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Clinical outcomes of stereotactic magnetic resonance image‐guided adaptive radiotherapy for primary and metastatic tumors in the abdomen and pelvis
PURPOSE: Stereotactic body radiotherapy (SBRT) delivers ablative doses with excellent local control. However, implementing SBRT for abdominal and pelvic tumors has been limited by the risk for treatment‐related gastrointestinal toxicity. MRI‐guided radiotherapy may ameliorate these risks and increas...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8419771/ https://www.ncbi.nlm.nih.gov/pubmed/34288538 http://dx.doi.org/10.1002/cam4.4139 |
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author | Yoon, Stephanie M. Luterstein, Elaine Chu, Fang‐I Cao, Minsong Lamb, James Agazaryan, Nzhde Low, Daniel Raldow, Ann Steinberg, Michael L. Lee, Percy |
author_facet | Yoon, Stephanie M. Luterstein, Elaine Chu, Fang‐I Cao, Minsong Lamb, James Agazaryan, Nzhde Low, Daniel Raldow, Ann Steinberg, Michael L. Lee, Percy |
author_sort | Yoon, Stephanie M. |
collection | PubMed |
description | PURPOSE: Stereotactic body radiotherapy (SBRT) delivers ablative doses with excellent local control. However, implementing SBRT for abdominal and pelvic tumors has been limited by the risk for treatment‐related gastrointestinal toxicity. MRI‐guided radiotherapy may ameliorate these risks and increase the therapeutic ratio. We report the clinical outcomes of stereotactic MRI‐guided adaptive radiotherapy (SMART) for primary and metastatic tumors in the abdomen and pelvis. METHODS: From November 2014 to August 2017, the first 106 consecutive patients with 121 tumors in the abdomen and pelvis were treated with SMART at a single institution. Of the cohort, 41.5%, 15.1%, and 43.4% had primary, locally recurrent, and oligometastatic tumors, respectively. SMART was delivered using a tri‐cobalt‐60 gantry with on‐board 0.35 Tesla MRI with respiratory breath‐hold and daily adaptive re‐planning when anatomically necessary. A median of 40Gy in five fractions was prescribed. The Common Terminology Criteria for Adverse Events v.4.03 was used to score treatment‐related toxicities. Local control (LC), progression‐free survival (PFS), and overall survival (OS) were estimated using Kaplan–Meier method. RESULTS: Of the 510 treatments, seventy‐one (13.9%) were adapted. Fatigue, nausea, and pain were the most common acute toxicities. 0.9 and 0% of patients experienced acute grade three and four toxicities, respectively. 5.2 and 2.1% of patients experienced late grade three and four toxicities, respectively. After a median follow‐up of 20.4 months, the 2‐year LC rate was 74% on a per‐lesion basis. Two‐year LC was 96% for lesions that were treated with BED(10)≥100 versus 69% for BED(10)<100 (p = 0.02). PFS was significantly different between patients with and without locally controlled tumors (2‐year PFS 21 vs. 8%, p = 0.03). Two‐year OS was 57% for the entire cohort. CONCLUSIONS: Favorable LC and PFS outcomes were observed with minimal morbidity for tumors in the abdomen and pelvis treated with SMART. Future prospective clinical trials to validate these findings are warranted. |
format | Online Article Text |
id | pubmed-8419771 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-84197712021-09-08 Clinical outcomes of stereotactic magnetic resonance image‐guided adaptive radiotherapy for primary and metastatic tumors in the abdomen and pelvis Yoon, Stephanie M. Luterstein, Elaine Chu, Fang‐I Cao, Minsong Lamb, James Agazaryan, Nzhde Low, Daniel Raldow, Ann Steinberg, Michael L. Lee, Percy Cancer Med Clinical Cancer Research PURPOSE: Stereotactic body radiotherapy (SBRT) delivers ablative doses with excellent local control. However, implementing SBRT for abdominal and pelvic tumors has been limited by the risk for treatment‐related gastrointestinal toxicity. MRI‐guided radiotherapy may ameliorate these risks and increase the therapeutic ratio. We report the clinical outcomes of stereotactic MRI‐guided adaptive radiotherapy (SMART) for primary and metastatic tumors in the abdomen and pelvis. METHODS: From November 2014 to August 2017, the first 106 consecutive patients with 121 tumors in the abdomen and pelvis were treated with SMART at a single institution. Of the cohort, 41.5%, 15.1%, and 43.4% had primary, locally recurrent, and oligometastatic tumors, respectively. SMART was delivered using a tri‐cobalt‐60 gantry with on‐board 0.35 Tesla MRI with respiratory breath‐hold and daily adaptive re‐planning when anatomically necessary. A median of 40Gy in five fractions was prescribed. The Common Terminology Criteria for Adverse Events v.4.03 was used to score treatment‐related toxicities. Local control (LC), progression‐free survival (PFS), and overall survival (OS) were estimated using Kaplan–Meier method. RESULTS: Of the 510 treatments, seventy‐one (13.9%) were adapted. Fatigue, nausea, and pain were the most common acute toxicities. 0.9 and 0% of patients experienced acute grade three and four toxicities, respectively. 5.2 and 2.1% of patients experienced late grade three and four toxicities, respectively. After a median follow‐up of 20.4 months, the 2‐year LC rate was 74% on a per‐lesion basis. Two‐year LC was 96% for lesions that were treated with BED(10)≥100 versus 69% for BED(10)<100 (p = 0.02). PFS was significantly different between patients with and without locally controlled tumors (2‐year PFS 21 vs. 8%, p = 0.03). Two‐year OS was 57% for the entire cohort. CONCLUSIONS: Favorable LC and PFS outcomes were observed with minimal morbidity for tumors in the abdomen and pelvis treated with SMART. Future prospective clinical trials to validate these findings are warranted. John Wiley and Sons Inc. 2021-07-20 /pmc/articles/PMC8419771/ /pubmed/34288538 http://dx.doi.org/10.1002/cam4.4139 Text en © 2021 The Authors. Cancer Medicine published by John Wiley & Sons Ltd. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Clinical Cancer Research Yoon, Stephanie M. Luterstein, Elaine Chu, Fang‐I Cao, Minsong Lamb, James Agazaryan, Nzhde Low, Daniel Raldow, Ann Steinberg, Michael L. Lee, Percy Clinical outcomes of stereotactic magnetic resonance image‐guided adaptive radiotherapy for primary and metastatic tumors in the abdomen and pelvis |
title | Clinical outcomes of stereotactic magnetic resonance image‐guided adaptive radiotherapy for primary and metastatic tumors in the abdomen and pelvis |
title_full | Clinical outcomes of stereotactic magnetic resonance image‐guided adaptive radiotherapy for primary and metastatic tumors in the abdomen and pelvis |
title_fullStr | Clinical outcomes of stereotactic magnetic resonance image‐guided adaptive radiotherapy for primary and metastatic tumors in the abdomen and pelvis |
title_full_unstemmed | Clinical outcomes of stereotactic magnetic resonance image‐guided adaptive radiotherapy for primary and metastatic tumors in the abdomen and pelvis |
title_short | Clinical outcomes of stereotactic magnetic resonance image‐guided adaptive radiotherapy for primary and metastatic tumors in the abdomen and pelvis |
title_sort | clinical outcomes of stereotactic magnetic resonance image‐guided adaptive radiotherapy for primary and metastatic tumors in the abdomen and pelvis |
topic | Clinical Cancer Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8419771/ https://www.ncbi.nlm.nih.gov/pubmed/34288538 http://dx.doi.org/10.1002/cam4.4139 |
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