org/10.1259/bjr.20160732CrossRefPubMedPubMedCentral

Nagata Y, Takayama K, Matsuo Y et al (2005) Clinical outcomes of a phase I/II study of 48 Gy of stereotactic body radiotherapy in 4 fractions for primary lung cancer using a stereotactic body frame. Int J Radiat Oncol Biol Phys 63:1427–1431. https://doi.org/10.1016/j.ijrobp.2005.05.034CrossRefPubMed

Nissen HD, Appelt AL (2013) Improved heart, lung and target dose with deep inspiration breath hold in a large clinical series of breast cancer patients. Radiother Oncol 106:28–32. https://doi.org/10.1016/j.radonc.2012.10.016CrossRefPubMed

Oechsner M, Dusberg M, Borm KJ, Combs SE, Wilkens JJ, Duma MN (2019) Deep inspiration breath-hold for left-sided breast irradiation: analysis of dose-mass histograms and the impact of lung expansion. Radiat Oncol 14:109. https://doi.org/10.1186/s13014-019-1293-1CrossRefPubMedPubMedCentral

Onishi H, Shirato H, Nagata Y et al (2007) Hypofractionated stereotactic radiotherapy (HypoFXSRT) for stage I non-small cell lung cancer: updated results of 257 patients in a Japanese multi-institutional study. J Thorac Oncol 2:S94-100. https://doi.org/10.1097/JTO.0b013e318074de34CrossRefPubMed

Palma DA, Olson R, Harrow S et al (2019) Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): a randomised, phase 2, open-label trial. Lancet 393:2051–2058. https://doi.org/10.1016/s0140-6736(18)32487-5CrossRefPubMed

Park K, Vansteenkiste J, Lee KH et al (2020) Pan-Asian adapted ESMO clinical practice guidelines for the management of patients with locally-advanced unresectable non-small-cell lung cancer: a KSMO-ESMO initiative endorsed by CSCO, ISMPO, JSMO, MOS, SSO and TOS. Ann Oncol 31:191–201. https://doi.org/10.1016/j.annonc.2019.10.026CrossRefPubMed

Prunaretty J, Boisselier P, Ailleres N et al (2019) Tracking, gating, free-breathing, which technique to use for lung stereotactic treatments? A dosimetric comparison. Rep Pract Oncol Radiother 24:97–104. https://doi.org/10.1016/j.rpor.2018.11.003CrossRefPubMed

Remouchamps VM, Vicini FA, Sharpe MB, Kestin LL, Martinez AA, Wong JW (2003) Significant reductions in heart and lung doses using deep inspiration breath hold with active breathing control and intensity-modulated radiation therapy for patients treated with locoregional breast irradiation. Int J Radiat Oncol Biol Phys 55:392–406. https://doi.org/10.1016/s0360-3016(02)04143-3CrossRefPubMed

Sawant A, Keall P, Pauly KB et al (2014) Investigating the feasibility of rapid MRI for image-guided motion management in lung cancer radiotherapy. Biomed Res Int 2014:485067. https://doi.org/10.1155/2014/485067CrossRefPubMedPubMedCentral

Shibamoto Y, Hashizume C, Baba F et al (2015) Stereotactic body radiotherapy using a radiobiology-based regimen for stage I non-small-cell lung cancer: five-year mature results. J Thorac Oncol 10:960–964. https://doi.org/10.1097/jto.0000000000000525CrossRefPubMed

Shinde A, Li R, Kim J, Salgia R, Hurria A, Amini A (2018) Stereotactic body radiation therapy (SBRT) for early-stage lung cancer in the elderly. Semin Oncol 45:210–219. https://doi.org/10.1053/j.seminoncol.2018.06.002CrossRefPubMed

Shirato H, Onimaru R, Ishikawa M et al (2012) Real-time 4-D radiotherapy for lung cancer. Cancer Sci 103:1–6. https://doi.org/10.1111/j.1349-7006.2011.02114.xCrossRefPubMed

Shultz DB, Filippi AR, Thariat J, Mornex F, Loo BW Jr, Ricardi U (2014) Stereotactic ablative radiotherapy for pulmonary oligometastases and oligometastatic lung cancer. J Thorac Oncol 9:1426–1433. https://doi.org/10.1097/jto.0000000000000317CrossRefPubMed

Temming S, Kocher M, Stoelben E et al (2018) Risk-adapted robotic stereotactic body radiation therapy for inoperable early-stage non-small-cell lung cancer. Strahlenther Onkol 194:91–97. https://doi.org/10.1007/s00066-017-1194-xCrossRefPubMed

Timmerman RD, Paulus R, Pass HI et al (2018) Stereotactic body radiation therapy for operable early-stage lung cancer: findings from the NRG oncology RTOG 0618 trial. JAMA Oncol 4:1263–1266. https://doi.org/10.1001/jamaoncol.2018.1251CrossRefPubMedPubMedCentral

Videtic GM, Paulus R, Singh AK et al (2019) Long-term follow-up on NRG oncology RTOG 0915 (NCCTG N0927): a randomized phase 2 study comparing 2 stereotactic body radiation therapy schedules for medically inoperable patients with stage I peripheral non-small cell lung cancer. Int J Radiat Oncol Biol Phys 103:1077–1084. https://doi.org/10.1016/j.ijrobp.2018.11.051CrossRefPubMed

Wojcieszynski AP, Hill PM, Rosenberg SA et al (2017) Dosimetric comparison of real-time MRI-guided tri-cobalt-60 versus linear accelerator-based stereotactic body radiation therapy lung cancer plans. Technol Cancer Res Treat 16:366–372. https://doi.org/10.1177/1533034617691407CrossRefPubMedPubMedCentral

Yamada Y, Yamada M, Chubachi S et al (2020) Comparison of inspiratory and expiratory lung and lobe volumes among supine, standing, and sitting positions using conventional and upright CT. Sci Rep 10:16203. https://doi.org/10.1038/s41598-020-73240-8CrossRefPubMedPubMedCentral

Zhao J, Yorke ED, Li L et al (2016) Simple factors associated with radiation-induced lung toxicity after stereotactic body radiation therapy of the thorax: a pooled analysis of 88 studies. Int J Radiat Oncol Biol Phys 95:1357–1366. https://doi.org/10.1016/j.ijrobp.2016.03.024CrossRefPubMedPubMedCentral

Titel: Application of real-time MRI-guided linear accelerator in stereotactic ablative body radiotherapy for non-small cell lung cancer: one step forward to precise targeting
verfasst von: Hye Jin Kang
Yoo-Kang Kwak
Myungsoo Kim
So Jung Lee
Publikationsdatum: 30.08.2022
Verlag: Springer Berlin Heidelberg
Erschienen in: Journal of Cancer Research and Clinical Oncology / Ausgabe 11/2022
Print ISSN: 0171-5216
Elektronische ISSN: 1432-1335
DOI: https://doi.org/10.1007/s00432-022-04264-y

Springer Medizin

Application of real-time MRI-guided linear accelerator in stereotactic ablative body radiotherapy for non-small cell lung cancer: one step forward to precise targeting

Abstract

Purpose

Methods

Results

Conclusion

Neu im Fachgebiet Onkologie

Adjuvante Immuntherapie verlängert Leben bei RCC

Alectinib verbessert krankheitsfreies Überleben bei ALK-positivem NSCLC

Bei Senioren mit Prostatakarzinom auf Anämie achten!

ICI-Therapie in der Schwangerschaft wird gut toleriert

Update Onkologie

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 11/2022

Quality of life, distress, and posttraumatic growth 5 years after colorectal cancer diagnosis according to history of inpatient rehabilitation

Clinical experience with venetoclax in patients with newly diagnosed, relapsed, or refractory acute myeloid leukemia

Melanocytic nevi in sentinel lymph nodes: association with cutaneous nevi and clinical relevance in patients with cutaneous melanomas

Prevalence of abnormal Pap smear results in inflammatory bowel disease: a prospective study

Cetuximab resistance induced by hepatocyte growth factor is overcome by MET inhibition in KRAS, NRAS, and BRAF wild-type colorectal cancers

Neoadjuvant versus adjuvant chemotherapy in bladder cancer: a nationwide cohort study

Neu im Fachgebiet Onkologie

Adjuvante Immuntherapie verlängert Leben bei RCC

Alectinib verbessert krankheitsfreies Überleben bei ALK-positivem NSCLC

Bei Senioren mit Prostatakarzinom auf Anämie achten!

ICI-Therapie in der Schwangerschaft wird gut toleriert

Update Onkologie