Phase I trial of stereotactic MR-guided online adaptive radiation therapy (SMART) for the treatment of oligometastatic or unresectable primary malignancies of the abdomen
Phase I trial of stereotactic MR-guided online adaptive radiation therapy (SMART) for the treatment of oligometastatic or unresectable primary malignancies of the abdomen
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DOI：
10.1016/j.radonc.2017.11.032
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发表时间：
2018-03-01
影响因子：
5.7
通讯作者：
Olsen, Jeffrey
中科院分区：
文献类型：
--
作者：
Henke, Lauren;Kashani, Rojano;Olsen, Jeffrey
宗旨/目标：SBRT用于治疗寡转移性或不可切除的原发性腹部恶性肿瘤，尽管消融剂量输送受到邻近危险器官（OAR）的限制。立体定向、磁共振（MR）引导的在线自适应放射治疗（SMART）可提高SBRT的治疗率。本前瞻性I期临床试验评估SMART治疗腹部恶性肿瘤的可行性和潜在优势。材料/方法：20例原发性肝转移少或不能切除的患者（n = 10）和非肝性腹部恶性肿瘤患者（n = 10）接受SMART治疗。初始计划规定50戈伊/5次（BED 100戈伊），目标是95% PTV覆盖率达到95%处方，受严格OAR限制。根据需要创建每日实时在线自适应计划，基于每日设置MR图像集肿瘤/OAR“每日解剖结构”，以保留硬OAR约束、逐步增加PTV剂量或两者兼而有之。治疗时间，病人的结果，和初始和自适应计划之间的剂量测定比较prospectively recorded.Results：在线自适应计划创建时，治疗81/97分数，由于初始计划违反OAR的限制（61/97）或观察到的机会PTV剂量递增（20/97）。计划调整增加了PTV覆盖率在64/97分数。0级>= 3急性（
Purpose/objectives: SBRT is used to treat oligometastatic or unresectable primary abdominal malignancies, although ablative dose delivery is limited by proximity of organs-at-risk (OAR). Stereotactic, magnetic resonance (MR)-guided online-adaptive radiotherapy (SMART) may improve SBRT's therapeutic ratio. This prospective Phase I trial assessed feasibility and potential advantages of SMART to treat abdominal malignancies.Materials/methods: Twenty patients with oligometastatic or unresectable primary liver (n = 10) and non liver (n = 10) abdominal malignancies underwent SMART. Initial plans prescribed 50 Gy/5 fractions (BED 100 Gy) with goal 95% PTV coverage by 95% of prescription, subject to hard OAR constraints. Daily real-time online-adaptive plans were created as needed, based on daily setup MR-image-set tumor/OAR "anatomy-of-the-day" to preserve hard OAR constraints, escalate PTV dose, or both. Treatment times, patient outcomes, and dosimetric comparisons between initial and adaptive plans were prospectively recorded.Results: Online adaptive plans were created at time of treatment for 81/97 fractions, due to initial plan violation of OAR constraints (61/97) or observed opportunity for PTV dose escalation (20/97). Plan adaptation increased PTV coverage in 64/97 fractions. Zero Grade >= 3 acute (