Advances in Radiation Oncology (Jul 2017)

Two-and-a-half-year clinical experience with the world's first magnetic resonance image guided radiation therapy system

  • Benjamin W. Fischer-Valuck, MD,
  • Lauren Henke, MD,
  • Olga Green, PhD,
  • Rojano Kashani, PhD,
  • Sahaja Acharya, MD,
  • Jeffrey D. Bradley, MD,
  • Clifford G. Robinson, MD,
  • Maria Thomas, MD, PhD,
  • Imran Zoberi, MD,
  • Wade Thorstad, MD,
  • Hiram Gay, MD,
  • Jiayi Huang, MD,
  • Michael Roach, MD,
  • Vivian Rodriguez, PhD,
  • Lakshmi Santanam, PhD,
  • Harold Li, PhD,
  • Hua Li, PhD,
  • Jessika Contreras, MD,
  • Thomas Mazur, PhD,
  • Dennis Hallahan, MD,
  • Jeffrey R. Olsen, MD,
  • Parag Parikh, MD,
  • Sasa Mutic, PhD,
  • Jeff Michalski, MD, MBA

DOI
https://doi.org/10.1016/j.adro.2017.05.006
Journal volume & issue
Vol. 2, no. 3
pp. 485 – 493

Abstract

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Purpose: Magnetic resonance image guided radiation therapy (MR-IGRT) has been used at our institution since 2014. We report on more than 2 years of clinical experience in treating patients with the world's first MR-IGRT system. Methods and materials: A clinical service was opened for MR-IGRT in January 2014 with an MR-IGRT system consisting of a split 0.35T magnetic resonance scanner that straddles a ring gantry with 3 multileaf collimator-equipped 60Co heads. The service was expanded to include online adaptive radiation therapy (ART) MR-IGRT and cine gating after 6 and 9 months, respectively. Patients selected for MR-IGRT were enrolled in a prospective registry between January 2014 and June 2016. Patients were treated with a variety of radiation therapy techniques including intensity modulated radiation therapy and stereotactic body radiation therapy (SBRT). When applicable, online ART was performed and gating on sagittal 2-dimensional cine MR was used. The charts of patients treated with MR-IGRT were reviewed to report on the clinical and treatment characteristics of the initial patients who were treated with this novel technique. Results: A total of 316 patients have been treated with the MR-IGRT system, which has been integrated into a high-volume clinic. The cases were most commonly selected for improved soft tissue visualization, ART, and cine gating. Seventy-six patients were treated with 3-dimensional conformal radiation therapy, 146 patients with intensity modulated radiation therapy, and 94 patients with SBRT. The most commonly treated disease sites were the abdomen (28%), breast (26%), pelvis (22%), thorax (19%), and head and neck (5%). Sixty-seven patients were treated with online ART over a total of 244 adapted fractions. Cine treatment gating was used for a total of 81 patients. Conclusions: MR-IGRT has been successfully implemented in a high-volume radiation clinic and provides unique advantages in the treatment of a variety of malignancies. Additional clinical trials are in development to formally evaluate MR-IGRT in the treatment of multiple disease sites with techniques such as SBRT and ART.