Frontiers in Oncology (Jan 2022)
Adaptive MR-Guided Stereotactic Radiotherapy is Beneficial for Ablative Treatment of Lung Tumors in High-Risk Locations
- Sebastian Regnery,
- Sebastian Regnery,
- Sebastian Regnery,
- Sebastian Regnery,
- Sebastian Regnery,
- Carolin Buchele,
- Carolin Buchele,
- Fabian Weykamp,
- Fabian Weykamp,
- Fabian Weykamp,
- Fabian Weykamp,
- Moritz Pohl,
- Philipp Hoegen,
- Philipp Hoegen,
- Philipp Hoegen,
- Philipp Hoegen,
- Philipp Hoegen,
- Tanja Eichkorn,
- Tanja Eichkorn,
- Tanja Eichkorn,
- Tanja Eichkorn,
- Thomas Held,
- Thomas Held,
- Thomas Held,
- Thomas Held,
- Jonas Ristau,
- Jonas Ristau,
- Jonas Ristau,
- Carolin Rippke,
- Carolin Rippke,
- Laila König,
- Laila König,
- Laila König,
- Laila König,
- Michael Thomas,
- Michael Thomas,
- Michael Thomas,
- Hauke Winter,
- Hauke Winter,
- Hauke Winter,
- Sebastian Adeberg,
- Sebastian Adeberg,
- Sebastian Adeberg,
- Sebastian Adeberg,
- Sebastian Adeberg,
- Jürgen Debus,
- Jürgen Debus,
- Jürgen Debus,
- Jürgen Debus,
- Jürgen Debus,
- Sebastian Klüter,
- Sebastian Klüter,
- Juliane Hörner-Rieber,
- Juliane Hörner-Rieber,
- Juliane Hörner-Rieber,
- Juliane Hörner-Rieber,
- Juliane Hörner-Rieber
Affiliations
- Sebastian Regnery
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Sebastian Regnery
- National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
- Sebastian Regnery
- National Center for Tumor diseases, Heidelberg, Germany
- Sebastian Regnery
- Heidelberg Ion-Beam Therapy Center, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Sebastian Regnery
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
- Carolin Buchele
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Carolin Buchele
- National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
- Fabian Weykamp
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Fabian Weykamp
- National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
- Fabian Weykamp
- National Center for Tumor diseases, Heidelberg, Germany
- Fabian Weykamp
- Heidelberg Ion-Beam Therapy Center, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Moritz Pohl
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
- Philipp Hoegen
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Philipp Hoegen
- National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
- Philipp Hoegen
- National Center for Tumor diseases, Heidelberg, Germany
- Philipp Hoegen
- Heidelberg Ion-Beam Therapy Center, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Philipp Hoegen
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
- Tanja Eichkorn
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Tanja Eichkorn
- National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
- Tanja Eichkorn
- National Center for Tumor diseases, Heidelberg, Germany
- Tanja Eichkorn
- Heidelberg Ion-Beam Therapy Center, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Thomas Held
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Thomas Held
- National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
- Thomas Held
- National Center for Tumor diseases, Heidelberg, Germany
- Thomas Held
- Heidelberg Ion-Beam Therapy Center, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Jonas Ristau
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Jonas Ristau
- National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
- Jonas Ristau
- National Center for Tumor diseases, Heidelberg, Germany
- Carolin Rippke
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Carolin Rippke
- National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
- Laila König
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Laila König
- National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
- Laila König
- National Center for Tumor diseases, Heidelberg, Germany
- Laila König
- Heidelberg Ion-Beam Therapy Center, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Michael Thomas
- National Center for Tumor diseases, Heidelberg, Germany
- Michael Thomas
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
- Michael Thomas
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research, Heidelberg, Germany
- Hauke Winter
- National Center for Tumor diseases, Heidelberg, Germany
- Hauke Winter
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research, Heidelberg, Germany
- Hauke Winter
- Department of Thoracic Surgery, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
- Sebastian Adeberg
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Sebastian Adeberg
- National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
- Sebastian Adeberg
- National Center for Tumor diseases, Heidelberg, Germany
- Sebastian Adeberg
- Heidelberg Ion-Beam Therapy Center, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Sebastian Adeberg
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
- Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Jürgen Debus
- National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
- Jürgen Debus
- National Center for Tumor diseases, Heidelberg, Germany
- Jürgen Debus
- Heidelberg Ion-Beam Therapy Center, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Jürgen Debus
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
- Sebastian Klüter
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Sebastian Klüter
- National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
- Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Juliane Hörner-Rieber
- National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
- Juliane Hörner-Rieber
- National Center for Tumor diseases, Heidelberg, Germany
- Juliane Hörner-Rieber
- Heidelberg Ion-Beam Therapy Center, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Juliane Hörner-Rieber
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
- DOI
- https://doi.org/10.3389/fonc.2021.757031
- Journal volume & issue
-
Vol. 11
Abstract
PurposeTo explore the benefit of adaptive magnetic resonance-guided stereotactic body radiotherapy (MRgSBRT) for treatment of lung tumors in different locations with a focus on ultracentral lung tumors (ULT).Patients & MethodsA prospective cohort of 21 patients with 23 primary and secondary lung tumors was analyzed. Tumors were located peripherally (N = 10), centrally (N = 2) and ultracentrally (N = 11, planning target volume (PTV) overlap with proximal bronchi, esophagus and/or pulmonary artery). All patients received MRgSBRT with gated dose delivery and risk-adapted fractionation. Before each fraction, the baseline plan was recalculated on the anatomy of the day (predicted plan). Plan adaptation was performed in 154/165 fractions (93.3%). Comparison of dose characteristics between predicted and adapted plans employed descriptive statistics and Bayesian linear multilevel models. The posterior distributions resulting from the Bayesian models are presented by the mean together with the corresponding 95% compatibility interval (CI).ResultsPlan adaptation decreased the proportion of fractions with violated planning objectives from 94% (predicted plans) to 17% (adapted plans). In most cases, inadequate PTV coverage was remedied (predicted: 86%, adapted: 13%), corresponding to a moderate increase of PTV coverage (mean +6.3%, 95% CI: [5.3–7.4%]) and biologically effective PTV doses (BED10) (BEDmin: +9.0 Gy [6.7–11.3 Gy], BEDmean: +1.4 Gy [0.8–2.1 Gy]). This benefit was smaller in larger tumors (−0.1%/10 cm³ PTV [−0.2 to −0.02%/10 cm³ PTV]) and ULT (−2.0% [−3.1 to −0.9%]). Occurrence of exceeded maximum doses inside the PTV (predicted: 21%, adapted: 4%) and violations of OAR constraints (predicted: 12%, adapted: 1%, OR: 0.14 [0.04–0.44]) was effectively reduced. OAR constraint violations almost exclusively occurred if the PTV had touched the corresponding OAR in the baseline plan (18/19, 95%).ConclusionAdaptive MRgSBRT is highly recommendable for ablative treatment of lung tumors whose PTV initially contacts a sensitive OAR, such as ULT. Here, plan adaptation protects the OAR while maintaining best-possible PTV coverage.
Keywords
- stereotactic body radiotherapy
- image-guidance
- radiotherapy
- pulmonary cancer
- magnetic resonance imaging
- MR-guided radiotherapy