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. 2025 Mar 25:53:100950.
doi: 10.1016/j.ctro.2025.100950. eCollection 2025 Jul.

Adaptive radiotherapy for oropharyngeal cancer with daily adapt-to-shape workflow on 1.5 T MRI-linac: Preliminary outcomes and comparison with helical tomotherapy

Andrea Emanuele Guerini  1 , Michela Buglione  1   2 , Stefania Nici  3 , Stefano Riga  3 , Ludovica Pegurri  1 , Eneida Mataj  1 , Davide Farina  4 , Marco Ravanelli  4 , Paolo Rondi  4 , Gianluca Cossali  1 , Davide Tomasini  1 , Luca Triggiani  1 , Giorgio Facheris  1 , Luigi Spiazzi  3   2 , Stefano Maria Magrini  1   2
Affiliations

Adaptive radiotherapy for oropharyngeal cancer with daily adapt-to-shape workflow on 1.5 T MRI-linac: Preliminary outcomes and comparison with helical tomotherapy

Andrea Emanuele Guerini et al. Clin Transl Radiat Oncol. .

Abstract

Introduction: MR-linac could offer several advantages for radical radiochemotherapy (RCHT) in oropharyngeal squamous cell carcinoma (OPSCC) patients. Currently, only a few case series have been published and no comparison with other techniques have been performed.

Methods: Data of 34 consecutive patients treated from September 2022 to May 2024 at a single Institution with RCHT on Unity® MR-linac for OPSCC with daily adaptive radiotherapy (RT) according to the adapt-to-shape (ATS) workflow were prospectively analyzed. A comparative cohort of 34 patients with similar characteristics treated with helical treatment on Radixact® was retrieved.

Results: Characteristics were well balanced across the two groups. Maximal toxicity grade ≥2 rate was borderline higher at RT end in MRI-linac group (p 0.049), but lower one month after RT (76.5 % vs 91.2 %; p = 0.257).Non-significantly lower rates of grade ≥2 xerostomia and dysgeusia were reported in Unity® group one and three months after RT. Higher rates of hospitalizations were reported in Radixact group at 20 fractions and at RT end (64.1 % vs 35.3 %; p = 0.015). Mean Karnofsky performance status (KPS) was higher in Unity group three months after RT (87.67 vs 83.87; p = 0.038).After a median follow up of 361.5 days, local complete response was reported for 93.6 % of patients treated with Unity® and 96.8 % of patients treated with Radixact®.

Conclusions: Results of this analysis support the feasibility of an ATS MR-linac workflow for RCHT in OPSCC. Compared with tomotherapy, treatment with Unity® resulted in significantly lower rates of hospitalization and higher KPS three months after RT. Grade 2 xerostomia and dysgeusia rates were non-significantly lower in Unity group. Optimal results in terms of local control were reported for both techniques.

Keywords: Adaptive radiotherapy; Head and neck; MR-guided radiotherapy; MR-linac; MRI-linac; Oropharyngeal; Oropharynx; Radiotherapy; Tomotherapy.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Rate of grade ≥2 toxicity rates (%) in Unity group (U) and Radixact group (R) at 20 fractions (20 fr), radiotherapy end (RT end) and one month after RT end (1 mo) and three months after RT end (3 mo).
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