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:10.1016/j.adro.2017.05.006

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

Affiliations

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

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.

Published in Advances in Radiation Oncology

ISSN: 2452-1094 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Medicine (General): Medical physics. Medical radiology. Nuclear medicine; Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: http://www.journals.elsevier.com/advances-in-radiation-oncology/

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