Ablative radiotherapy for liver tumors using stereotactic MRI-guidance: A prospective phase I trial

Ritchell van Dams, Trudy C. Wu, Amar U. Kishan, Ann C. Raldow, Fang I. Chu, Jackie Hernandez, Minsong Cao, James M. Lamb, Argin Mikaeilian, Daniel A. Low, Michael L. Steinberg, Percy Lee

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background and purpose: To prospectively determine the feasibility, safety, and efficacy of stereotactic body radiation therapy (SBRT) to primary and secondary liver tumors with MR-guided radiation therapy (MRgRT). Materials and methods: Treatment plans with a conventional CT-guided linear accelerator and a MRI-guided tri-60Co teletherapy unit (MR-Co) were generated and compared for patients undergoing liver-directed SBRT from 2015 to 2017. If dosimetric parameters were met on MR-Co, patients were treated with MRgRT. The highest priority constraint was >1000 cc or >800 cc of normal liver receiving <15 Gy for single- or multiple-lesion treatments, respectively. Treatment was delivered every other day. Results: Of 23 patients screened, 20 patients (8 primary, 12 secondary) and 25 liver tumors underwent MR-guided SBRT to a median dose of 54 Gy (range 11.5–60) in a median of 3 fractions (range 1–5). With a median follow up of 18.9 months, the 1- and 2-year estimate of local control were 94.7% and 79.6%, respectively. A difference in local control between single and multiple lesions or BED ≥ 100 Gy10 and BED < 100 Gy10, respectively, was observed. The 2-year estimate of overall survival (OS) was 50.7% with a median OS of 29 months. There were no acute grade ≥ 3 toxicities and one late grade 3/4 toxicity from a single patient whose plan exceeded an unrecognized dose constraint at the time. Conclusion: MR-guided SBRT is a viable and safe option in the delivery of ultrahypofractionated ablative radiation treatment to primary and secondary liver tumors resulting in high rates of local control and very favorable toxicity profiles.

Original languageEnglish (US)
Pages (from-to)14-20
Number of pages7
JournalRadiotherapy and Oncology
Volume170
DOIs
StatePublished - May 2022

Keywords

  • Ablative radiotherapy
  • Clinical trial
  • Liver tumors
  • MR-guided

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging

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