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MRI-guided Real-time Online Gated Stereotactic Body Radiation Therapy for Liver Tumors
Bhanu Prasad Venkatesulu1, Emily Ness1, Dylan Ross1
1Departments of Radiation Oncology.
Background:
Liver tumors are commonly encountered in oncology. The study aimed to assess the impact of magnetic resonance imaging (MRI)-guided stereotactic body radiation therapy (SBRT) (MRgSBRT) on disease-related outcomes and the toxicity profile.
Methods:
Patients who received MRgSBRT from 2019 to 2021 for primary and metastatic liver tumors were included in this analysis. The protocol for treatment simulation included Gadoxetate disodium injection followed by a single-dimensional post-exhale MRI (0.35-T MRI linear accelerator) and computed tomography simulation. The patient demographics and treatment-related outcomes were assessed. The time-to-event curves were analyzed for freedom from local progression (FFLP) and overall survival (OS).
Results:
A total of 35 patients were eligible for analysis with a median age of 70 years (range 25 to 95). The median follow-up was 19.4 months (range 1 to 37 mo). The one-year OS was 77.7%, with an estimated 3 years of 47.9%. Patients with the locally controlled disease had a better median OS of 27.8 months (95% CI [23.8-31.6]) compared with 13.5 months (95% CI [5.6-21.3], P =0.007) in patients with local disease progression. The 1-year FFLP was 95.6%, and 3-year estimated FFLP was 87.1%. Patients who received a radiation dose of biologically equivalent dose≥100 Gy had FFLP of 30.9 months (95% CI [28.7-33.1]) compared with 13.3 months (95% CI [5.3-21.3], P =0.004) in patients who received <100 Gy biologically equivalent dose.
Conclusion:
MRI-guided SBRT provides optimal local control, associated with improved OS in a heavily morbid, pretreated older cohort of patients with reasonable safety profiles.
Insights
Magnetic resonance imaging-guided stereotactic body radiation therapy (MRgSBRT) offers excellent local control for liver tumors. This advanced treatment improves overall survival in older patients with significant comorbidities, demonstrating a favorable safety profile.
Area of Science:
- Oncology
- Radiation Oncology
- Medical Imaging
Background:
- Liver tumors are a common oncological challenge.
- Assessing the efficacy and safety of novel radiation techniques is crucial.
Purpose of the Study:
- To evaluate the impact of MRI-guided stereotactic body radiation therapy (MRgSBRT) on disease outcomes.
- To assess the toxicity profile of MRgSBRT for liver tumors.
Main Methods:
- Retrospective analysis of 35 patients with primary or metastatic liver tumors treated with MRgSBRT (2019-2021).
- Treatment simulation involved Gadoxetate disodium injection, post-exhale MRI, and CT simulation.
- Outcomes assessed included freedom from local progression (FFLP) and overall survival (OS).
Main Results:
- One-year OS was 77.7%, with a 3-year OS of 47.9%.
- Patients with local disease control had significantly better median OS (27.8 months) compared to those with progression (13.5 months).
- A biologically equivalent dose (BED) ≥100 Gy correlated with improved FFLP (30.9 months) versus <100 Gy BED (13.3 months).
Conclusions:
- MRI-guided SBRT achieves optimal local control for liver tumors.
- MRgSBRT is associated with improved overall survival in a challenging patient cohort.
- The treatment demonstrates a reasonable safety profile in older, pretreated patients.
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