Clinical Implementation and Initial Experience With a 1.5 Tesla MR-Linac for MR-Guided Radiation Therapy for Gynecologic Cancer: An R-IDEAL Stage 1 and 2a First in Humans Feasibility Study of New Technology Implementation.
Clinical Implementation and Initial Experience With a 1.5 Tesla MR-Linac for MR-Guided Radiation Therapy for Gynecologic Cancer: An R-IDEAL Stage 1 and 2a First in Humans Feasibility Study of New Technology Implementation.
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DOI：
10.1016/j.prro.2022.03.002
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发表时间：
2022-07
影响因子：
3.3
通讯作者：
Lin, Lilie L.
中科院分区：
文献类型：
--
作者：
Lakomy, David S.;Yang, Jinzhong;Vedam, Sastry;Wang, Jihong;Lee, Belinda;Sobremonte, Angela;Castillo, Pamela;Hughes, Neil;Mohammedsaid, Mustefa;Jhingran, Anuja;Klopp, Ann H.;Choi, Seungtaek;Fuller, C. David;Lin, Lilie L.
磁共振成像引导的直线加速器系统（MR直线加速器）可以促进放射治疗计划的日常调整。在这里，我们报告我们的早期临床经验，使用磁共振直线加速器的适应性放射治疗妇科恶性肿瘤。计划使用Elekta Monaco v5.4.01进行治疗，并通过1.5特斯拉Elekta Unity MR直线加速器进行治疗。该系统可根据肿瘤和周围正常结构的位置（ATP）或形状（ATS）进行日常调整。ATS方法可以在调整计划之前手动编辑肿瘤和周围正常结构的轮廓。在此，我们记录了每个治疗分次的持续时间;分次之间的设置变异性（通过每个计划中的等中心点偏移进行评估）;并且，为了保证质量，计算了符合3%/3 mm距离一致的γ标准的计划百分比。使用可变形的累积剂量计算来比较仅接受ATP部分治疗的患者的累积剂量与计划剂量。在10名接受90次MR直线加速器治疗的患者中，大多数接受了加强剂量，以防止淋巴结或孤立肿瘤复发。每次治疗持续时间中位数为32分钟; ATP组的治疗时间短于ATS组（30分钟vs 42分钟，P<0.0001）。所有部分计划的γ标准超过>90%（中位数99.9%，范围92.4%-100%），即，所有图则均通过质素保证测试。各轴平均等中心偏移<0.5cm。对于所有ATP病例，总肿瘤体积的累积剂量均在参考计划的5%范围内。盆腔周围病变的累积剂量在参考计划的<1%范围内，而盆腔中央肿瘤的累积剂量在-1.6%至-4.4%范围内。MR直线加速器是治疗妇科癌症患者的可靠且临床可行的工具。
Magnetic resonance imaging–guided linear accelerator systems (MR-linacs) can facilitate the daily adaptation of radiotherapy plans. Here, we report our early clinical experience using an MR-linac for adaptive radiotherapy of gynecologic malignancies. Treatments were planned with an Elekta Monaco v5.4.01 and delivered by a 1.5 Tesla Elekta Unity MR-linac. The system offers a choice of daily adaptation based on either position (ATP) or shape (ATS) of the tumor and surrounding normal structures. The ATS approach has the option of manually editing the contours of tumors and surrounding normal structures before the plan is adapted. Here we documented the duration of each treatment fraction; set-up variability (assessed by isocenter shifts in each plan) between fractions; and, for quality assurance, calculated the percentage of plans meeting the γ-criterion of 3%/3-mm distance to agreement. Deformable accumulated dose calculations were used to compare accumulated versus planned dose for patient treated with exclusively ATP fractions. Of the 10 patients treated with 90 fractions on the MR-linac, most received boost doses to recurrence in nodes or isolated tumors. Each treatment fraction lasted a median 32 minutes; fractions were shorter with ATP than with ATS (30 min vs 42 min, P<0.0001). The γ criterion for all fraction plans exceeded >90% (median 99.9%, range 92.4%–100%), i.e., all plans passed quality assurance testing. The average extent of isocenter shift was <0.5 cm in each axis. The accumulated dose to the gross tumor volume was within 5% of the reference plan for all ATP cases. Accumulated doses for lesions in the pelvic periphery were within <1% of the reference plan as opposed to −1.6% to −4.4% for central pelvic tumors. The MR-linac is a reliable and clinically feasible tool for treating patients with gynecologic cancer.
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DOI：
10.1186/s13014-021-01858-7
发表时间：
2021-07-21
期刊：
Radiation oncology (London, England)
影响因子：
--
作者：
Da Silva Mendes V;Nierer L;Li M;Corradini S;Reiner M;Kamp F;Niyazi M;Kurz C;Landry G;Belka C
通讯作者：
Belka C
DOI：
10.1016/j.ijrobp.2020.12.015
发表时间：
2021-04-01
期刊：
International journal of radiation oncology, biology, physics
影响因子：
--
作者：
McDonald BA;Vedam S;Yang J;Wang J;Castillo P;Lee B;Sobremonte A;Ahmed S;Ding Y;Mohamed ASR;Balter P;Hughes N;Thorwarth D;Nachbar M;Philippens MEP;Terhaard CHJ;Zips D;Böke S;Awan MJ;Christodouleas J;Fuller CD;MR-Linac Consortium Head and Neck Tumor Site Group
通讯作者：
MR-Linac Consortium Head and Neck Tumor Site Group
影响因子：
3.4
作者：
Kong, V;Hansen, V. N.;Hafeez, S.
通讯作者：
Hafeez, S.
DOI：
10.1007/s00259-020-05112-2
发表时间：
2021-04
影响因子：
9.1
作者：
Adam JA;Loft A;Chargari C;Delgado Bolton RC;Kidd E;Schöder H;Veit-Haibach P;Vogel WV
通讯作者：
Vogel WV
影响因子：
3.1
作者：
Bartels MMTJ;Verpalen IM;Ferrer CJ;Slotman DJ;Phernambucq ECJ;Verhoeff JJC;Eppinga WSC;Braat MNGJA;van den Hoed RD;van 't Veer-Ten Kate M;de Boer E;Naber HR;Nijholt IM;Bartels LW;Bos C;Moonen CTW;Boomsma MF;Verkooijen HM
通讯作者：
Verkooijen HM