A Multi-Institutional Experience of MR-Guided Liver Stereotactic Body Radiation Therapy

Stephen A. Rosenberg, Lauren E. Henke, Narek Shaverdian, Kathryn Mittauer, Andrzej P. Wojcieszynski, Craig R. Hullett, Mitchell Kamrava, James Lamb, Minsong Cao, Olga L. Green, Rojano Kashani, Bhudatt Paliwal, John Bayouth, Paul M. Harari, Jeffrey R. Olsen, Percy Lee, Parag J. Parikh, Michael Bassetti

Research output: Contribution to journalArticle

Abstract

Purpose: Daily magnetic resonance (MR)–guided radiation has the potential to improve stereotactic body radiation therapy (SBRT) for tumors of the liver. Magnetic resonance imaging (MRI) introduces unique variables that are untested clinically: electron return effect, MRI geometric distortion, MRI to radiation therapy isocenter uncertainty, multileaf collimator position error, and uncertainties with voxel size and tracking. All could lead to increased toxicity and/or local recurrences with SBRT. In this multi-institutional study, we hypothesized that direct visualization provided by MR guidance could allow the use of small treatment volumes to spare normal tissues while maintaining clinical outcomes despite the aforementioned uncertainties in MR-guided treatment. Methods and materials: Patients with primary liver tumors or metastatic lesions treated with MR-guided liver SBRT were reviewed at 3 institutions. Toxicity was assessed using National Cancer Institute Common Terminology Criteria for Adverse Events Version 4. Freedom from local progression (FFLP) and overall survival were analyzed with the Kaplan-Meier method and χ 2 test. Results: The study population consisted of 26 patients: 6 hepatocellular carcinomas, 2 cholangiocarcinomas, and 18 metastatic liver lesions (44% colorectal metastasis). The median follow-up was 21.2 months. The median dose delivered was 50 Gy at 10 Gy/fraction. No grade 4 or greater gastrointestinal toxicities were observed after treatment. The 1-year and 2-year overall survival in this cohort is 69% and 60%, respectively. At the median follow-up, FFLP for this cohort was 80.4%. FFLP for patients with hepatocellular carcinomas, colorectal metastasis, and all other lesions were 100%, 75%, and 83%, respectively. Conclusions: This study describes the first clinical outcomes of MR-guided liver SBRT. Treatment was well tolerated by patients with excellent local control. This study lays the foundation for future dose escalation and adaptive treatment for liver-based primary malignancies and/or metastatic disease.

Original languageEnglish (US)
Pages (from-to)142-149
Number of pages8
JournalAdvances in Radiation Oncology
Volume4
Issue number1
DOIs
StatePublished - Jan 1 2019

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ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Rosenberg, S. A., Henke, L. E., Shaverdian, N., Mittauer, K., Wojcieszynski, A. P., Hullett, C. R., Kamrava, M., Lamb, J., Cao, M., Green, O. L., Kashani, R., Paliwal, B., Bayouth, J., Harari, P. M., Olsen, J. R., Lee, P., Parikh, P. J., & Bassetti, M. (2019). A Multi-Institutional Experience of MR-Guided Liver Stereotactic Body Radiation Therapy. Advances in Radiation Oncology, 4(1), 142-149. https://doi.org/10.1016/j.adro.2018.08.005