The Role of Daily Adaptive Stereotactic MR-Guided Radiotherapy for Renal Cell Cancer

Novel magnetic-resonance-guided radiotherapy (MRgRT) permits real-time soft-tissue visualization, respiratory-gated delivery with minimal safety margins, and time-consuming daily plan re-optimisation. We report on early clinical outcomes of MRgRT and routine plan re-optimization for large primary re...

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Bibliographic Details
Published in:Cancers 2020-10, Vol.12 (10), p.2763
Main Authors: Tetar, Shyama U., Bohoudi, Omar, Senan, Suresh, Palacios, Miguel A., Oei, Swie S., Wel, Antoinet M. van der, Slotman, Berend J., Moorselaar, R. Jeroen A. van, Lagerwaard, Frank J., Bruynzeel, Anna M. E.
Format: Article
Language:English
Subjects:
Abdomen
Ablation
Adaptation
Algorithms
Clinical outcomes
Dosage
Dosimetry
Drug therapy
Kidney cancer
Optimization
Patient outcomes
Patients
Planning
Radiation therapy
Radiotherapy
Registration
Renal cell carcinoma
Small intestine
Statistical analysis
Surgery
Toxicity
Tumors
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Summary:Novel magnetic-resonance-guided radiotherapy (MRgRT) permits real-time soft-tissue visualization, respiratory-gated delivery with minimal safety margins, and time-consuming daily plan re-optimisation. We report on early clinical outcomes of MRgRT and routine plan re-optimization for large primary renal cell cancer (RCC). Thirty-six patients were treated with MRgRT in 40 Gy/5 fractions. Prior to each fraction, re-contouring of tumor and normal organs on a pretreatment MR-scan allowed daily plan re-optimization. Treatment-induced toxicity and radiological responses were scored, which was followed by an offline analysis to evaluate the need for such daily re-optimization in 180 fractions. Mean age and tumor diameter were 78.1 years and 5.6 cm, respectively. All patients completed MRgRT with an average fraction duration of 45 min. Local control (LC) and overall survival rates at one year were 95.2% and 91.2%. No grade ≥3 toxicity was reported. Plans without re-optimization met institutional radiotherapy constraints in 83.9% of 180 fractions. Thus, daily plan re-optimization was required for only a minority of patients, who can be identified upfront by a higher volume of normal organs receiving 25 Gy in baseline plans. In conclusion, stereotactic MRgRT for large primary RCC showed low toxicity and high LC, while daily plan re-optimization was required only in a minority of patients.
ISSN:2072-6694
2072-6694
DOI:10.3390/cancers12102763