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Grimbergen G, Eijkelenkamp H, Bernchou U, Bouchart C, Brown K, Chuter R, Dunlop A, Scripes PG, Heerkens HD, de Leon J, Ng SSW, Renz PB, Shessel A, Intven MPW, Meijer GJ. Toward Global Consensus for MR-Guided Treatment Planning for Pancreatic Tumors on a 1.5 T MR-Linac. Int J Radiat Oncol Biol Phys 2023; 117:e305. [PMID: 37785110 DOI: 10.1016/j.ijrobp.2023.06.2326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) MR-guided SBRT with a 1.5 T MR-Linac is a relatively new therapy for pancreatic tumors with varying expertise levels. Moreover, treatment planning in the upper abdomen can be challenging as target coverage is often compromised by dosimetric constraints of abutting bowel structures. This may lead to large differences between centers in protocols, practices. To increase harmonization a worldwide consortium was founded among 1.5 T MR-Linac users. In this work we report on the outcome of the first phase within this collaboration, which is the assessment of the baseline variation between the treatment planning protocols and subsequent dose distributions. MATERIALS/METHODS Twelve centers across three continents (North America, Europe, and Australia) participated in this consortium. Each center was sent the same two anonymized data sets reflecting two cases of locally advanced pancreatic cancer of different complexity levels. The data sets included a CT scan, a predefined structure set containing the gross target volume (GTV) and the OARs, a brief medical history, tumor motion characteristics, and auxiliary CT and MR imaging. Centers were asked to create an MRgRT treatment plan according to their clinical five-fraction SBRT protocol, using their institutional margin structures, beam setup, target prescriptions, and OAR constraints. Key DVH parameters that were evaluated are D99%, D90%, D50%, D1% for the GTV and D0.5cc for the duodenum, small bowel, and stomach. RESULTS In general, large variations were observed in planning objectives and machine settings yielding widely varying inhomogeneous dose distributions to both the tumor and organs at risk (Table 1). This was especially manifest for case 2 where the tumor abutted with both the duodenum and small bowel over a trajectory of multiple centimeters. Not only were different trade-offs between target coverage and OAR sparing observed, but also different strategies for optimizing the integral dose to the tumor. CONCLUSION These results indicate a large variety in the treatment planning strategies that could well translate to differences in outcome. Based on this first evaluation, the consortium will work towards a collective consensus protocol with a second evaluation round after internal discussions.
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Affiliation(s)
- G Grimbergen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H Eijkelenkamp
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - U Bernchou
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - C Bouchart
- Department of Radiation Oncology, HUB Institut Jules Bordet, Brussels, Belgium
| | - K Brown
- Department of Radiation Oncology, ONJ Centre, Austin Hospital, Heidelberg, VIC, Australia
| | - R Chuter
- The Christie NHS Foundation, Manchester, United Kingdom
| | - A Dunlop
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - P Godoy Scripes
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - H D Heerkens
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J de Leon
- GenesisCare, Alexandria, NSW, Australia
| | - S S W Ng
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - P B Renz
- Allegheny Health Network Cancer Institute, Department of Radiation Oncology, Pittsburgh, PA
| | - A Shessel
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - M P W Intven
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G J Meijer
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
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Huo M, Morley L, Dawson L, Bissonnette J, Helou J, Giuliani M, Berlin A, Shultz D, Hosni A, Shessel A, Barry A. PO-1757: Peer Review in Stereotactic Body Radiotherapy: The Impact of Case Volume. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01775-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Driscoll B, Wong R, Vishway C, Laidley D, Myrehaug S, Brierley J, Juergens R, Shessel A, Farncombe T, Zukotynski K, Stodilka R, Caldwell C, Yeung I. Optimizing the SPECT Imaging Workflow For Individualized Dosimetry in Lu177-DOTATATE Treatment Of Progressive Metastatic Neoendocrine Tumors. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Stanescu T, Shessel A, Carpino-Rocca C, Simeonov A, Lukovic J, Velec M, Hosni A, Dawson L. Development of an Online Adaptive Procedure for MRI-Guided Liver SBRT. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lowrey N, Sole C, Dinniwell R, Conrad T, Liu F, Levin W, Fyles T, Xie J, Shessel A, Simeonov A, Purdie T, Koch A, Han K. Magnetic Resonance Imaging for Breast Lumpectomy Cavity Delineation: Computed Tomography Comparison and Sequence Variation. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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