Initial Feasibility and Clinical Implementation of Daily MR-Guided Adaptive Head and Neck Cancer Radiation Therapy on a 1.5T MR-Linac System: Prospective R-IDEAL 2a/2b Systematic Clinical Evaluation of Technical Innovation
MR-Linac Consortium Head and Neck Tumor Site Group and the Joint Head and Neck Radiotherapy-MRI Development Cooperative
(2021) International Journal of Radiation Oncology Biology Physics, volume 109, issue 5, pp. 1606 - 1618
(Article)
Abstract
Purpose: This prospective study is, to our knowledge, the first report of daily adaptive radiation therapy (ART) for head and neck cancer (HNC) using a 1.5T magnetic resonance imaging-linear accelerator (MR-linac) with particular focus on safety and feasibility and dosimetric results of an online rigid registration-based adapt to position (ATP)
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workflow. Methods and Materials: Ten patients with HNC received daily ART on a 1.5T/7MV MR-linac, 6 using ATP only and 4 using ATP with 1 offline adapt-to-shape replan. Setup variability with custom immobilization masks was assessed by calculating the mean systematic error (M), standard deviation of the systematic error (Σ), and standard deviation of the random error (σ) of the isocenter shifts. Quality assurance was performed with a cylindrical diode array using 3%/3 mm γ criteria. Adaptive treatment plans were summed for each patient to compare the delivered dose with the planned dose from the reference plan. The impact of dosimetric variability between adaptive fractions on the summation plan doses was assessed by tracking the number of optimization constraint violations at each individual fraction. Results: The random errors (mm) for the x, y, and z isocenter shifts, respectively, were M = –0.3, 0.7, 0.1; Σ = 3.3, 2.6, 1.4; and σ = 1.7, 2.9, 1.0. The median (range) γ pass rate was 99.9% (90.9%-100%). The differences between the reference and summation plan doses were –0.61% to 1.78% for the clinical target volume and –11.74% to 8.11% for organs at risk (OARs), although an increase greater than 2% in OAR dose only occurred in 3 cases, each for a single OAR. All cases had at least 2 fractions with 1 or more constraint violations. However, in nearly all instances, constraints were still met in the summation plan despite multiple single-fraction violations. Conclusions: Daily ART on a 1.5T MR-linac using an online ATP workflow is safe and clinically feasible for HNC and results in delivered doses consistent with planned doses.
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Keywords: Radiation, Oncology, Radiology Nuclear Medicine and imaging, Cancer Research, Journal Article
ISSN: 0360-3016
Publisher: Elsevier
Note: Funding Information: Disclosures: B.A.M. reports grants from the National Institutes of Health (NIH)/National Institute of Dental and Craniofacial Research (NIDCR) and research support from a Dr. John J. Kopchick Fellowship via The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences during the conduct of the study and personal fees (travel funds and speaking honorarium) from Elekta AB outside the submitted work. J.Y. reports grants from Elekta AB and personal fees (licensing royalties) from Varian Medical Systems outside the submitted work. J.W. reports grants from Elekta AB outside the submitted work. A.S.R.M. reports grants from NIH/NIDCR outside the submitted work. P.B. reports sponsored research agreements from Varian Associates and RaySearch Laboratories outside the submitted work. D.T. reports grants from the German Research Foundation (DFG) and nonfinancial support from Elekta AB and Philips during the conduct of the study and grants from Elekta AB and Siemens Healthineers and nonfinancial support from PTW Freiburg outside the submitted work. M.N. reports grants from DFG and nonfinancial support from Elekta AB and Philips during the conduct of the study and grants, personal fees (travel funds and speaking honoraria), and nonfinancial support from Elekta AB outside the submitted work. M.E.P.P. reports grants and nonfinancial support from Elekta AB and nonfinancial support from Philips Health care outside the submitted work. C.H.J.T. reports personal fees (travel funds) from Elekta AB outside the submitted work. D.Z. and S.B. report grants from DFG and nonfinancial support from Elekta AB and Philips during the conduct of the study and personal fees (travel funds and speaking honoraria) and nonfinancial support from Elekta AB outside the submitted work. M.J.A. reports personal fees from Elekta outside the submitted work. J.C. is an employee of Elekta, Inc, and reports grants from NIH/NIDCR during the conduct of the study. C.D.F. reports grants from NIH/NIDCR, NIH/National Cancer Institute (NCI), NIH/National Institute of Biomedical Imaging and Bioengineering, and Elekta AB during the conduct of the study; grants from the Patient-centered Outcomes Research Institute, NIH/NCI, NIH/NIDCR, MD Anderson, the Sister Institute Network Fund (MD Anderson), the National Science Foundation Division of Civil, Mechanical, and Manufacturing Innovation, and Elekta AB outside the submitted work; and personal fees (travel funds and speaking honoraria) from Elekta AB outside the submitted work. The remaining authors reported no disclosures or conflicts of interest. Funding Information: Disclosures: B.A.M. reports grants from the National Institutes of Health (NIH)/National Institute of Dental and Craniofacial Research (NIDCR) and research support from a Dr. John J. Kopchick Fellowship via The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences during the conduct of the study and personal fees (travel funds and speaking honorarium) from Elekta AB outside the submitted work. J.Y. reports grants from Elekta AB and personal fees (licensing royalties) from Varian Medical Systems outside the submitted work. J.W. reports grants from Elekta AB outside the submitted work. A.S.R.M. reports grants from NIH/NIDCR outside the submitted work. P.B. reports sponsored research agreements from Varian Associates and RaySearch Laboratories outside the submitted work. D.T. reports grants from the German Research Foundation (DFG) and nonfinancial support from Elekta AB and Philips during the conduct of the study and grants from Elekta AB and Siemens Healthineers and nonfinancial support from PTW Freiburg outside the submitted work. M.N. reports grants from DFG and nonfinancial support from Elekta AB and Philips during the conduct of the study and grants, personal fees (travel funds and speaking honoraria), and nonfinancial support from Elekta AB outside the submitted work. M.E.P.P. reports grants and nonfinancial support from Elekta AB and nonfinancial support from Philips Health care outside the submitted work. C.H.J.T. reports personal fees (travel funds) from Elekta AB outside the submitted work. D.Z. and S.B. report grants from DFG and nonfinancial support from Elekta AB and Philips during the conduct of the study and personal fees (travel funds and speaking honoraria) and nonfinancial support from Elekta AB outside the submitted work. M.J.A. reports personal fees from Elekta outside the submitted work. J.C. is an employee of Elekta, Inc, and reports grants from NIH/NIDCR during the conduct of the study. C.D.F. reports grants from NIH/NIDCR, NIH/National Cancer Institute (NCI), NIH/National Institute of Biomedical Imaging and Bioengineering, and Elekta AB during the conduct of the study; grants from the Patient-centered Outcomes Research Institute, NIH/NCI, NIH/NIDCR, MD Anderson, the Sister Institute Network Fund (MD Anderson), the National Science Foundation Division of Civil, Mechanical, and Manufacturing Innovation, and Elekta AB outside the submitted work; and personal fees (travel funds and speaking honoraria) from Elekta AB outside the submitted work. The remaining authors reported no disclosures or conflicts of interest. Publisher Copyright: © 2020 The Authors
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