Radiation Oncology (Aug 2022)

Clinical adoption patterns of 0.35 Tesla MR-guided radiation therapy in Europe and Asia

  • Berend J. Slotman,
  • Mary Ann Clark,
  • Enis Özyar,
  • Myungsoo Kim,
  • Jun Itami,
  • Agnès Tallet,
  • Jürgen Debus,
  • Raphael Pfeffer,
  • PierCarlo Gentile,
  • Yukihiro Hama,
  • Nicolaus Andratschke,
  • Olivier Riou,
  • Philip Camilleri,
  • Claus Belka,
  • Magali Quivrin,
  • BoKyong Kim,
  • Anders Pedersen,
  • Mette van Overeem Felter,
  • Young Il Kim,
  • Jin Ho Kim,
  • Martin Fuss,
  • Vincenzo Valentini

DOI
https://doi.org/10.1186/s13014-022-02114-2
Journal volume & issue
Vol. 17, no. 1
pp. 1 – 9

Abstract

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Abstract Background Magnetic resonance-guided radiotherapy (MRgRT) utilization is rapidly expanding, driven by advanced capabilities including better soft tissue imaging, continuous intrafraction target visualization, automatic triggered beam delivery, and the availability of on-table adaptive replanning. Our objective was to describe patterns of 0.35 Tesla (T)-MRgRT utilization in Europe and Asia among early adopters of this novel technology. Methods Anonymized administrative data from all 0.35T-MRgRT treatment systems in Europe and Asia were extracted for patients who completed treatment from 2015 to 2020. Detailed treatment information was analyzed for all MR-linear accelerators (linac) and -cobalt systems. Results From 2015 through the end of 2020, there were 5796 completed treatment courses delivered in 46,389 individual fractions. 23.5% of fractions were adapted. Ultra-hypofractionated (UHfx) dose schedules (1–5 fractions) were delivered for 63.5% of courses, with 57.8% of UHfx fractions adapted on-table. The most commonly treated tumor types were prostate (23.5%), liver (14.5%), lung (12.3%), pancreas (11.2%), and breast (8.0%), with increasing compound annual growth rates (CAGRs) in numbers of courses from 2015 through 2020 (pancreas: 157.1%; prostate: 120.9%; lung: 136.0%; liver: 134.2%). Conclusions This is the first comprehensive study reporting patterns of utilization among early adopters of a 0.35T-MRgRT system in Europe and Asia. Intrafraction MR image-guidance, advanced motion management, and increasing adoption of on-table adaptive RT have accelerated a transition to UHfx regimens. MRgRT has been predominantly used to treat tumors in the upper abdomen, pelvis and lungs, and increasingly with adaptive replanning, which is a radical departure from legacy radiotherapy practices.

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