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. 2022 Mar:168:106-112.
doi: 10.1016/j.radonc.2022.01.038. Epub 2022 Feb 2.

SMART ablation of lymphatic oligometastases in the pelvis and abdomen: Clinical and dosimetry outcomes

Sebastian Regnery  1 , Carolin Buchele  2 , Lars Piskorski  2 , Fabian Weykamp  3 , Thomas Held  3 , Tanja Eichkorn  3 , Carolin Rippke  2 , C Katharina Renkamp  2 , Sebastian Klüter  2 , Jonas Ristau  3 , Laila König  3 , Stefan A Koerber  1 , Sebastian Adeberg  1 , Jürgen Debus  1 , Juliane Hörner-Rieber  4
Affiliations

SMART ablation of lymphatic oligometastases in the pelvis and abdomen: Clinical and dosimetry outcomes

Sebastian Regnery et al. Radiother Oncol. 2022 Mar.

Abstract

Purpose: To demonstrate dosimetry benefits and report clinical outcomes of stereotactic magnetic resonance (MR)-guided online adaptive radiotherapy (SMART) of abdominopelvic lymphatic oligometastases.

Patients & methods: Prospective registry data of 26 patients with 31 oligoprogressive lymphatic metastases (1-2 lesions) who received SMART between April 2020 and April 2021 was analyzed. Prostate cancer was the most common histology (69%). Most patients (63%) had received previous abdominopelvic radiotherapy (RT). SMART was delivered in 3-7 fractions based on planning target volume (PTV) location and previous dose exposures. For SMART, the baseline plan was recalculated on daily 3D MR-imaging (predicted plan), and plan adaptation was mandatory in case of planning objective violations.

Results: Plan adaptation was mostly performed due to violation of planning objectives in the predicted plan (134/140 fractions, 96%) and significantly improved plan dosimetry: (1) PTV coverage was increased (predicted: median 89%, adapted: median 95%, p < 0.001), (2) organs-at-risk (OAR) overdoses were reduced (predicted: 27/140 (19%), adapted: 1/140 (1%), p < 0.001) and (3) PTV overdoses were reduced (predicted: 21/140 (15%), adapted: 1/140 (1%), p < 0.001). After a median follow-up of 9.8 months, one patient had in-field tumor progression and twelve patients had out-field tumor progression (at 6 months: progression-free survival: 63% [46-88%], local control rate: 97% [90-100%]). Treatment was tolerated well and no grade ≥3 toxicity was reported.

Conclusion: SMART improves target volume coverage and yields superior OAR protection compared to non-adaptive radiotherapy, thus representing an innovative approach to challenging cases, such as repeated radiotherapy.

Keywords: Image-guided radiotherapy (IGRT); Lymphatic metastasis; Magnetic resonance imaging (MRI); Pelvic neoplasms; Prostate cancer; Stereotactic body radiotherapy (SBRT).

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Conflict of interest statement

Conflict of interest statement J. H.-R. and S. K. received speaker fees and travel reimbursement from ViewRay Inc. J. H.-R. received travel reimbursement from IntraOP Medical and Elekta Instrument AB and a grant from IntraOP Medical outside the submitted work. S.A. received grants from Accuray International Sàrl, Merck Serono GmbH and Novocure GmbH outside the submitted work. S.A. received consulting fees from Accuray International Sàrl and honoraria for lectures/presentations from Accuray International Sàrl and MSD outside the submitted work. S.A. received travel reimbursements from AstraZeneca outside the submitted work. S.A. participated on advisory boards for Sanofi Genzyme outside the submitted work. J.D. and S.A.K. received grants from View Ray Inc. S.A.K. received honoraria from IBA Dosimetry outside the submitted work. J.D. received grants from CRI–The Clinical Research Institute GmbH, Accuray Incorporated, Accuray International Sàrl, RaySearch Laboratories AB, Vision RT limited, Astellas Pharma GmbH, Astra Zeneca GmbH, Solution Akademie GmbH, Ergomed PLC Surrey Research Park, Merck Serono GmbH, Siemens Healthcare GmbH, Quintiles GmbH, Pharmaceutecal Research Associates GmbH, Boehringer Ingelheim Pharma GmbH Co, PTW-Freiburg Dr. Pychlau GmbH, Nanobiotix A.A. and IntraOP Medical outside the submitted work. T.E. received grants from Ruprecht-Karls Universität Heidelberg, Herbert Kienzle Foundation and Else Kröner-Fresenius Foundation and received travel reimbursement from Bristol-Myers Squibb outside the submitted work.

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