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Uno T, Tsuneda M, Abe K, Fujita Y, Harada R, Saito M, Kanazawa A, Kodate A, Abe Y, Ikeda Y, Nemoto MW, Yokota H. A new workflow of the on-line 1.5-T MR-guided adaptive radiation therapy. Jpn J Radiol 2023; 41:1316-1322. [PMID: 37354344 PMCID: PMC10613593 DOI: 10.1007/s11604-023-01457-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/04/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE The aim of this study was to develop a new workflow for 1.5-T magnetic resonance (MR)-guided on-line adaptive radiation therapy (MRgART) and assess its feasibility in achieving dose constraints. MATERIALS AND METHODS We retrospectively evaluated the clinical data of patients who underwent on-line adaptive radiation therapy using a 1.5-T MR linear accelerator (MR-Linac). The workflow in MRgART was established by reviewing the disease site, number of fractions, and re-planning procedures. Five cases of prostate cancer were selected to evaluate the feasibility of the new workflow with respect to achieving dose constraints. RESULTS Between December 2021 and September 2022, 50 consecutive patients underwent MRgART using a 1.5-T MR-Linac. Of these, 20 had prostate cancer, 10 had hepatocellular carcinoma, 6 had pancreatic cancer, 5 had lymph node oligo-metastasis, 3 had renal cancer, 3 had bone metastasis, 2 had liver metastasis from colon cancer, and 1 had a mediastinal tumor. Among a total of 247 fractions, 235 (95%) were adapt-to-shape (ATS)-based re-planning. The median ATS re-planning time in all 50 cases was 17 min. In the feasibility study, all dose constraint sets were met in all 5 patients by ATS re-planning. Conversely, a total of 14 dose constraints in 5 patients could not be achieved by virtual plan without using adaptive re-planning. These dose constraints included the minimum dose received by the highest irradiated volume of 1 cc in the planning target volume and the maximum dose of the rectal/bladder wall. CONCLUSION A new workflow of 1.5-T MRgART was established and found to be feasible. Our evaluation of the dose constraint achievement demonstrated the effectiveness of the workflow.
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Affiliation(s)
- Takashi Uno
- Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba, 260-8670, Japan.
| | - Masato Tsuneda
- Department of Radiation Oncology, MR Linac ART Division, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba, 260-8670, Japan
| | - Kota Abe
- Department of Radiation Oncology, MR Linac ART Division, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba, 260-8670, Japan
| | - Yukio Fujita
- Department of Radiation Oncology, MR Linac ART Division, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba, 260-8670, Japan
| | - Rintaro Harada
- Department of Radiology, Chiba University Hospital, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba, 260-8670, Japan
| | - Makoto Saito
- Department of Radiology, Chiba University Hospital, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba, 260-8670, Japan
| | - Aki Kanazawa
- Department of Radiology, Chiba University Hospital, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba, 260-8670, Japan
| | - Asuka Kodate
- Department of Radiology, Chiba University Hospital, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba, 260-8670, Japan
| | - Yukinao Abe
- Department of Radiology, Chiba University Hospital, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba, 260-8670, Japan
| | - Yohei Ikeda
- Department of Radiology, Chiba University Hospital, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba, 260-8670, Japan
| | - Miho Watanabe Nemoto
- Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba, 260-8670, Japan
| | - Hajime Yokota
- Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba, 260-8670, Japan
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Lawes R, Barnes H, Herbert T, Mitchell A, Nill S, Oelfke U, Pathmanathan A, Smith GA, Sritharan K, Tree A, McNair H, Dunlop A. MRI-guided adaptive radiotherapy for prostate cancer: When do we need to account for intra-fraction motion? Clin Transl Radiat Oncol 2022; 37:85-88. [PMID: 36118123 PMCID: PMC9471961 DOI: 10.1016/j.ctro.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/01/2022] [Accepted: 09/04/2022] [Indexed: 12/03/2022] Open
Abstract
A shift of the daily plan can mitigate target position changes that occur between daily MR acquisition and treatment for MR-linac radiotherapy, but increases the session time. We demonstrated that our workflow strategy and decision-making process, to determine whether a subsequent shift is necessary, is appropriate.
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Affiliation(s)
- R. Lawes
- Royal Marsden NHS Foundation Trust, United Kingdom
| | - H. Barnes
- Royal Marsden NHS Foundation Trust, United Kingdom
| | - T. Herbert
- Royal Marsden NHS Foundation Trust, United Kingdom
| | - A. Mitchell
- Royal Marsden NHS Foundation Trust, United Kingdom
| | - S. Nill
- Joint Department of Physics, Royal Marsden NHS Foundation Trust, and Institute of Cancer Research, United Kingdom
| | - U. Oelfke
- Joint Department of Physics, Royal Marsden NHS Foundation Trust, and Institute of Cancer Research, United Kingdom
| | - A. Pathmanathan
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, United Kingdom
| | | | - K. Sritharan
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, United Kingdom
| | - A. Tree
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, United Kingdom
| | - H.A. McNair
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, United Kingdom
| | - A. Dunlop
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, United Kingdom
- Joint Department of Physics, Royal Marsden NHS Foundation Trust, and Institute of Cancer Research, United Kingdom
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