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Review
. 2020 Jul 28:10:1107.
doi: 10.3389/fonc.2020.01107. eCollection 2020.

Optimizing MR-Guided Radiotherapy for Breast Cancer Patients

Maureen L Groot Koerkamp  1 , Jeanine E Vasmel  1 , Nicola S Russell  2 , Simona F Shaitelman  3 , Carmel N Anandadas  4 , Adam Currey  5 , Danny Vesprini  6 , Brian M Keller  6 , Chiara De-Colle  7 , Kathy Han  8 , Lior Z Braunstein  9 , Faisal Mahmood  10   11 , Ebbe L Lorenzen  10 , Marielle E P Philippens  1 , Helena M Verkooijen  12 , Jan J W Lagendijk  1 , Antonetta C Houweling  1 , H J G Desiree van den Bongard  1 , Anna M Kirby  13
Affiliations
Review

Optimizing MR-Guided Radiotherapy for Breast Cancer Patients

Maureen L Groot Koerkamp et al. Front Oncol. .

Abstract

Current research in radiotherapy (RT) for breast cancer is evaluating neoadjuvant as opposed to adjuvant partial breast irradiation (PBI) with the aim of reducing the volume of breast tissue irradiated and therefore the risk of late treatment-related toxicity. The development of magnetic resonance (MR)-guided RT, including dedicated MR-guided RT systems [hybrid machines combining an MR scanner with a linear accelerator (MR-linac) or 60Co sources], could potentially reduce the irradiated volume even further by improving tumour visibility before and during each RT treatment. In this position paper, we discuss MR guidance in relation to each step of the breast RT planning and treatment pathway, focusing on the application of MR-guided RT to neoadjuvant PBI.

Keywords: MR-guided radiotherapy; MR-linac; breast cancer; hybrid machine; magnetic resonance imaging (MRI); neoadjuvant radiation therapy; partial breast irradiation.

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Figures

Figure 1
Figure 1
Supine patient setup for MRI simulation. In this setup, a 5-degree inclined wedge is used. Height-adjustable coil bridges are used as support for the anterior receiver coil to prevent deformation of the body contour.
Figure 2
Figure 2
Patient and receiver coil positioning in prone position, including challenges in this position. The images show three different patients. (A) No space for the receiver coil on the back of the patient if the breast hangs freely without touching the scanner table; (B) the receiver coil fits above the patient while also the breast hangs freely; (C) when the receiver coil is fitted in the MRI bore above the patient, the breast touches the table top and is deformed. Light blue shapes represent the receiver coils (horizontal: receiver coil array; vertical: single flex coil). SNR, signal-to-noise ratio.
Figure 3
Figure 3
Imaging of a primary breast tumour on CT (A,D), (contrast-enhanced) MRI (B,E), and CBCT (C,F) scans indicating the difference in tumour visibility (inside the red circle) between these modalities in two different patients (A–C and D–F). (D–F) The marker inserted in the tumour medial in the left breast is observed as a void on MRI (indicated by the red circles).
Figure 4
Figure 4
Simulation of a single fraction neoadjuvant PBI treatment plan (ABLATIVE trial approach, 1 × 20 Gy to GTV) for the 1.5-T MR-linac. The calculated dose distribution shows the electron stream effect in air resulting in dose outside of the treatment field in both cranial and caudal directions. Scale is set to 100% reference dose = 20 Gy.
See this image and copyright information in PMC

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