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. 2025 Jun 4:S1879-8500(25)00149-3.
doi: 10.1016/j.prro.2025.05.006. Online ahead of print.

Prospective Assessment of MR Guided Single-Fraction Stereotactic Ablative Radiation Therapy for Peripheral Lung Metastases: Dosimetric and Clinical Outcomes

Svenja Hering  1 , Richard Gaus  2 , Jan Hofmaier  3 , Sina Mansoorian  3 , Sebastian Marschner  3 , Nina-Sophie Schmidt-Hegemann  3 , Vanessa da Silva Mendes  3 , Amanda Tufman  4 , Niels Reinmuth  5 , Guillaume Landry  3 , Maximilian Niyazi  6 , Claus Belka  7 , Stefanie Corradini  3 , Chukwuka Eze  8
Affiliations

Prospective Assessment of MR Guided Single-Fraction Stereotactic Ablative Radiation Therapy for Peripheral Lung Metastases: Dosimetric and Clinical Outcomes

Svenja Hering et al. Pract Radiat Oncol. .

Abstract

Objectives: This study aimed to evaluate the feasibility and safety of online MR guided single-fraction stereotactic ablative radiation therapy (SABR) and to assess acute changes in pulmonary function tests (PFTs), inflammatory markers, patient-reported quality of life (QoL), and dosimetric outcomes.

Methods and materials: Patients with lung metastases were included in this single-center prospective study. Patients underwent MR guided single-fraction SABR. The primary endpoints encompassed local control (LC) and overall survival. Secondary endpoints included acute toxicity (Common Terminology Criteria for Adverse Events version 5.0), changes in PFTs, inflammatory markers, QoL, and dosimetric outcomes.

Results: Between 10/2020 and 10/2022, 26 patients with 30 lung metastases were prospectively enrolled. At a median follow-up of 19.9 months (range, 16.1 to 25.6 months), the 1- and 2-year LC rates were 96.2% (95% CI, 88.7% to 100.0%) and 77.5% (95% CI, 55.9% to 99.1%). No Common Terminology Criteria for Adverse Events grade 3+ side effects were observed. While there was a slight median reduction of 4% in forced expiratory volume in 1 second (L) (P = .009, range, -24% to 20%), other PFT parameters remained stable. The neutrophil-to-lymphocyte ratio increased by a median of 13% (P = .002, range, -10% to 207%), while serum C-reactive protein and albumin levels remained unchanged. Patient-reported QoL did not exhibit significant changes, except for a minimal increase in the median score for cognitive functioning from 1 to 1.5 (P = .041).

Conclusions: MR guided single-fraction SABR is a safe and effective treatment option for peripheral lung metastases, demonstrating encouraging LC.

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Conflict of interest statement

Disclosures The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The Department of Radiation Oncology of the LMU University Hospital, LMU Munich has research agreements with Viewray Inc, Elekta, Brainlab, and C-RAD. Viewray Inc did not fund this study and was not involved and had no influence on the study design, the collection or analysis of data, or on the writing of the manuscript. Amanda Tufman reports receiving consulting fees from Boehringer Ingelheim, Daiichi, AstraZeneca, Roche, Pfizer, BMS, MSD, Sanofi, Lilly, and Novartis, payment or honoraria from Boehringer Ingelheim, Daiichi, AstraZeneca, Roche, Pfizer, BMS, MSD, Sanofi, Lilly, and Novartis, support for attending meetings and/or travel from Sanofi, Janssen, Daiichi; BMS, MSD, and AstraZeneca, participation on a Data Safety Monitoring Board or Advisory Board of AIO (ROSE Study) and having a leadership or fiduciary role with and having a leadership or fiduciary role with AIO, ERS. Niels Reinmuth reports payment or honoraria from Amgen, AstraZeneca, Bristol-Myers Squibb, Boehringer-Ingelheim, Daiichi-Sankyo, GlaxoSmithKline, Hoffmann-La Roche, Janssen, Lilly, MSD, Merck, Pfizer, Sanofi, Symphogen, and Takeda and support for attending meetings and/or travel from Johnson&Johnson, Roche, Takeda. Maximilian Niyazi reports research grants and speaker fees/travel support from Brainlab, ViewRay, AstraZeneca. Claus Belka reports receiving grants or contracts from ViewRay, Brainlab, and Elekta; payment or honoraria from Bristol-Myers Squibb, Roche, Merck, AstraZeneca, Opasca, C-RAD, Elekta, and ViewRay; receiving support for attending meetings or travel from Bristol-Myers Squibb, Roche, Merck, AstraZeneca, Elekta, and ViewRay; and having a leadership or fiduciary role with ESTRO, all outside the submitted work. Stefanie Corradini reports research grants and speaker fees/travel support from Elekta, ViewRay and Brainlab. Chukwuka Eze reports consulting fees from Novartis, AstraZeneca, payment or honoraria from AstraZeneca outside the submitted work and received funding in form of a research grant from the German Cancer Aid.