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Shen J, Zhong N, Chen Z, Ma D, Lin J. The impacts of physical factors on huge hepatocellular carcinoma treated by transarterial chemoembolization combined with radiotherapy. Future Oncol 2024:1-11. [PMID: 39263953 DOI: 10.1080/14796694.2024.2395801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 08/20/2024] [Indexed: 09/13/2024] Open
Abstract
Aims: To assess the influence of various physical factors on the outcome of transarterial chemoembolization combined with γ-ray hypofractionated radiation therapy (TACE-γHRT) for unresectable huge (≥10 cm) hepatocellular carcinoma (UH-HCC) patients.Materials & methods: A total of 162 UH-HCC patients with different tumor locations treated with TACE-γHRT and a retrospective analysis was conducted to evaluate the impacts of selected physical parameters on clinical outcomes.Results: The selected physical factors influenced the clinical outcomes significantly. No adverse events exceeding grade 3 were observed in the enrolled patients.Conclusion: Higher P70 and marginal dose, smaller tumor size and tumor location of neither skin nor gastrointestinal tracts involved were independent predictors for better overall survival and progression free survival.
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Affiliation(s)
- Juanjuan Shen
- Department of Tumor Radiotherapy, 900th Hospital of PLA, Fuzhou, China
| | - Nanbao Zhong
- Department of Tumor Radiotherapy, 900th Hospital of PLA, Fuzhou, China
| | - Zhonghua Chen
- Department of Tumor Radiotherapy, 900th Hospital of PLA, Fuzhou, China
| | - Danyu Ma
- Department of Tumor Radiotherapy, 900th Hospital of PLA, Fuzhou, China
| | - Jianhai Lin
- Department of Tumor Radiotherapy, 900th Hospital of PLA, Fuzhou, China
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2
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Chiloiro G, Panza G, Boldrini L, Romano A, Placidi L, Nardini M, Galetto M, Votta C, Campitelli M, Cellini F, Massaccesi M, Gambacorta MA. REPeated mAgnetic resonance Image-guided stereotactic body Radiotherapy (MRIg-reSBRT) for oligometastatic patients: REPAIR, a mono-institutional retrospective study. Radiat Oncol 2024; 19:52. [PMID: 38671526 PMCID: PMC11055272 DOI: 10.1186/s13014-024-02445-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/22/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Oligo-progression or further recurrence is an open issue in the multi-integrated management of oligometastatic disease (OMD). Re-irradiation with stereotactic body radiotherapy (re-SBRT) technique could represent a valuable treatment option to improve OMD clinical outcomes. MRI-guided allows real-time visualization of the target volumes and online adaptive radiotherapy (oART). The aim of this retrospective study is to evaluate the efficacy and toxicity profile of MRI-guided repeated SBRT (MRIg-reSBRT) in the OMD setting and propose a re-SBRT classification. METHODS We retrospectively analyzed patients (pts) with recurrent liver metastases or abdominal metastatic lesions between 1 and 5 centimeters from liver candidate to MRIg-reSBRT showing geometric overlap between the different SBRT courses and assessing whether they were in field (type 1) or not (type 2). RESULTS Eighteen pts completed MRIg-reSBRT course for 25 metastatic hepatic/perihepatic lesions from July 2019 to January 2020. A total of 20 SBRT courses: 15 Type 1 re-SBRT (75%) and 5 Type 2 re-SBRT (25%) was delivered. Mean interval between the first SBRT and MRIg-reSBRT was 8,6 months. Mean prescribed dose for the first treatment was 43 Gy (range 24-50 Gy, mean BEDα/β10=93), while 41 Gy (range 16-50 Gy, mean BEDα/β10=92) for MRIg-reSBRT. Average liver dose was 3,9 Gy (range 1-10 Gy) and 3,7 Gy (range 1,6-8 Gy) for the first SBRT and MRIg-reSBRT, respectively. No acute or late toxicities were reported at a median follow-up of 10,7 months. The 1-year OS and PFS was 73,08% and 50%, respectively. Overall Clinical Benefit was 54%. CONCLUSIONS MRIg-reSBRT could be considered an effective and safe option in the multi-integrated treatment of OMD.
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Affiliation(s)
- Giuditta Chiloiro
- Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Rome, Italy
| | - Giulia Panza
- Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Rome, Italy.
| | - Luca Boldrini
- Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Rome, Italy
| | - Angela Romano
- Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Rome, Italy
| | - Lorenzo Placidi
- Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Rome, Italy
| | - Matteo Nardini
- Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Rome, Italy
| | - Matteo Galetto
- Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Rome, Italy
| | - Claudio Votta
- Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Rome, Italy
| | - Maura Campitelli
- Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Rome, Italy
| | - Francesco Cellini
- Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Rome, Italy
| | | | - Maria Antonietta Gambacorta
- Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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3
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Gutman MJ, Serra LM, Koshy M, Katipally RR. SBRT for Liver Tumors: What the Interventional Radiologist Needs to Know. Semin Intervent Radiol 2024; 41:1-10. [PMID: 38495259 PMCID: PMC10940045 DOI: 10.1055/s-0043-1778657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
This review summarizes the clinical evidence supporting the utilization of stereotactic body radiotherapy (SBRT) for liver tumors, including hepatocellular carcinoma, liver metastases, and cholangiocarcinoma. Emerging prospective evidence has demonstrated the benefit and low rates of toxicity across a broad range of clinical contexts. We provide an introduction for the interventional radiologist, with a discussion of underlying themes such as tumor dose-response, mitigation of liver toxicity, and the technical considerations relevant to performing liver SBRT. Ultimately, we recommend that SBRT should be routinely included in the armamentarium of locoregional therapies for liver malignancies, alongside those liver-directed therapies offered by interventional radiology.
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Affiliation(s)
- Michael J. Gutman
- Department of Radiation and Cellular Oncology, The University of Chicago Medicine, Chicago, Illinois
| | - Lucas M. Serra
- Department of Radiation and Cellular Oncology, The University of Chicago Medicine, Chicago, Illinois
| | - Matthew Koshy
- Department of Radiation and Cellular Oncology, The University of Chicago Medicine, Chicago, Illinois
| | - Rohan R. Katipally
- Department of Radiation and Cellular Oncology, The University of Chicago Medicine, Chicago, Illinois
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4
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Prime S, Schiff JP, Hosni A, Stanescu T, Dawson LA, Henke LE. The Use of MR-Guided Radiation Therapy for Liver Cancer. Semin Radiat Oncol 2024; 34:36-44. [PMID: 38105091 DOI: 10.1016/j.semradonc.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
The role of radiotherapy in the management of primary and metastatic liver malignancies has expanded in recent years due to advances such as IGRT and SBRT. MRI-guided radiotherapy (MRgRT) has arisen as an excellent option for the management of hepatocellular carcinoma, cholangiocarcinoma, and liver metastases due to the ability to combine improved hepatic imaging with conformal treatment planning paradigms like adaptive radiotherapy and advanced motion management techniques. Herein we review the data for MRgRT for liver malignancies, as well as describe workflow and technical considerations for the 2 commercially available MRgRT delivery platforms.
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Affiliation(s)
- Sabrina Prime
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO
| | - Joshua P Schiff
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO
| | - Ali Hosni
- Radiation Medicine Program, Princess Margaret Cancer Centre, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Teodor Stanescu
- Radiation Medicine Program, Princess Margaret Cancer Centre, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Laura A Dawson
- Radiation Medicine Program, Princess Margaret Cancer Centre, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Lauren E Henke
- University Hospitals/Case Western Reserve University, Department of Radiation Oncology, Cleveland, OH.
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5
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Bordeau K, Michalet M, Dorion V, Keskes A, Valdenaire S, Debuire P, Cantaloube M, Cabaillé M, Draghici R, Ychou M, Assenat E, Jarlier M, Gourgou S, Guiu B, Ursic-Bedoya J, Aillères N, Fenoglietto P, Azria D, Riou O. A prospective registry study of stereotactic magnetic resonance guided radiotherapy (MRgRT) for primary liver tumors. Radiother Oncol 2023; 189:109912. [PMID: 37739315 DOI: 10.1016/j.radonc.2023.109912] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/04/2023] [Accepted: 09/09/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND PURPOSE Stereotactic body radiation therapy (SBRT) has demonstrated safe and effective results for primary liver tumors. Magnetic Resonance guided Radiotherapy (MRgRT) is an innovative radiotherapy modality for abdominal tumors. The aim of this study is to report on acute and late toxicities and initial oncological results for primary liver tumors treated with MRgRT. MATERIALS AND METHODS We prospectively included in our cohort all patients treated by MRgRT for a primary liver tumor at the Montpellier Cancer Institute. The primary endpoint was acute and late toxicities assessed according to CTCAE v 5.0. The mean prescribed dose was 50 Gy in 5 fractions. RESULTS Between October 2019 and April 2022, MRgRT treated 56 patients for 72 primary liver lesions. No acute or late toxicities of CTCAE grade greater than 2 attributable to radiotherapy were noted during follow-up. No cases of radiation-induced liver disease (RILD), either classical or non-classical, occurred. After a median follow-up of 13.2 months (95% CI [8.8; 15.7]), overall survival was 85.1% (95% CI: [70.8; 92.7]) at 1 year and 74.2% at 18 months (95% CI [52.6; 87.0]). Local control was 98.1% (95% CI: [87.4; 99.7]) and 94.7% (95% CI: [79.5; 98.7]) at 12 and 18 months, respectively. Among the HCC subgroup, no local recurrences were observed. CONCLUSION MRgRT for primary liver tumors is safe without severe adverse events and reach excellent local control. Numerous studies are underway to better assess the value of MRI guidance and adaptive process in these indications.
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Affiliation(s)
- Karl Bordeau
- University Federation of Radiation Oncology of Mediterranean Occitanie, Montpellier Cancer Institute (ICM), Univ Montpellier, INSERM U1194 IRCM, Montpellier, France
| | - Morgan Michalet
- University Federation of Radiation Oncology of Mediterranean Occitanie, Montpellier Cancer Institute (ICM), Univ Montpellier, INSERM U1194 IRCM, Montpellier, France
| | - Valérie Dorion
- University Federation of Radiation Oncology of Mediterranean Occitanie, Montpellier Cancer Institute (ICM), Univ Montpellier, INSERM U1194 IRCM, Montpellier, France
| | - Aïcha Keskes
- University Federation of Radiation Oncology of Mediterranean Occitanie, Montpellier Cancer Institute (ICM), Univ Montpellier, INSERM U1194 IRCM, Montpellier, France
| | - Simon Valdenaire
- University Federation of Radiation Oncology of Mediterranean Occitanie, Montpellier Cancer Institute (ICM), Univ Montpellier, INSERM U1194 IRCM, Montpellier, France
| | - Pierre Debuire
- University Federation of Radiation Oncology of Mediterranean Occitanie, Montpellier Cancer Institute (ICM), Univ Montpellier, INSERM U1194 IRCM, Montpellier, France
| | - Marie Cantaloube
- University Federation of Radiation Oncology of Mediterranean Occitanie, Montpellier Cancer Institute (ICM), Univ Montpellier, INSERM U1194 IRCM, Montpellier, France
| | - Morgane Cabaillé
- University Federation of Radiation Oncology of Mediterranean Occitanie, Montpellier Cancer Institute (ICM), Univ Montpellier, INSERM U1194 IRCM, Montpellier, France
| | - Roxana Draghici
- University Federation of Radiation Oncology of Mediterranean Occitanie, Montpellier Cancer Institute (ICM), Univ Montpellier, INSERM U1194 IRCM, Montpellier, France
| | - Marc Ychou
- Medical oncology department, ICM, Montpellier Cancer Institute, Univ Montpellier, Montpellier, France
| | - Eric Assenat
- Medical oncology department, CHU St Eloi 34000, Montpellier, France
| | - Marta Jarlier
- Biometrics Unit ICM, Montpellier Cancer Institute, Univ Montpellier, Montpellier, France
| | - Sophie Gourgou
- Biometrics Unit ICM, Montpellier Cancer Institute, Univ Montpellier, Montpellier, France
| | - Boris Guiu
- Radiology department, CHU St Eloi 34000, Montpellier, France
| | - José Ursic-Bedoya
- Liver Transplantation Unit, Department of Hepatology, Montpellier University Hospital, University of Montpellier, 34295, Montpellier, France
| | - Norbert Aillères
- University Federation of Radiation Oncology of Mediterranean Occitanie, Montpellier Cancer Institute (ICM), Univ Montpellier, INSERM U1194 IRCM, Montpellier, France
| | - Pascal Fenoglietto
- University Federation of Radiation Oncology of Mediterranean Occitanie, Montpellier Cancer Institute (ICM), Univ Montpellier, INSERM U1194 IRCM, Montpellier, France
| | - David Azria
- University Federation of Radiation Oncology of Mediterranean Occitanie, Montpellier Cancer Institute (ICM), Univ Montpellier, INSERM U1194 IRCM, Montpellier, France
| | - Olivier Riou
- University Federation of Radiation Oncology of Mediterranean Occitanie, Montpellier Cancer Institute (ICM), Univ Montpellier, INSERM U1194 IRCM, Montpellier, France.
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Chuong MD, Palm RF, Tjong MC, Hyer DE, Kishan AU. Advances in MRI-Guided Radiation Therapy. Surg Oncol Clin N Am 2023; 32:599-615. [PMID: 37182995 DOI: 10.1016/j.soc.2023.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Image guidance for radiation therapy (RT) has evolved over the last few decades and now is routinely performed using cone-beam computerized tomography (CBCT). Conventional linear accelerators (LINACs) that use CBCT have limited soft tissue contrast, are not able to image the patient's internal anatomy during treatment delivery, and most are not capable of online adaptive replanning. RT delivery systems that use MRI have become available within the last several years and address many of the imaging limitations of conventional LINACs. Herein, the authors review the technical characteristics and advantages of MRI-guided RT as well as emerging clinical outcomes.
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Affiliation(s)
- Michael D Chuong
- Department of Radiation Oncology, Miami Cancer Institute, 8900 North Kendall Drive, Miami, FL 33176, USA.
| | - Russell F Palm
- Department of Radiation Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Michael C Tjong
- Department of Radiation Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Daniel E Hyer
- Department of Radiation Oncology, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242, USA
| | - Amar U Kishan
- Department of Radiation Oncology, University of California Los Angeles, 1338 S Hope Street, Los Angeles, CA 90015, USA
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7
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Abstract
During the past 30 years, several advances have been made allowing for safer and more effective treatment of patients with liver cancer. This report reviews recent advances in radiation therapy for primary liver cancers including hepatocellular carcinoma and intrahepatic cholangiocarcinoma. First, studies focusing on liver stereotactic body radiation therapy (SBRT) are reviewed focusing on lessons learned and knowledge gained from early pioneering trials. Then, new technologies to enhance SBRT treatments are explored including adaptive therapy and MRI-guided and biology-guided radiation therapy. Finally, treatment with Y-90 transarterial radioembolization is reviewed with a focus on novel approaches focused on personalized therapy.
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8
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Zaki P, Chuong MD, Schaub SK, Lo SS, Ibrahim M, Apisarnthanarax S. Proton Beam Therapy and Photon-Based Magnetic Resonance Image-Guided Radiation Therapy: The Next Frontiers of Radiation Therapy for Hepatocellular Carcinoma. Technol Cancer Res Treat 2023; 22:15330338231206335. [PMID: 37908130 PMCID: PMC10621304 DOI: 10.1177/15330338231206335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 08/21/2023] [Accepted: 09/21/2023] [Indexed: 11/02/2023] Open
Abstract
External beam radiation therapy (EBRT) has increasingly been utilized in the treatment of hepatocellular carcinoma (HCC) due to technological advances with positive clinical outcomes. Innovations in EBRT include improved image guidance, motion management, treatment planning, and highly conformal techniques such as intensity-modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT). Moreover, proton beam therapy (PBT) and magnetic resonance image-guided radiation therapy (MRgRT) have expanded the capabilities of EBRT. PBT offers the advantage of minimizing low- and moderate-dose radiation to the surrounding normal tissue, thereby preserving uninvolved liver and allowing for dose escalation. MRgRT provides the advantage of improved soft tissue delineation compared to computerized tomography (CT) guidance. Additionally, MRgRT with online adaptive therapy is particularly useful for addressing motion not otherwise managed and reducing high-dose radiation to the normal tissue such as the stomach and bowel. PBT and online adaptive MRgRT are emerging technological advancements in EBRT that may provide a significant clinical benefit for patients with HCC.
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Affiliation(s)
- Peter Zaki
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Michael D. Chuong
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL, USA
| | - Stephanie K. Schaub
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Simon S. Lo
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Mariam Ibrahim
- School of Medicine, St. George's University, St. George's, Grenada
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9
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Bordeau K, Michalet M, Keskes A, Debrigode C, Azria D, Riou O. Radiothérapie stéréotaxique des tumeurs primitives hépatiques : indications et nouvelles techniques. Cancer Radiother 2022; 26:851-857. [DOI: 10.1016/j.canrad.2022.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 11/26/2022]
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10
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Lewis S, Barry A, Hawkins MA. Hypofractionation in Hepatocellular Carcinoma - The Effect of Fractionation Size. Clin Oncol (R Coll Radiol) 2022; 34:e195-e209. [PMID: 35314091 DOI: 10.1016/j.clon.2022.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 02/11/2022] [Accepted: 02/24/2022] [Indexed: 12/26/2022]
Abstract
The use of stereotactic body radiotherapy (SBRT) in hepatocellular carcinoma (HCC) has increased over the years. Several prospective studies have demonstrated its safety and efficacy, and randomised trials are underway. The advancement in technology has enabled the transition from three-dimensional conformal radiotherapy to highly focused SBRT. Liver damage is the primary limiting toxicity with radiation, with the incidence of grade 3 varying from 0 to 30%. The reported radiotherapy fractionation schedule for HCC, and in practice use, ranges from one to 10 fractions, based on clinician preference and technology available, tumour location and tumour size. This review summarises the safety and efficacy of various SBRT fractionation schedules for HCC.
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Affiliation(s)
- S Lewis
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - A Barry
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - M A Hawkins
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK.
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11
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Lewis S, Dawson L, Barry A, Stanescu T, Mohamad I, Hosni A. Stereotactic body radiation therapy for hepatocellular carcinoma: from infancy to ongoing maturity. JHEP Rep 2022; 4:100498. [PMID: 35860434 PMCID: PMC9289870 DOI: 10.1016/j.jhepr.2022.100498] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/23/2022] [Accepted: 04/25/2022] [Indexed: 12/16/2022] Open
Affiliation(s)
- Shirley Lewis
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Canada
| | - Laura Dawson
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Canada
| | - Aisling Barry
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Canada
| | - Teodor Stanescu
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Canada
| | - Issa Mohamad
- Department of Radiation Oncology, King Hussein Cancer Centre, Jordan
| | - Ali Hosni
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Canada
- Corresponding author. Address: Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.
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12
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Cuccia F, Alongi F, Belka C, Boldrini L, Hörner-Rieber J, McNair H, Rigo M, Schoenmakers M, Niyazi M, Slagter J, Votta C, Corradini S. Patient positioning and immobilization procedures for hybrid MR-Linac systems. Radiat Oncol 2021; 16:183. [PMID: 34544481 PMCID: PMC8454038 DOI: 10.1186/s13014-021-01910-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 09/09/2021] [Indexed: 02/08/2023] Open
Abstract
Hybrid magnetic resonance (MR)-guided linear accelerators represent a new horizon in the field of radiation oncology. By harnessing the favorable combination of on-board MR-imaging with the possibility to daily recalculate the treatment plan based on real-time anatomy, the accuracy in target and organs-at-risk identification is expected to be improved, with the aim to provide the best tailored treatment. To date, two main MR-linac hybrid machines are available, Elekta Unity and Viewray MRIdian. Of note, compared to conventional linacs, these devices raise practical issues due to the positioning phase for the need to include the coil in the immobilization procedure and in order to perform the best reproducible positioning, also in light of the potentially longer treatment time. Given the relative novelty of this technology, there are few literature data regarding the procedures and the workflows for patient positioning and immobilization for MR-guided daily adaptive radiotherapy. In the present narrative review, we resume the currently available literature and provide an overview of the positioning and setup procedures for all the anatomical districts for hybrid MR-linac systems.
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Affiliation(s)
- Francesco Cuccia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar Di Valpolicella, VR, Italy.
| | - Filippo Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar Di Valpolicella, VR, Italy
- University of Brescia, Brescia, Italy
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Luca Boldrini
- Radiology, Radiation Oncology and Hematology Department, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Roma, Italy
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, University Hospital of Heidelberg, National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - Helen McNair
- The Royal Marsden NHS Foundation Trust, and Institute of Cancer Research Sutton, Surrey, UK
| | - Michele Rigo
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar Di Valpolicella, VR, Italy
| | - Maartje Schoenmakers
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Judith Slagter
- Department of Radiation Oncology - Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Claudio Votta
- Radiology, Radiation Oncology and Hematology Department, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Roma, Italy
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
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13
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MRI-guided radiotherapy for PVTT in HCC patients: evaluation of the efficacy and safety. J Cancer Res Clin Oncol 2021; 148:2405-2414. [PMID: 34490584 DOI: 10.1007/s00432-021-03788-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/28/2021] [Indexed: 10/25/2022]
Abstract
PURPOSE This study aims to evaluate the efficacy, feasibility, and safety of the magnetic resonance imaging (MRI)-guided tumor tracking hypofractionated radiotherapy (HFRT) and stereotactic body radiation therapy (SBRT) for portal vein tumor thrombus (PVTT) in hepatocellular carcinoma (HCC) patients. METHODS We retrospectively reviewed the twelve cases of unresectable HCC with tumor thrombus in the main trunk or first branch of the portal vein that were treated with MRI-guided tumor tracking HFRT or SBRT using the ViewRay Linac MRIdian system between June 2019 and January 2021. The HFRT was performed with a total of 50 Gy in 10 fractions, and SBRT performed in a range of 36-50 Gy with 4-5 fractions. The median biologic effective dose (BED) with an a/b ratio of 10 was 75 Gy10 (range 68.4-100 Gy10). RESULTS The median follow-up duration was 5.0 months (range 1.9-12.8 months). Ten patients (83.3%) showed an objective response of PVTT. At the time of analysis, ten patients (83.3%) showed local control. The 1-year intrahepatic control rate was 48.9%. Three patients (25%) showed mild gastrointestinal symptoms, and there were no cases of grade 3 or higher toxicity. For hepatic toxicity, there were no cases in which the Child-Pugh score increased by more than two points after RT without disease progression. CONCLUSION MRI-guided tumor tracking HFRT and SBRT was a feasible, effective, and safe treatment option in HCC patients with tumor thrombi in the main trunk or first branch of the portal vein.
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Boldrini L, Corradini S, Gani C, Henke L, Hosni A, Romano A, Dawson L. MR-Guided Radiotherapy for Liver Malignancies. Front Oncol 2021; 11:616027. [PMID: 33869001 PMCID: PMC8047407 DOI: 10.3389/fonc.2021.616027] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 03/15/2021] [Indexed: 12/12/2022] Open
Abstract
MR guided radiotherapy represents one of the most promising recent technological innovations in the field. The possibility to better visualize therapy volumes, coupled with the innovative online adaptive radiotherapy and motion management approaches, paves the way to more efficient treatment delivery and may be translated in better clinical outcomes both in terms of response and reduced toxicity. The aim of this review is to present the existing evidence about MRgRT applications for liver malignancies, discussing the potential clinical advantages and the current pitfalls of this new technology.
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Affiliation(s)
- Luca Boldrini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Roma, Italy
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Cihan Gani
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University, Tübingen, Germany
| | - Lauren Henke
- Department of Radiation Oncology, Washington University in St Louis, St Louis, MO, United States
| | - Ali Hosni
- Radiation Medicine Program, Princess Margaret Cancer Centre, Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Angela Romano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Roma, Italy
| | - Laura Dawson
- Radiation Medicine Program, Princess Margaret Cancer Centre, Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
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Feasibility and Early Clinical Experience of Online Adaptive MR-Guided Radiotherapy of Liver Tumors. Cancers (Basel) 2021; 13:cancers13071523. [PMID: 33810244 PMCID: PMC8037065 DOI: 10.3390/cancers13071523] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/13/2021] [Accepted: 03/20/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To assess the feasibility and early results of online adaptive MR-guided radiotherapy (oMRgRT) of liver tumors. METHODS We retrospectively examined consecutive patients with primary or secondary liver lesions treated at our institution using a 0.35T hybrid MR-Linac (Viewray Inc., Mountain View, CA, USA). Online-adaptive treatment planning was used to account for interfractional anatomical changes, and real-time intrafractional motion management using online 2D cine MRI was performed using a respiratory gating approach. Treatment response and toxicity were assessed during follow-up. RESULTS Eleven patients and a total of 15 lesions were evaluated. Histologies included cholangiocarcinomas and metastases of neuroendocrine tumors, colorectal carcinomas, sarcomas and a gastrointestinal stroma tumor. The median BED10 of the PTV prescription doses was 84.4 Gy (range 59.5-112.5 Gy) applied in 3-5 fractions and the mean GTV BED10 was in median 147.9 Gy (range 71.7-200.5 Gy). Online plan adaptation was performed in 98% of fractions. The median overall treatment duration was 53 min. The treatment was feasible and successfully completed in all patients. After a median follow-up of five months, no local failure occurred and no ≥ grade two toxicity was observed. OMRgRT resulted in better PTV coverage and fewer OAR constraint violations. CONCLUSION Early results of MR-linac based oMRgRT for the primary and secondary liver tumors are promising. The treatment was feasible in all cases and well tolerated with minimal toxicity. The technique should be compared to conventional SBRT in further studies to assess the advantages of the technique.
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