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Ugurluer G, Schneiders FL, Corradini S, Boldrini L, Kotecha R, Kelly P, Portelance L, Camilleri P, Ben-David MA, Poiset S, Marschner SN, Panza G, Kutuk T, Palacios MA, Castelluccia A, Zoto Mustafayev T, Atalar B, Senan S, Ozyar E. Factors influencing local control after MR-guided stereotactic body radiotherapy (MRgSBRT) for adrenal metastases. Clin Transl Radiat Oncol 2024; 46:100756. [PMID: 38450219 PMCID: PMC10915494 DOI: 10.1016/j.ctro.2024.100756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/08/2024] Open
Abstract
Purpose Stereotactic body radiotherapy (SBRT) is an effective treatment for adrenal gland metastases, but it is technically challenging and there are concerns about toxicity. We performed a multi-institutional pooled retrospective analysis to study clinical outcomes and toxicities after MR-guided SBRT (MRgSBRT) using for adrenal gland metastases. Methods and Materials Clinical and dosimetric data of patients treated with MRgSBRT on a 0.35 T MR-Linac at 11 institutions between 2016 and 2022 were analyzed. Local control (LC), local progression-free survival (LPFS), distant progression-free survival (DPFS) and overall survival (OS) were estimated using Kaplan-Meier method and log-rank test. Results A total of 255 patients (269 adrenal metastases) were included. Metastatic pattern was solitary in 25.9 % and oligometastatic in 58.0 % of patients. Median total dose was 45 Gy (range, 16-60 Gy) in a median of 5 fractions, and the median BED10 was 100 Gy (range, 37.5-132.0 Gy). Adaptation was done in 87.4 % of delivered fractions based on the individual clinicians' judgement. The 1- and 2- year LPFS rates were 94.0 % (95 % CI: 90.7-97.3 %) and 88.3 % (95 % CI: 82.4-94.2 %), respectively and only 2 patients (0.8 %) experienced grade 3 + toxicity. No local recurrences were observed after treatment to a total dose of BED10 > 100 Gy, with single fraction or fractional dose of > 10 Gy. Conclusions This is a large retrospective multi-institutional study to evaluate the treatment outcomes and toxicities with MRgSBRT in over 250 patients, demonstrating the need for frequent adaptation in 87.4 % of delivered fractions to achieve a 1- year LPFS rate of 94 % and less than 1 % rate of grade 3 + toxicity. Outcomes analysis in 269 adrenal lesions revealed improved outcomes with delivery of a BED10 > 100 Gy, use of single fraction SBRT and with fraction doses > 10 Gy, providing benchmarks for future clinical trials.
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Affiliation(s)
- Gamze Ugurluer
- Department of Radiation Oncology, Acibadem MAA University, School of Medicine, Istanbul, Turkey
| | - Famke L. Schneiders
- Department of Radiation Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians-University Munich, Germany
| | - Luca Boldrini
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Largo Agostino Gemelli 8, Rome, Italy
| | - Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Patrick Kelly
- Department of Radiation Oncology, Orlando Health Cancer Institute, Orlando, FL, USA
| | | | | | - Merav A. Ben-David
- Department of Radiation Oncology, Assuta Medical Center, Tel Aviv, Israel
- Faculty of Health Science, Ben-Gurion University, Beer Sheva, Israel
| | - Spencer Poiset
- Department of Radiation Oncology, Sidney Kimmel Cancer Center of Thomas Jefferson University, Philadelphia, PA, USA
| | - Sebastian N. Marschner
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians-University Munich, Germany
| | - Giulia Panza
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Largo Agostino Gemelli 8, Rome, Italy
| | - Tugce Kutuk
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Miguel A. Palacios
- Department of Radiation Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, Netherlands
| | | | | | - Banu Atalar
- Department of Radiation Oncology, Acibadem MAA University, School of Medicine, Istanbul, Turkey
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Enis Ozyar
- Department of Radiation Oncology, Acibadem MAA University, School of Medicine, Istanbul, Turkey
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Mercier C, Billiet C, Ost P, Joye I, Meijnders P, Vermeulen P, Dirix L, Verellen D, Dirix P. Long-Term Results of a Phase 1 Dose Escalation Trial of Ablative Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys 2024; 118:1490-1496. [PMID: 38151189 DOI: 10.1016/j.ijrobp.2023.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 12/02/2023] [Accepted: 12/15/2023] [Indexed: 12/29/2023]
Abstract
PURPOSE Stereotactic body radiation therapy is increasingly used for oligometastatic disease as well as palliation, but treatment protocols for nonspine bone and nodal metastases are lacking, with a wide variety of schedules applied. METHODS AND MATERIALS A prospective dose-escalation trial was initiated, involving 90 patients, among whom 52 (58%) had primary prostate tumors, 13 had breast tumors (14%), and 25 (28%) had other primary tumor types. All visible lymph node or nonspine bone oligometastases were treated in 3 consecutive cohorts: 5 × 7.0 Gy, 3 × 10.0 Gy, or 1 × 20.0 Gy. RESULTS Initial results revealed no dose-limiting toxicity after a median follow-up of 17.2 months. This update provides information on long-term toxicity, local failure (LF), and progression-free survival (PFS). After a median follow-up of 50 months, no new safety signals were observed. Grade 2 toxicity was 13%, 7% and 10% in the respective cohorts (P = .9), without grade 3 to 5 toxicities. LF rates were 9%, 3%, and 6% (P = .5) for the respective treatment groups, with an overall cumulative risk of LF of 7% (95% CI, 2-12) at 4 years. Median PFS was 16.5 months (95% CI, 9.8-21.5), and 4-year PFS was 21% (95% CI, 14-32). Median overall survival across groups was not reached (95% CI, 52.8 - not reached), 4-year OS was 68% (95% CI, 59-78). A subset of patients (23%) remained long-term disease-free, 37% had oligoprogressive disease at first recurrence and 40% developed polymetastatic relapse. CONCLUSIONS The safe and effective use of dose-escalated single-fraction stereotactic body radiation therapy for bone and lymph node metastases is supported by this trial, especially considering patient-convenience and cost-effectiveness. Caution is needed when generalizing these outcomes beyond breast and prostate cancer, given their underrepresentation in our study.
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Affiliation(s)
- Carole Mercier
- Department of Radiation Oncology, Iridium Network, Wilrijk (Antwerp), Belgium; Integrated Personalised and Precision Oncology Network, University Antwerp, Antwerp, Belgium.
| | - Charlotte Billiet
- Department of Radiation Oncology, Iridium Network, Wilrijk (Antwerp), Belgium; Integrated Personalised and Precision Oncology Network, University Antwerp, Antwerp, Belgium
| | - Piet Ost
- Department of Radiation Oncology, Iridium Network, Wilrijk (Antwerp), Belgium; Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Ines Joye
- Department of Radiation Oncology, Iridium Network, Wilrijk (Antwerp), Belgium; Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Paul Meijnders
- Department of Radiation Oncology, Iridium Network, Wilrijk (Antwerp), Belgium; Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Peter Vermeulen
- Integrated Personalised and Precision Oncology Network, University Antwerp, Antwerp, Belgium
| | - Luc Dirix
- Department of Medical Oncology, GZA Hospitals, Wilrijk (Antwerp), Belgium
| | - Dirk Verellen
- Department of Radiation Oncology, Iridium Network, Wilrijk (Antwerp), Belgium; Integrated Personalised and Precision Oncology Network, University Antwerp, Antwerp, Belgium
| | - Piet Dirix
- Department of Radiation Oncology, Iridium Network, Wilrijk (Antwerp), Belgium; Integrated Personalised and Precision Oncology Network, University Antwerp, Antwerp, Belgium
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van Overeem Felter M, Møller PK, Josipovic M, Bekke SN, Bernchou U, Serup-Hansen E, Madsen K, Parikh PJ, Kim J, Geertsen P, Behrens CP, Vogelius IR, Pøhl M, Schytte T, Persson GF. MR-guided stereotactic radiotherapy of infra-diaphragmatic oligometastases: Evaluation of toxicity and dosimetric parameters. Radiother Oncol 2024; 192:110090. [PMID: 38224916 DOI: 10.1016/j.radonc.2024.110090] [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: 04/21/2023] [Revised: 11/15/2023] [Accepted: 01/08/2024] [Indexed: 01/17/2024]
Abstract
BACKGROUND AND PURPOSE The SOFT trial is a prospective, multicenter, phase 2 trial investigating magnetic resonance (MR)-guided stereotactic ablative radiotherapy (SABR) for abdominal, soft tissue metastases in patients with oligometastatic disease (OMD) (clinicaltrials.gov ID NCT04407897). We present the primary endpoint analysis of 1-year treatment-related toxicity (TRAE). MATERIALS AND METHODS Patients with up to five oligometastases from non-hematological cancers were eligible for inclusion. A risk-adapted strategy prioritized fixed organs at risk (OAR) constraints over target coverage. Fractionation schemes were 45-67.5 Gy in 3-8 fractions. The primary endpoint was grade ≥ 4 TRAE within 12 months post-SABR. The association between the risk of gastrointestinal (GI) toxicity and clinical and dosimetric parameters was tested using a normal tissue complication probability model. RESULTS We included 121 patients with 147 oligometastatic targets, mainly located in the liver (41 %), lymph nodes (35 %), or adrenal glands (14 %). Nearly half of all targets (48 %, n = 71) were within 10 mm of a radiosensitive OAR. No grade 4 or 5 TRAEs, 3.5 % grade 3 TRAEs, and 43.7 % grade 2 TRAEs were reported within the first year of follow-up. We found a significant association between grade ≥ 2 GI toxicity and the parameters GI OAR D0.1cc, D1cc, and D20cc. CONCLUSION In this phase II study of MR-guided SABR of oligometastases in the infra-diaphragmatic region, we found a low incidence of toxicity despite half of the lesions being within 10 mm of a radiosensitive OAR. GI OAR D0.1cc, D1cc, and D20cc were associated with grade ≥ 2 GI toxicity.
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Affiliation(s)
- Mette van Overeem Felter
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark.
| | - Pia Krause Møller
- Department of Oncology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark; OPEN, Open Patient data Explorative Network at Odense University Hospital, J.B. Winsløws Vej 9a, 5000 Odense C, Denmark
| | - Mirjana Josipovic
- Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Susanne Nørring Bekke
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark
| | - Uffe Bernchou
- Department of Oncology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19, 3. 5000 Odense C, Denmark
| | - Eva Serup-Hansen
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark
| | - Kasper Madsen
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark
| | - Parag J Parikh
- Department of Oncology, Henry Ford Hospital, 2800 W Grand Blvd, Detroit, MI 48202, United States
| | - Joshua Kim
- Department of Oncology, Henry Ford Hospital, 2800 W Grand Blvd, Detroit, MI 48202, United States
| | - Poul Geertsen
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark
| | - Claus P Behrens
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark; Department of Health Technology, Technical University of Denmark, Frederiksborgvej 399, 4000 Roskilde, Denmark
| | - Ivan R Vogelius
- Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Mette Pøhl
- Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Tine Schytte
- Department of Oncology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19, 3. 5000 Odense C, Denmark
| | - Gitte Fredberg Persson
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
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Cruz-Lim EM, Mou B, Jiang W, Liu M, Bergman A, Schellenberg D, Alexander A, Berrang T, Bang A, Chng N, Matthews Q, Carolan H, Hsu F, Miller S, Atrchian S, Chan E, Ho C, Mohamed I, Lin A, Huang V, Mestrovic A, Hyde D, Lund C, Pai H, Valev B, Lefresne S, Tyldesley S, Olson R, Baker S. Predictors of Quality of Life Decline in Patients with Oligometastases treated with Stereotactic Ablative Radiotherapy: Analysis of the Population-Based SABR-5 Phase II Trial. Clin Oncol (R Coll Radiol) 2024; 36:141-147. [PMID: 38296662 DOI: 10.1016/j.clon.2024.01.007] [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: 09/13/2023] [Revised: 11/15/2023] [Accepted: 01/11/2024] [Indexed: 02/02/2024]
Abstract
AIMS Most patients experience stable quality of life (QoL) after stereotactic ablative radiotherapy (SABR) treatment for oligometastases. However, a subset of patients experience clinically relevant declines in QoL on post-treatment follow-up. This study aimed to identify risk factors for QoL decline. MATERIALS AND METHODS The SABR-5 trial was a population-based single-arm phase II study of SABR to up to five sites of oligometastases. Prospective QoL was measured using treatment site-specific tools at pre-treatment baseline and 3, 6, 9, 12, 15, 18, 21, 24, 30 and 36 months after treatment. The time to persistent QoL decline was calculated as the time from SABR to the first decline in QoL score meeting minimum clinically important difference with no improvement to baseline score on subsequent assessments. Univariable and multivariable logistic regression analyses were carried out to determine factors associated with QoL decline. RESULTS One hundred and thirty-three patients were included with a median follow-up of 32 months (interquartile range 25-43). Thirty-five patients (26%) experienced a persistent decline in QoL. The median time until persistent QoL decline was not reached. The cumulative incidence of QoL decline at 2 and 3 years were 22% (95% confidence interval 14.0-29.6) and 40% (95% confidence interval 28.0-51.2), respectively. In multivariable analysis, disease progression (odds ratio 5.23, 95% confidence interval 1.59-17.47, P = 0.007) and adrenal metastases (odds ratio 9.70, 95% confidence interval 1.41-66.93, P = 0.021) were associated with a higher risk of QoL decline. Grade 3 or higher (odds ratio 3.88, 95% confidence interval 0.92-16.31, P = 0.064) and grade 2 or higher SABR-associated toxicity (odds ratio 2.24, 95% confidence interval 0.85-5.91, P = 0.10) were associated with an increased risk of QoL decline but did not reach statistical significance. CONCLUSIONS Disease progression and adrenal lesion site were associated with persistent QoL decline following SABR. The development of grade 3 or higher toxicities was also associated with an increased risk, albeit not statistically significant. Further studies are needed, focusing on the QoL impact of metastasis-directed therapies.
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Affiliation(s)
- E M Cruz-Lim
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - B Mou
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - W Jiang
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Surrey, British Columbia, Canada
| | - M Liu
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - A Bergman
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - D Schellenberg
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Surrey, British Columbia, Canada
| | - A Alexander
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Victoria, British Columbia, Canada
| | - T Berrang
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Victoria, British Columbia, Canada
| | - A Bang
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - N Chng
- BC Cancer - Prince George, British Columbia, Canada
| | - Q Matthews
- BC Cancer - Prince George, British Columbia, Canada
| | - H Carolan
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - F Hsu
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Abbotsford, British Columbia, Canada
| | - S Miller
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Prince George, British Columbia, Canada
| | - S Atrchian
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - E Chan
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - C Ho
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Surrey, British Columbia, Canada
| | - I Mohamed
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - A Lin
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - V Huang
- BC Cancer - Surrey, British Columbia, Canada
| | - A Mestrovic
- BC Cancer - Vancouver, British Columbia, Canada
| | - D Hyde
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - C Lund
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Surrey, British Columbia, Canada
| | - H Pai
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Victoria, British Columbia, Canada
| | - B Valev
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Victoria, British Columbia, Canada
| | - S Lefresne
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - S Tyldesley
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - R Olson
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Prince George, British Columbia, Canada
| | - S Baker
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Surrey, British Columbia, Canada.
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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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6
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Schneiders FL, van Vliet C, Giraud N, Bruynzeel AM, Slotman BJ, Palacios MA, Senan S. Clinical outcomes of MR-guided adrenal stereotactic ablative radiotherapy with preferential sparing of organs at risk. Clin Transl Radiat Oncol 2023; 43:100680. [PMID: 37808454 PMCID: PMC10551830 DOI: 10.1016/j.ctro.2023.100680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/15/2023] [Accepted: 09/21/2023] [Indexed: 10/10/2023] Open
Abstract
Background and purpose The optimal stereotactic ablative radiotherapy (SABR) doses for adrenal tumors are unknown. Some trials have specified that organ at risk (OAR) dose constraints should take priority over target coverage. We performed a retrospective review of the outcomes of MR-guided adrenal SABR (MRgRT) delivered with OAR sparing. Materials and methods Patients who underwent adrenal MRgRT between 2016 and 2023 were identified from our Ethics-approved institutional database. Dose ranged between 8 and 24 Gy per fraction, delivered in 1-5 fractions. A 3 mm margin was added to the breath-hold gross tumor volume (GTV) to derive a PTV. Plan were delivered to an 'optimized' PTV that was generated by excluding any overlap with OARs. Results Adrenal SABR was performed in 107 patients (114 metastases). The commonest scheme used 5 fractions of 10 Gy (53.5 %); 82 % of plans delivered a BED10 ≧ 80 Gy. Systemic therapy was administered within 3 months preceding or following SABR in 53.5 % of patients. Grade 3 acute toxicity (CTCAE v5.0) occurred in 0.9 % of patients, and 4.4 % reported late toxicity, consisting of adrenal insufficiency and a vertebral collapse. Median follow-up was 13.8 months (range, 0.0-73.4 months). Local progression occurred in 7.4 % of evaluable patients. PTV underdosage was frequent, with a coverage compromise index (D99/prescription dose) of < 0.90 in 52 % of all plans. Recurrences were independent of the prescription doses. Conclusion MRgRT for adrenal metastases is well tolerated with high local control rates despite prioritizing OAR sparing over PTV coverage. Studies using deformable dose accumulation may lead to a better understanding of dose-response relationship with adaptive SABR.
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Affiliation(s)
- Famke L. Schneiders
- Department of Radiation Oncology, Amsterdam-UMC, Location VUmc, The Netherlands
- Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Claire van Vliet
- Department of Radiation Oncology, Amsterdam-UMC, Location VUmc, The Netherlands
| | - Nicolas Giraud
- Department of Radiation Oncology, Amsterdam-UMC, Location VUmc, The Netherlands
| | - Anna M.E. Bruynzeel
- Department of Radiation Oncology, Amsterdam-UMC, Location VUmc, The Netherlands
- Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Ben J. Slotman
- Department of Radiation Oncology, Amsterdam-UMC, Location VUmc, The Netherlands
- Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Miguel A. Palacios
- Department of Radiation Oncology, Amsterdam-UMC, Location VUmc, The Netherlands
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam-UMC, Location VUmc, The Netherlands
- Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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