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. 2021 Sep;10(17):5897-5906.
doi: 10.1002/cam4.4139. Epub 2021 Jul 20.

Clinical outcomes of stereotactic magnetic resonance image-guided adaptive radiotherapy for primary and metastatic tumors in the abdomen and pelvis

Stephanie M Yoon  1 , Elaine Luterstein  2 , Fang-I Chu  1 , Minsong Cao  1 , James Lamb  1 , Nzhde Agazaryan  1 , Daniel Low  1 , Ann Raldow  1 , Michael L Steinberg  1 , Percy Lee  3
Affiliations

Clinical outcomes of stereotactic magnetic resonance image-guided adaptive radiotherapy for primary and metastatic tumors in the abdomen and pelvis

Stephanie M Yoon et al. Cancer Med. 2021 Sep.

Abstract

Purpose: Stereotactic body radiotherapy (SBRT) delivers ablative doses with excellent local control. However, implementing SBRT for abdominal and pelvic tumors has been limited by the risk for treatment-related gastrointestinal toxicity. MRI-guided radiotherapy may ameliorate these risks and increase the therapeutic ratio. We report the clinical outcomes of stereotactic MRI-guided adaptive radiotherapy (SMART) for primary and metastatic tumors in the abdomen and pelvis.

Methods: From November 2014 to August 2017, the first 106 consecutive patients with 121 tumors in the abdomen and pelvis were treated with SMART at a single institution. Of the cohort, 41.5%, 15.1%, and 43.4% had primary, locally recurrent, and oligometastatic tumors, respectively. SMART was delivered using a tri-cobalt-60 gantry with on-board 0.35 Tesla MRI with respiratory breath-hold and daily adaptive re-planning when anatomically necessary. A median of 40Gy in five fractions was prescribed. The Common Terminology Criteria for Adverse Events v.4.03 was used to score treatment-related toxicities. Local control (LC), progression-free survival (PFS), and overall survival (OS) were estimated using Kaplan-Meier method.

Results: Of the 510 treatments, seventy-one (13.9%) were adapted. Fatigue, nausea, and pain were the most common acute toxicities. 0.9 and 0% of patients experienced acute grade three and four toxicities, respectively. 5.2 and 2.1% of patients experienced late grade three and four toxicities, respectively. After a median follow-up of 20.4 months, the 2-year LC rate was 74% on a per-lesion basis. Two-year LC was 96% for lesions that were treated with BED10 ≥100 versus 69% for BED10 <100 (p = 0.02). PFS was significantly different between patients with and without locally controlled tumors (2-year PFS 21 vs. 8%, p = 0.03). Two-year OS was 57% for the entire cohort.

Conclusions: Favorable LC and PFS outcomes were observed with minimal morbidity for tumors in the abdomen and pelvis treated with SMART. Future prospective clinical trials to validate these findings are warranted.

Keywords: MR-guided radiation therapy; abdominal pelvic tumors; cancer management; stereotactic ablative radiotherapy; stereotactic body radiation therapy.

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Conflict of interest statement

MC: ViewRay, Inc.: personal fees. JL: ViewRay, Inc: grants, personal fees. NA: Varian, Inc.: personal fees; Brainlab: grants, personal fees, and non‐financial support. DL: ViewRay, Inc: co‐principal investigator of trial, consultant. AR: ViewRay, Inc: grants, personal fees. MS: ViewRay, Inc: personal fees. PL: ViewRay, Inc: clinical advisory board, honorarium, non‐financial support, co‐principal investigator of trial; Varian, Inc: consultant, honorarium, non‐financial support; AstraZeneca, Inc.: research grant, honorarium, non‐financial support. All other authors have no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Kaplan–Meier curve for local control, stratified by biologic effective dose (BED10) groups. +Censored cases. †Per‐lesion analysis
FIGURE 2
FIGURE 2
Kaplan–Meier curve for progression‐free survival, stratified by tumor local control. +Censored cases
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