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Magnetic Resonance Guided Radiation Therapy for Pancreatic Adenocarcinoma, Advantages, Challenges, Current Approaches, and Future Directions

INTRODUCTION: Pancreatic adenocarcinoma (PAC) has some of the worst treatment outcomes for any solid tumor. PAC creates substantial difficulty for effective treatment with traditional RT delivery strategies primarily secondary to its location and limited visualization using CT. Several of these chal...

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Autores principales: Hall, William A., Small, Christina, Paulson, Eric, Koay, Eugene J., Crane, Christopher, Intven, Martijn, Daamen, Lois A., Meijer, Gert J., Heerkens, Hanne D., Bassetti, Michael, Rosenberg, Stephen A., Aitken, Katharine, Myrehaug, Sten, Dawson, Laura A., Lee, Percy, Gani, Cihan, Chuong, Michael David, Parikh, Parag J., Erickson, Beth A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8144850/
https://www.ncbi.nlm.nih.gov/pubmed/34046339
http://dx.doi.org/10.3389/fonc.2021.628155
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author Hall, William A.
Small, Christina
Paulson, Eric
Koay, Eugene J.
Crane, Christopher
Intven, Martijn
Daamen, Lois A.
Meijer, Gert J.
Heerkens, Hanne D.
Bassetti, Michael
Rosenberg, Stephen A.
Aitken, Katharine
Myrehaug, Sten
Dawson, Laura A.
Lee, Percy
Gani, Cihan
Chuong, Michael David
Parikh, Parag J.
Erickson, Beth A.
author_facet Hall, William A.
Small, Christina
Paulson, Eric
Koay, Eugene J.
Crane, Christopher
Intven, Martijn
Daamen, Lois A.
Meijer, Gert J.
Heerkens, Hanne D.
Bassetti, Michael
Rosenberg, Stephen A.
Aitken, Katharine
Myrehaug, Sten
Dawson, Laura A.
Lee, Percy
Gani, Cihan
Chuong, Michael David
Parikh, Parag J.
Erickson, Beth A.
author_sort Hall, William A.
collection PubMed
description INTRODUCTION: Pancreatic adenocarcinoma (PAC) has some of the worst treatment outcomes for any solid tumor. PAC creates substantial difficulty for effective treatment with traditional RT delivery strategies primarily secondary to its location and limited visualization using CT. Several of these challenges are uniquely addressed with MR-guided RT. We sought to summarize and place into context the currently available literature on MR-guided RT specifically for PAC. METHODS: A literature search was conducted to identify manuscript publications since September 2014 that specifically used MR-guided RT for the treatment of PAC. Clinical outcomes of these series are summarized, discussed, and placed into the context of the existing pancreatic literature. Multiple international experts were involved to optimally contextualize these publications. RESULTS: Over 300 manuscripts were reviewed. A total of 6 clinical outcomes publications were identified that have treated patients with PAC using MR guidance. Successes, challenges, and future directions for this technology are evident in these publications. MR-guided RT holds theoretical promise for the treatment of patients with PAC. As with any new technology, immediate or dramatic clinical improvements associated with its use will take time and experience. There remain no prospective trials, currently publications are limited to small retrospective experiences. The current level of evidence for MR guidance in PAC is low and requires significant expansion. Future directions and ongoing studies that are currently open and accruing are identified and reviewed. CONCLUSIONS: The potential promise of MR-guided RT for PAC is highlighted, the challenges associated with this novel therapeutic intervention are also reviewed. Outcomes are very early, and will require continued and long term follow up. MR-guided RT should not be viewed in the same fashion as a novel chemotherapeutic agent for which dosing, administration, and toxicity has been established in earlier phase studies. Instead, it should be viewed as a novel procedural intervention which must be robustly tested, refined and practiced before definitive conclusions on the potential benefits or detriments can be determined. The future of MR-guided RT for PAC is highly promising and the potential implications on PAC are substantial.
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spelling pubmed-81448502021-05-26 Magnetic Resonance Guided Radiation Therapy for Pancreatic Adenocarcinoma, Advantages, Challenges, Current Approaches, and Future Directions Hall, William A. Small, Christina Paulson, Eric Koay, Eugene J. Crane, Christopher Intven, Martijn Daamen, Lois A. Meijer, Gert J. Heerkens, Hanne D. Bassetti, Michael Rosenberg, Stephen A. Aitken, Katharine Myrehaug, Sten Dawson, Laura A. Lee, Percy Gani, Cihan Chuong, Michael David Parikh, Parag J. Erickson, Beth A. Front Oncol Oncology INTRODUCTION: Pancreatic adenocarcinoma (PAC) has some of the worst treatment outcomes for any solid tumor. PAC creates substantial difficulty for effective treatment with traditional RT delivery strategies primarily secondary to its location and limited visualization using CT. Several of these challenges are uniquely addressed with MR-guided RT. We sought to summarize and place into context the currently available literature on MR-guided RT specifically for PAC. METHODS: A literature search was conducted to identify manuscript publications since September 2014 that specifically used MR-guided RT for the treatment of PAC. Clinical outcomes of these series are summarized, discussed, and placed into the context of the existing pancreatic literature. Multiple international experts were involved to optimally contextualize these publications. RESULTS: Over 300 manuscripts were reviewed. A total of 6 clinical outcomes publications were identified that have treated patients with PAC using MR guidance. Successes, challenges, and future directions for this technology are evident in these publications. MR-guided RT holds theoretical promise for the treatment of patients with PAC. As with any new technology, immediate or dramatic clinical improvements associated with its use will take time and experience. There remain no prospective trials, currently publications are limited to small retrospective experiences. The current level of evidence for MR guidance in PAC is low and requires significant expansion. Future directions and ongoing studies that are currently open and accruing are identified and reviewed. CONCLUSIONS: The potential promise of MR-guided RT for PAC is highlighted, the challenges associated with this novel therapeutic intervention are also reviewed. Outcomes are very early, and will require continued and long term follow up. MR-guided RT should not be viewed in the same fashion as a novel chemotherapeutic agent for which dosing, administration, and toxicity has been established in earlier phase studies. Instead, it should be viewed as a novel procedural intervention which must be robustly tested, refined and practiced before definitive conclusions on the potential benefits or detriments can be determined. The future of MR-guided RT for PAC is highly promising and the potential implications on PAC are substantial. Frontiers Media S.A. 2021-05-11 /pmc/articles/PMC8144850/ /pubmed/34046339 http://dx.doi.org/10.3389/fonc.2021.628155 Text en Copyright © 2021 Hall, Small, Paulson, Koay, Crane, Intven, Daamen, Meijer, Heerkens, Bassetti, Rosenberg, Aitken, Myrehaug, Dawson, Lee, Gani, Chuong, Parikh and Erickson https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Hall, William A.
Small, Christina
Paulson, Eric
Koay, Eugene J.
Crane, Christopher
Intven, Martijn
Daamen, Lois A.
Meijer, Gert J.
Heerkens, Hanne D.
Bassetti, Michael
Rosenberg, Stephen A.
Aitken, Katharine
Myrehaug, Sten
Dawson, Laura A.
Lee, Percy
Gani, Cihan
Chuong, Michael David
Parikh, Parag J.
Erickson, Beth A.
Magnetic Resonance Guided Radiation Therapy for Pancreatic Adenocarcinoma, Advantages, Challenges, Current Approaches, and Future Directions
title Magnetic Resonance Guided Radiation Therapy for Pancreatic Adenocarcinoma, Advantages, Challenges, Current Approaches, and Future Directions
title_full Magnetic Resonance Guided Radiation Therapy for Pancreatic Adenocarcinoma, Advantages, Challenges, Current Approaches, and Future Directions
title_fullStr Magnetic Resonance Guided Radiation Therapy for Pancreatic Adenocarcinoma, Advantages, Challenges, Current Approaches, and Future Directions
title_full_unstemmed Magnetic Resonance Guided Radiation Therapy for Pancreatic Adenocarcinoma, Advantages, Challenges, Current Approaches, and Future Directions
title_short Magnetic Resonance Guided Radiation Therapy for Pancreatic Adenocarcinoma, Advantages, Challenges, Current Approaches, and Future Directions
title_sort magnetic resonance guided radiation therapy for pancreatic adenocarcinoma, advantages, challenges, current approaches, and future directions
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8144850/
https://www.ncbi.nlm.nih.gov/pubmed/34046339
http://dx.doi.org/10.3389/fonc.2021.628155
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