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Gani C, Boeke S, McNair H, et al. Marker-less online MR-guided stereotactic body radiotherapy of liver metastases at a 1.5 T MR-Linac - Feasibility, workflow data and patient acceptance. Clin Transl Radiat Oncol. 2020;26:55-61doi: 10.1016/j.ctro.2020.11.014.
Gani, C., Boeke, S., McNair, H., Ehlers, J., Nachbar, M., Mönnich, D., Stolte, A., Boldt, J., Marks, C., Winter, J., Künzel, L. A., Gatidis, S., Bitzer, M., Thorwarth, D., & Zips, D. (2021). Marker-less online MR-guided stereotactic body radiotherapy of liver metastases at a 1.5 T MR-Linac - Feasibility, workflow data and patient acceptance. Clinical and translational radiation oncology, 2655-61. https://doi.org/10.1016/j.ctro.2020.11.014
Gani, Cihan, et al. "Marker-less online MR-guided stereotactic body radiotherapy of liver metastases at a 1.5 T MR-Linac - Feasibility, workflow data and patient acceptance." Clinical and translational radiation oncology vol. 26 (2021): 55-61. doi: https://doi.org/10.1016/j.ctro.2020.11.014
Gani C, Boeke S, McNair H, Ehlers J, Nachbar M, Mönnich D, Stolte A, Boldt J, Marks C, Winter J, Künzel LA, Gatidis S, Bitzer M, Thorwarth D, Zips D. Marker-less online MR-guided stereotactic body radiotherapy of liver metastases at a 1.5 T MR-Linac - Feasibility, workflow data and patient acceptance. Clin Transl Radiat Oncol. 2020 Nov 30;26:55-61. doi: 10.1016/j.ctro.2020.11.014. eCollection 2021 Jan. PMID: 33319073; PMCID: PMC7723999.
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Clin Transl Radiat Oncol. 2020 Nov 30;26:55-61. doi: 10.1016/j.ctro.2020.11.014. eCollection 2021 Jan.

Marker-less online MR-guided stereotactic body radiotherapy of liver metastases at a 1.5 T MR-Linac - Feasibility, workflow data and patient acceptance.

Clinical and translational radiation oncology

Cihan Gani, S Boeke, H McNair, J Ehlers, M Nachbar, D Mönnich, A Stolte, J Boldt, C Marks, J Winter, Luise A Künzel, S Gatidis, M Bitzer, D Thorwarth, D Zips

Affiliations

  1. Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany.
  2. German Cancer Consortium (DKTK), Partner Site Tübingen, and German Cancer Research Center (DKFZ), Heidelberg, Germany.
  3. Department of Radiotherapy, The Royal Marsden Hospital NHS Foundation Trust, United Kingdom.
  4. Section for Biomedical Physics. Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany.
  5. Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital, Eberhard Karls University, Tübingen, Germany.
  6. Department of Gastroenterology, Gastrointestinal Oncology, Hepatology and Infectious Diseases, Eberhard Karls University, Tübingen, Germany.

PMID: 33319073 PMCID: PMC7723999 DOI: 10.1016/j.ctro.2020.11.014

Abstract

INTRODUCTION: Stereotactic body radiotherapy (SBRT) is an established ablative treatment for liver tumors with excellent local control rates. Magnetic resonance imaging guided radiotherapy (MRgRT) provides superior soft tissue contrast and may therefore facilitate a marker-less liver SBRT workflow. The goal of the present study was to investigate feasibility, workflow parameters, toxicity and patient acceptance of MRgSBRT on a 1.5 T MR-Linac.

METHODS: Ten consecutive patients with liver metastases treated on a 1.5 T MR-Linac were included in this prospective trial. Tumor delineation was performed on four-dimensional computed tomography scans and both exhale triggered and free-breathing T2 MRI scans from the MR-Linac. An internal target volume based approach was applied. Organ at risk constraints were based on the UKSABR guidelines (Version 6.1). Patient acceptance regarding device specific aspects was assessed and toxicity was scored according to the common toxicity criteria of adverse events, version 5.

RESULTS: Nine of ten tumors were clearly visible on the 1.5 T MR-Linac. No patient had fiducial markers placed for treatment. All patients were treated with three or five fractions. Median dose to 98% of the gross tumor volume was 38.5 Gy. The median time from "patient identity check" until "beam-off" was 31 min. Median beam on time was 9.6 min. Online MRgRT was well accepted in general and no treatment had to be interrupted on patient request. No event of symptomatic radiation induced liver disease was observed after a median follow-up of ten month (range 3-17 months).

CONCLUSION: Our early experience suggests that online 1.5 T MRgSBRT of liver metastases represents a promising new non-invasive marker-free treatment modality based on high image quality, clinically reasonable in-room times and high patient acceptance. Further studies are necessary to assess clinical outcome, to validate advanced motion management and to explore the benefit of online response adaptive liver SBRT.

© 2020 The Author(s).

Conflict of interest statement

The Department of Radiation Oncology Tübingen receives within the frame of research agreements financial and technical support as well as sponsoring for travels and scientific symposia from: Elekta AB

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