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MRI-guided Radiotherapy (MRgRT) for treatment of Oligometastases: Review of clinical applications and challenges. Int J Radiat Oncol Biol Phys 2022; 114:950-967. [PMID: 35901978 DOI: 10.1016/j.ijrobp.2022.07.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE Early clinical results on the application of magnetic resonance imaging (MRI) coupled with a linear accelerator to deliver MR-guided radiation therapy (MRgRT) have demonstrated feasibility for safe delivery of stereotactic body radiotherapy (SBRT) in treatment of oligometastatic disease. Here we set out to review the clinical evidence and challenges associated with MRgRT in this setting. METHODS AND MATERIALS We performed a systematic review of the literature pertaining to clinical experiences and trials on the use of MRgRT primarily for the treatment of oligometastatic cancers. We reviewed the opportunities and challenges associated with the use of MRgRT. RESULTS Benefits of MRgRT pertaining to superior soft-tissue contrast, real-time imaging and gating, and online adaptive radiotherapy facilitate safe and effective dose escalation to oligometastatic tumors while simultaneously sparing surrounding healthy tissues. Challenges concerning further need for clinical evidence and technical considerations related to planning, delivery, quality assurance (QA) of hypofractionated doses, and safety in the MRI environment must be considered. CONCLUSIONS The promising early indications of safety and effectiveness of MRgRT for SBRT-based treatment of oligometastatic disease in multiple treatment locations should lead to further clinical evidence to demonstrate the benefit of this technology.
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Klusa D, Lohaus F, Furesi G, Rauner M, Benešová M, Krause M, Kurth I, Peitzsch C. Metastatic Spread in Prostate Cancer Patients Influencing Radiotherapy Response. Front Oncol 2021; 10:627379. [PMID: 33747899 PMCID: PMC7971112 DOI: 10.3389/fonc.2020.627379] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/30/2020] [Indexed: 12/18/2022] Open
Abstract
Radiotherapy and surgery are curative treatment options for localized prostate cancer (PCa) with a 5-year survival rate of nearly 100%. Once PCa cells spread into distant organs, such as bone, the overall survival rate of patients drops dramatically. The metastatic cascade and organotropism of PCa cells are regulated by different cellular subtypes, organ microenvironment, and their interactions. This cross-talk leads to pre-metastatic niche formation that releases chemo-attractive factors enforcing the formation of distant metastasis. Biological characteristics of PCa metastasis impacting on metastatic sites, burden, and latency is of clinical relevance. Therefore, the implementation of modern hybrid imaging technologies into clinical routine increased the sensitivity to detect metastases at earlier stages. This enlarged the number of PCa patients diagnosed with a limited number of metastases, summarized as oligometastatic disease. These patients can be treated with androgen deprivation in combination with local-ablative radiotherapy or radiopharmaceuticals directed to metastatic sites. Unfortunately, the number of patients with disease recurrence is high due to the enormous heterogeneity within the oligometastatic patient population and the lack of available biomarkers with predictive potential for metastasis-directed radiotherapy. Another, so far unmet clinical need is the diagnosis of minimal residual disease before onset of clinical manifestation and/or early relapse after initial therapy. Here, monitoring of circulating and disseminating tumor cells in PCa patients during the course of radiotherapy may give us novel insight into how metastatic spread is influenced by radiotherapy and vice versa. In summary, this review critically compares current clinical concepts for metastatic PCa patients and discuss the implementation of recent preclinical findings improving our understanding of metastatic dissemination and radiotherapy resistance into standard of care.
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Affiliation(s)
- Daria Klusa
- National Center for Tumor Diseases (NCT), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Fabian Lohaus
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Giulia Furesi
- Helmholtz-Zentrum Dresden—Rossendorf (HZDR), Dresden,Germany
| | - Martina Rauner
- Helmholtz-Zentrum Dresden—Rossendorf (HZDR), Dresden,Germany
| | | | - Mechthild Krause
- National Center for Tumor Diseases (NCT), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ina Kurth
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Claudia Peitzsch
- National Center for Tumor Diseases (NCT), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Elhalawani H, Elgohari B, Lin TA, Mohamed ASR, Fitzgerald TJ, Laurie F, Ulin K, Kalpathy-Cramer J, Guerrero T, Holliday EB, Russo G, Patel A, Jones W, Walker GV, Awan M, Choi M, Dagan R, Mahmoud O, Shapiro A, Kong FMS, Gomez D, Zeng J, Decker R, Spoelstra FOB, Gaspar LE, Kachnic LA, Thomas CR, Okunieff P, Fuller CD. An in-silico quality assurance study of contouring target volumes in thoracic tumors within a cooperative group setting. Clin Transl Radiat Oncol 2019; 15:83-92. [PMID: 30775563 PMCID: PMC6365802 DOI: 10.1016/j.ctro.2019.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 12/25/2022] Open
Abstract
We aimed at quantifying inter-observer Pancoast tumors delineation variability. Experts’ delineations were used to define ground truth. Other observers’ delineations were compared against ground truth. High degree of variability was noted for most target volumes except GTV_P. This unveils potentials for protocol modification for future IMRT studies.
Introduction Target delineation variability is a significant technical impediment in multi-institutional trials which employ intensity modulated radiotherapy (IMRT), as there is a real potential for clinically meaningful variances that can impact the outcomes in clinical trials. The goal of this study is to determine the variability of target delineation among participants from different institutions as part of Southwest Oncology Group (SWOG) Radiotherapy Committee’s multi-institutional in-silico quality assurance study in patients with Pancoast tumors as a “dry run” for trial implementation. Methods CT simulation scans were acquired from four patients with Pancoast tumor. Two patients had simulation 4D-CT and FDG-FDG PET-CT while two patients had 3D-CT and FDG-FDG PET-CT. Seventeen SWOG-affiliated physicians independently delineated target volumes defined as gross primary and nodal tumor volumes (GTV_P & GTV_N), clinical target volume (CTV), and planning target volume (PTV). Six board-certified thoracic radiation oncologists were designated as the ‘Experts’ for this study. Their delineations were used to create a simultaneous truth and performance level estimation (STAPLE) contours using ADMIRE software (Elekta AB, Sweden 2017). Individual participants’ contours were then compared with Experts’ STAPLE contours. Results When compared to the Experts’ STAPLE, GTV_P had the best agreement among all participants, while GTV_N showed the lowest agreement among all participants. There were no statistically significant differences in all studied parameters for all TVs for cases with 4D-CT versus cases with 3D-CT simulation scans. Conclusions High degree of inter-observer variation was noted for all target volume except for GTV_P, unveiling potentials for protocol modification for subsequent clinically meaningful improvement in target definition. Various similarity indices exist that can be used to guide multi-institutional radiotherapy delineation QA credentialing.
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Affiliation(s)
- Hesham Elhalawani
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, TX 77030, USA
| | - Baher Elgohari
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, TX 77030, USA
| | - Timothy A Lin
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, TX 77030, USA.,Baylor College of Medicine, TX 77030, USA
| | - Abdallah S R Mohamed
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, TX 77030, USA.,Department of Clinical Oncology and Nuclear Medicine, Alexandria University, Alexandria, Egypt
| | - Thomas J Fitzgerald
- Imaging and Radiation Oncology Core QA Center Rhode Island, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Fran Laurie
- Imaging and Radiation Oncology Core QA Center Rhode Island, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Kenneth Ulin
- Imaging and Radiation Oncology Core QA Center Rhode Island, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jayashree Kalpathy-Cramer
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Massachusetts, USA
| | - Thomas Guerrero
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, USA
| | - Emma B Holliday
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, TX 77030, USA
| | - Gregory Russo
- Department of Radiation Oncology, Boston Medical Center, Massachusetts, USA
| | - Abhilasha Patel
- Department of Radiation Oncology, University of Texas Health Sciences Center at San Antonio, TX, USA
| | - William Jones
- Department of Radiation Oncology, University of Texas Health Sciences Center at San Antonio, TX, USA
| | - Gary V Walker
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, TX 77030, USA.,Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, Arizona, USA
| | - Musaddiq Awan
- Department of Radiation Oncology, Case Western Reserve University, OH, USA
| | - Mehee Choi
- Department of Radiation Oncology, Northwestern University, IL, USA
| | - Roi Dagan
- University of Florida Health Proton Therapy Institute, FL, USA
| | - Omar Mahmoud
- Department of Radiation Oncology, University of Miami, FL, USA
| | - Anna Shapiro
- Department of Radiation Oncology, Upstate Cancer Center, SUNY Upstate Medical University, NY, USA
| | - Feng-Ming Spring Kong
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, OH, USA
| | - Daniel Gomez
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, TX 77030, USA
| | - Jing Zeng
- Department of Radiation Oncology, University of Washington Medical Center, WA, USA
| | - Roy Decker
- Department of Therapeutic Radiology, Yale University School of Medicine, Connecticut, USA
| | - Femke O B Spoelstra
- Department of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Laurie E Gaspar
- Department of Radiation Oncology, Vanderbilt University, TN, USA
| | - Lisa A Kachnic
- Department of Radiation Oncology, Vanderbilt University Medical Center, Tennessee, USA
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health & Science University, Oregon, USA
| | - Paul Okunieff
- SWOG, Department of Radiation Oncology, University of Florida College of Medicine, Florida, USA
| | - Clifton D Fuller
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, TX 77030, USA
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