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Safety and Tolerability of Online Adaptive High-Field Magnetic Resonance-Guided Radiotherapy
Jasmijn M Westerhoff1, Lois A Daamen1, John P Christodouleas2,3
1University Medical Center Utrecht, Division of Imaging and Oncology, Utrecht, the Netherlands.
JAMA Network Open
|May 1, 2024
Summary
Online adaptive radiotherapy using a 1.5-T MR-Linac is safe and well-tolerated. This approach, adapting radiation plans daily, showed a low risk of severe toxic effects in solid tumor patients.
Area of Science:
- Oncology
- Medical Physics
- Radiotherapy
Background:
- The introduction of online adaptive magnetic resonance (MR)-guided radiotherapy (MRgRT) systems, specifically the 1.5-T MR-Linac, enables real-time adjustments to radiation plans.
- This adaptive capability allows for modifications based on daily changes in patient anatomy visualized by MR imaging.
Purpose of the Study:
- To assess the safety, tolerability, and technical feasibility of treatments delivered by a 1.5-T MR-Linac.
- To specifically evaluate the online adaptive strategy, known as the adapt-to-shape (ATS) approach, in patients with solid tumors.
Main Methods:
- A cohort study of 1772 adult patients with solid tumors treated with a 1.5-T MR-Linac between February 2019 and October 2021.
- Data were collected internationally (Canada, Denmark, Netherlands, UK, US) as part of the MOMENTUM study.
- Evaluation focused on treatment completion, patterns of care, and acute high-grade (grade 3 or higher) radiotherapy-related toxic effects within 3 months.
Main Results:
- A total of 1793 treatment courses were analyzed, with common treatment sites including prostate, metastatic lymph nodes, and brain.
- Online adaptive radiotherapy (ATS) was utilized in 58.6% of treatment courses, with 95.9% of MRgRT courses completed as planned.
- The incidence of grade 3 radiotherapy-related toxic effects was low (1.4% overall, 0.4% with ATS), with no grade 4 or 5 toxic effects reported.
Conclusions:
- Treatment with the 1.5-T MR-Linac demonstrated favorable safety and tolerability profiles in this patient cohort.
- The online adaptation strategy (ATS) was technically feasible and associated with a reduced risk of acute grade 3 toxic effects.
- These findings support the clinical utility of online adaptive MRgRT for solid tumors.
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