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Multi-Institutional Outcomes of Stereotactic Magnetic Resonance Image Guided Adaptive Radiation Therapy With a Median Biologically Effective Dose of 100 Gy10 for Non-bone Oligometastases
Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FloridaDepartment of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FloridaDepartment of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FloridaDepartment of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FloridaDepartment of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FloridaDepartment of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FloridaDepartment of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FloridaDepartment of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FloridaDepartment of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FloridaDepartment of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FloridaDepartment of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FloridaDepartment of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FloridaDepartment of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
Randomized data show a survival benefit of stereotactic ablative body radiation therapy in selected patients with oligometastases (OM). Stereotactic magnetic resonance guided adaptive radiation therapy (SMART) may facilitate the delivery of ablative dose for OM lesions, especially those adjacent to historically dose-limiting organs at risk, where conventional approaches preclude ablative dosing.
Methods and Materials
The RSSearch Registry was queried for OM patients (1-5 metastatic lesions) treated with SMART. Freedom from local progression (FFLP), freedom from distant progression (FFDP), progression-free survival (PFS), and overall survival (LS) were estimated using the Kaplan-Meier method. FFLP was evaluated using RECIST 1.1 criteria. Toxicity was evaluated using Common Terminology Criteria for Adverse Events version 4 criteria.
Results
Ninety-six patients with 108 OM lesions were treated on a 0.35 T MR Linac at 2 institutions between 2018 and 2020. SMART was delivered to mostly abdominal or pelvic lymph nodes (48.1%), lung (18.5%), liver and intrahepatic bile ducts (16.7%), and adrenal gland (11.1%). The median prescribed radiation therapy dose was 48.5 Gy (range, 30-60 Gy) in 5 fractions (range, 3-15). The median biologically effective dose corrected using an alpha/beta value of 10 was 100 Gy10 (range, 48-180). No acute or late grade 3+ toxicities were observed with median 10 months (range, 3-25) follow-up. Estimated 1-year FFLP, FFDP, PFS, and OS were 92.3%, 41.1%, 39.3%, and 89.6%, respectively. Median FFDP and PFS were 8.9 months (95% confidence interval, 5.2-12.6 months) and 7.6 months (95% confidence interval, 4.5-10.6 months), respectively.
Conclusions
To our knowledge, this represents the largest analysis of SMART using ablative dosing for non-bone OM. A median prescribed biologically effective dose of 100 Gy10 resulted in excellent early FFLP and no significant toxicity, likely facilitated by continuous intrafraction MR visualization, breath hold delivery, and online adaptive replanning. Additional prospective evaluation of dose-escalated SMART for OM is warranted.
Introduction
Resection can result in improved long-term outcomes and even cure for some patients with limited metastatic disease.
Oligometastases (OM) can also be effectively treated with stereotactic ablative radiation therapy (SABR), which has emerged as a noninvasive alternative to surgery. When used in addition to chemotherapy, SABR may improve freedom from local progression (FFLP), progression-free survival (PFS), and overall survival (OS) in patients with OM compared with chemotherapy alone.
Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): A randomised, phase 2, open-label trial.
Stereotactic ablative body radiotherapy in patients with oligometastatic cancers: A prospective, registry-based, single-arm, observational, evaluation study.
Although SABR is well tolerated for most patients, severe toxicity is possible. In the SABR-COMET trial, 3 patients (4.5%) experienced treatment-related death.
Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): A randomised, phase 2, open-label trial.
Excessive toxicity when treating central tumors in a phase II study of stereotactic body radiation therapy for medically inoperable early-stage lung cancer.
Evaluation of safety of stereotactic body radiotherapy for the treatment of patients with multiple metastases: Findings from the NRG-BR001 phase 1 trial.
Population based phase II trial of stereotactic ablative radiotherapy (sabr) for up to 5 oligometastases: Preliminary results of the SABR-5 trial 2021.
Moreover, the proximity of certain organs at risk (OARs) may necessitate that the prescribed dose be constrained to limit toxicity.
Magnetic resonance-guided radiation therapy (MRgRT) is particularly well suited to deliver ablative dose with ultrahypofractionation even for lesions in challenging anatomic locations that otherwise may be prescribed a lower dose using computerized tomography (CT) guidance.
A primary reason for this is the ability to visualize both the target and critical surrounding OARs on a daily basis, as well as during the delivery of each fraction, and responding to change from 1 day to the next through adaptation, and change during treatment delivery through beam gating/hold. This is distinctly different from all other radiation therapy technology platforms, where continuous intrafraction tracking usually relies on a surrogate fiducial, rather than the complex and dynamic anatomic interplay between the target and OARs. The feasibility of stereotactic magnetic resonance-guided adaptive radiation therapy (SMART) has been demonstrated for tumors in the chest, abdomen, and pelvis.
Phase I trial of stereotactic MR-guided online adaptive radiation therapy (SMART) for the treatment of oligometastatic or unresectable primary malignancies of the abdomen.
Ablative 5-fraction stereotactic magnetic resonance-guided radiation therapy with on-table adaptive replanning and elective nodal irradiation for inoperable pancreas cancer.
Stereotactic MR-guided online adaptive radiation therapy (SMART) for the treatment of liver metastases in oligometastatic patients: Initial clinical experience.
However, most of the supporting literature consists of small retrospective and phase 1 trials. The intent of this analysis was to evaluate multi-institutional outcomes of SMART for OM to better understand the benefits of this novel technology.
Methods and Materials
The Radiosurgery Society RSSearch Registry was queried for patients treated with MRgRT for OM, defined as 5 or fewer metastatic lesions. RSSearch is managed by the Radiosurgery Society, a nonprofit professional medical society. A description of the methodology, database design and initial patient and treatment characteristics of patients enrolled in RSSearch has been previously reported.
After receiving institutional review board approval, we performed a retrospective analysis of safety and efficacy outcomes in these patients. All patients were treated using the ViewRay MRIdian Linac (Oakwood Village, OH) between September 2018 and September 2020 at 2 tertiary cancer care institutions.
Simulation, treatment planning, and treatment delivery on the MRIdian Linac have been previously published in detail.
Ablative 5-fraction stereotactic magnetic resonance-guided radiation therapy with on-table adaptive replanning and elective nodal irradiation for inoperable pancreas cancer.
Briefly, patients were simulated in the supine position typically with at least the ipsilateral arm raised above the head. Simulation scans were acquired on the MRIdian Linac in breath hold over 17 to 25 seconds based on a balanced free precession technique. Intravenous or oral contrast was not used as the tumor and normal anatomy are well-visualized due to the superior soft tissue contrast provided by the magnetic resonance imaging (MRI) scans. The simulation MRI scan was used as the primary scan for contouring and planning while a simulation CT scan was obtained for electron density. The gross tumor volume (GTV) encompassed visible tumor as defined on the simulation imaging as well as diagnostic scans with a 3 to 8 mm (median 3 mm) set up margin expansion to the planning target volume (PTV). Dose constraints used during planning and on-table adaptive review are presented in Table 1.
Table 1Dose constraints used for 50 Gy in 5 fraction (biologically effective dose: 100 Gy10) stereotactic magnetic resonance image guided adaptive radiation therapy in oligometastases
All treatments were planned using a step-and-shoot intensity modulated radiation therapy technique. During daily set-up for treatment, a volumetric MRI is obtained to visualize the target volume and OARs. Tumor target volumes were registered rigidly from the simulation MRI to the daily localization MRI scan, and OAR volumes undergo deformable registration using an intensity-based algorithm. GTV contours were manually adjusted by the attending physician and relevant OAR contours were adjusted to reflect the anatomy of the day (Fig. 1). For each fraction, predicted dose was computed (ie, the baseline plan was recalculated on the anatomy of the day and a reoptimized adaptive plan was generated). The adaptive plan was used for treatment if superior (ie, insufficient target volume coverage; <95% of PTV receives 100% of the dose) or OARs dose violations significantly exceeding the predicted dose. Before treatment, calculation fidelity was verified through a secondary Monte Carlo-based quality assurance (QA) dose calculation. After QA, treatment was delivered during breath hold, guided by visual biofeedback provided to the patient with an in-room monitor that projected the real-time MRI 2-dimensional sagittal at 4 or 8 frames per second. The time for workflow steps was documented for each patient and included timestamps of setup, 3-dimensional MRI localization, segmentation, dose prediction and reoptimization with QA, real-target cine MRI, beam delivery, and any unexpected treatment disruptions.
Figure 1Isodose distributions from the original treatment plan (A) compared with each daily fraction (B-F) achieved with on-table adaptive replanning to ensure organ at risk constraints are met due to interfraction anatomic changes of a patient with lung carcinoma with abdominopelvic lymph node metastasis.
was used to score treatment-related toxicities during follow-up visits by treating physicians. Toxicities were acute when occurring within 90 days from completion of SMART, and any afterward was considered late. Treatment response was evaluated using Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria.
Patients were followed every 3 months with CT, positron emission tomography, CT, or MRI. OS was calculated from the date of initiating SMART to the day of last follow-up or death. Freedom from distant progression (FFDP), PFS, FFLP and OS were estimated using the Kaplan-Meier method. Statistical analysis was performed using SPSS, version 27 (SPSS Inc, Chicago, IL).
Results
From September 2018 to September 2020, 108 OM lesions in 96 consecutive patients met inclusion criteria for this study. Patient demographics and disease characteristics are described in Table 2. The median age was 61.5 years (range, 23-89 years) and 53.1% were male. The most common primary tumor sites were lung (31.5%) followed by colorectal (26.8%) and gynecologic malignancies (13.0%). The most common treatment sites for SMART were abdominal/pelvic lymph nodes (52 lesions, 48.1%), lung (20, 18.5%), liver and intrahepatic bile ducts (18, 16.7%), adrenal gland (12, 11.1%), and subcutaneous soft tissues (6, 5.6%). All patients had good performance status (Eastern Cooperative Oncology Group 0-1). Seventy-nine lesions (73.2%) were metachronous and 27 (25.0%) were synchronous OM. The primary tumor was definitively managed in 34.7% patients and 50% received chemotherapy for OM before SMART. All patients were treated without fiducial markers and with real-time MR-based tumor tracking and automated beam gating, allowing for intra- and interfraction visualization of both the target and the critical OARs.
Table 2Patient, tumor, and treatment characteristics
All patients completed planned treatment with SMART and required adaptive planning for ≥1 fraction. The reasons for plan adaptation were insufficient target coverage in 233 (54.2%) fractions, OARs dose violations in 111 (25.8%) fractions, and both target coverage and OARs dose violations in 86 (20.0%) fractions (Table 2). A total of 571 fractions were delivered and 430 fractions (75.3%) were reoptimized. The median prescribed dose and fraction number were 48.5 Gy (range, 30-60 Gy) and 5 fractions (range, 3-15 fractions), respectively. The median biologically effective dose corrected using an alpha/beta value of 10 (biologically effective dose [BED]) was 100 Gy10 (range: 48-180). The median GTV and PTV were 7.1 cm3 (range, 0.4-452.4 cm3) and 14.5 cm3 (range, 1.5-567.8 cm3), respectively. The median time in the treatment room for set-up was 45 minutes per fraction (interquartile range, 35 to 56 min) and median treatment delivery time with gating was 21 min per fraction (interquartile range, 14-27 min).
Median follow-up time from completion of SMART was 10 months (range, 3-25 months). Thirty-five (36.4%) patients received chemotherapy and 16 (16.7%) patients received immunotherapy after SMART. Complete radiographic response occurred in 61 (56.5%) OM lesions, stable disease in 24 (22.2%) lesions, partial response in 16 (14.8%), and local progression in 7 (6.5%) lesions. Distant progression occurred in 63 cases (58.3%). There was no treatment-related grade 3+ toxicity after SMART. We recorded grade 1 toxicity in 11 (10.2%) patients and grade 2 toxicity in 3 (2.8%) patients. One-year FFLP, FFDP, PFS, and OS were 92.3% (95% confidence interval [CI], 86.3%-98.3%), 41.1% (95% CI, 30.2%-52.0%), 39.3% (95% CI, 28.6%-50.0%), and 89.6% (95% CI, 82.6%-96.6%), respectively (Fig. 2A-D). Median FFDP and PFS were 8.9 months (95% Cl, 5.2-12.6 months) and 7.6 months (95% Cl, 4.5-10.6 months), respectively. Median OS and FFLP were not reached yet.
Figure 2(A) Kaplan-Meier Freedom from local progression, (B) Freedom from distant progression, (C) Progression free survival, (D) Overall survival.
SABR for patients with OM may improve survival for certain subsets of patients. MRgRT represents a promising ablative treatment modality for OM lesions due to its excellent soft tissue contrast, motion management and automatic beam gating, and online adaptive replanning capability that enables safe dose escalation even to lesions in proximity to radiosensitive OARs such as the stomach and bowel. In what is, to our knowledge, the largest analysis of SMART for none-bone OM to date, no patient experienced grade 3 or higher toxicity. This is noteworthy given the predominance of lesions, especially abdominopelvic lymph nodes, treated with dose escalation in proximity to gastrointestinal OARs, which are notably underrepresented in previous OM trials and compares favorably to prospective trials such as SABR-COMET.
Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): A randomised, phase 2, open-label trial.
Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): A randomised, phase 2, open-label trial.
Stereotactic ablative body radiotherapy in patients with oligometastatic cancers: A prospective, registry-based, single-arm, observational, evaluation study.
Excessive toxicity when treating central tumors in a phase II study of stereotactic body radiation therapy for medically inoperable early-stage lung cancer.
The potential to cause severe or fatal toxicity should not be overlooked for the utilization of SABR for oligometastatic disease. Three (4.5%) grade 5 treatment-related toxicities occurred in the SABR-COMET trial.
Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): A randomised, phase 2, open-label trial.
Population based phase II trial of stereotactic ablative radiotherapy (sabr) for up to 5 oligometastases: Preliminary results of the SABR-5 trial 2021.
presented the results of SABR-5 trial that also included one (0.3%) grade 5 toxicity. Clinical outcomes and toxicity rates for select OM trials are summarized in Table 3. Moreover, the most frequently prescribed fractionation in OM was 35 Gy in 5 fractions in the SABR trials, and the median BED was about 60 Gy10 which can be a suboptimal for achieving durable FFLP.
Table 3Summary of selected clinical reports of SABR and SMART for oligometastatic disease
Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): A randomised, phase 2, open-label trial.
Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): A randomised, phase 2, open-label trial.
Phase 3 multi-center, prospective, randomized trial comparing single-dose 24 Gy radiation therapy to a 3-fraction SBRT regimen in the treatment of oligometastatic cancer.
Population based phase II trial of stereotactic ablative radiotherapy (sabr) for up to 5 oligometastases: Preliminary results of the SABR-5 trial 2021.
Stereotactic ablative body radiotherapy in patients with oligometastatic cancers: A prospective, registry-based, single-arm, observational, evaluation study.
Phase I trial of stereotactic MR-guided online adaptive radiation therapy (SMART) for the treatment of oligometastatic or unresectable primary malignancies of the abdomen.
Stereotactic MR-guided online adaptive radiation therapy (SMART) for the treatment of liver metastases in oligometastatic patients: Initial clinical experience.
Patterns of care, tolerability, and safety of the first cohort of patients treated on a novel high-field MR-linac within the momentum study: Initial results from a prospective multi-institutional registry.
A meta-analysis of 1006 patients who received SABR for adrenal metastasis demonstrated a strong correlation between prescribed dose and 1- and 2-year LC; BED 60 Gy10 versus 100 Gy10 was associated with 2-year LC of 47.8% versus 85.6%, respectively.
A multi-institutional analysis of SABR for 381 colorectal OM concluded that BED 120 Gy10 was significantly associated with improved LC on multivariate analysis.
An analysis of a large multi-institutional database reveals important associations between treatment parameters and clinical outcomes for stereotactic body radiotherapy (SBRT) of oligometastatic colorectal cancer.
However, non-ablative dose regimens are routinely used to minimize the risk of severe toxicity especially for lesions in challenging anatomic locations and in proximity to certain OARs such as the bowel. The most common regimen used in the SABR-COMET trial, for example, was 35 Gy in 5 fractions (BED = 59.5 Gy10).
Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): A randomised, phase 2, open-label trial.
Despite the majority of lesions in our study being in proximity to gastrointestinal luminal OARs, the median prescribed BED was 100 Gy10 that resulted in excellent 1-year FFLP with minimal severe toxicity, likely facilitated by online adaptive replanning.
Phase I trial of stereotactic MR-guided online adaptive radiation therapy (SMART) for the treatment of oligometastatic or unresectable primary malignancies of the abdomen.
demonstrated the importance of the SMART approach with 50 Gy in 5 fractions (BED 100 Gy10) in their phase 1 trial including 20 patients with OM or unresectable abdominal tumors, where adaptive plans were created for 83.5% of fractions and in which PTV coverage was increased in 66% of fractions. No patient developed grade 3+ toxicity. Henke et al also published results of a phase 1 trial of SMART for ovarian OM showing that dose escalation was safe.
Stereotactic MR-guided online adaptive radiation therapy (SMART) for the treatment of liver metastases in oligometastatic patients: Initial clinical experience.
evaluated SMART in 21 patients treated to 24 liver metastases to a median total dose of 50 Gy in 5 fractions (BED = 100 Gy10) and 83.7% of fractions were reoptimized; no grade 3+ toxicity was reported. In our study, there was no reported grade 3 or higher toxicity despite the median prescribed BED of 100 Gy10, adding to the evidence suggesting that SMART is an ideal strategy to deliver ablative dose even to lesions in challenging anatomic locations, such as lymph nodes in the abdomen and pelvis.
Oligometastatic involvement of lymph nodes appears in 15% to 20% of cancer cases and depends on primary tumor type and histology.
Although several studies have shown improved survival after complete resection of abdominopelvic lymph node metastases, resection of such nodal metastases is technically challenging, and radiation therapy offers an effective alternative.
van Dams R, Wu TC, Kishan AU, et al. Ablative radiotherapy for liver tumors using stereotactic mri-guidance: A prospective phase I trial [e-pub ahead of print]. Radiother Oncol. doi:10.1016/j.radonc.2021.06.005, accessed January 31, 2022.
reported a retrospective analysis of 13 OM patients with bladder primary who received most commonly 25 Gy in 5 fractions (BED = 37.5 Gy10) to abdominopelvic lymph nodes, but this nonablative dose showed in-field progression among 38% of patients within 3 months. Franzese et al
Assessing the role of stereotactic body radiation therapy in a large cohort of patients with lymph node oligometastases: Does it affect systemic treatment's intensification?.
reported the SABR results of 278 patients with 418 oligometastatic lymph nodes with a median follow-up of 15.1 months and local control was 87.2% at 1 year. In their study, they showed that better local control was associated with BED greater than 75 Gy10. In a recent study, Sheikh et al
An analysis of a large multi-institutional database reveals important associations between treatment parameters and clinical outcomes for stereotactic body radiotherapy (SBRT) of oligometastatic colorectal cancer.
reported the outcomes of 235 patients with a total of 381 OM colorectal cancer lesions. On multivariable analysis, a BED of more than 120 Gy10 was associated with a reduction in local recurrence compared with less than 93.6 Gy10. However, with SABR, dose escalation to BED 100 Gy10 in the abdominopelvic region may not be possible due to the location of OARs around the target lymph nodes.
Stereotactic ablative body radiotherapy in patients with oligometastatic cancers: A prospective, registry-based, single-arm, observational, evaluation study.
By using real-time visualization and online adaptive capability, SMART can be more suitable for abdominopelvic lymph nodes due to the ability to visualize and track several critical organs such as the stomach and bowel. In previous studies of SMART, patients with abdominopelvic lymph nodes were underrepresented. In our study, of the 108 treated lesions, 52 (48.1%) were abdominopelvic lymph nodes. We believe that this study can contribute to the literature regarding the usage of SMART for abdominopelvic lymph node metastases.
Our study has several limitations including the fact that this is a retrospective study that may underreport toxicity, has short follow-up time, and includes a heterogeneous group of primary diagnosis and treatment doses. We reported the short-term toxicity experience in our study due to the median 10-months follow-up; however, longer follow-up is needed to draw conclusions on long-term safety and efficacy. Furthermore, the important toxicities on SABR-511 and SABR-COMET
Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): A randomised, phase 2, open-label trial.
trials occurred outside of the short-term period used in this study, we are planning to report long-term follow-up results in a forthcoming analysis to better understand late toxicity and long-term clinical outcomes and compare with SABR trials once mature date become available. Finally, because most fractions were adapted, the cumulative dose was not evaluated in terms of clinical outcomes.
Conclusions
This study demonstrates that SMART is feasible with at least no significant short-term toxicity for delivering ablative dose to OM near OARs. These outcomes are noteworthy given the predominance of OM, especially LNs, treated with dose escalation despite their proximity to gastrointestinal OARs; such lesions are notably underrepresented in SABR OM trials. In fact, in this report, there were no bone lesions treated, a significant departure from conventional trials of OM. Since our study has only 10 months median follow-up, longer follow-up required to better understand both long-term safety as well as durability of local control consequential to these high-dose radiation therapy regimens (BED ≥ 100 Gy10). Furthermore, to overcome the biases associated with retrospective evaluations, a prospective trial is planned at our institution to evaluate the outcomes of SMART with OM.
Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): A randomised, phase 2, open-label trial.
Stereotactic ablative body radiotherapy in patients with oligometastatic cancers: A prospective, registry-based, single-arm, observational, evaluation study.
Excessive toxicity when treating central tumors in a phase II study of stereotactic body radiation therapy for medically inoperable early-stage lung cancer.
Evaluation of safety of stereotactic body radiotherapy for the treatment of patients with multiple metastases: Findings from the NRG-BR001 phase 1 trial.
Population based phase II trial of stereotactic ablative radiotherapy (sabr) for up to 5 oligometastases: Preliminary results of the SABR-5 trial 2021.
Phase I trial of stereotactic MR-guided online adaptive radiation therapy (SMART) for the treatment of oligometastatic or unresectable primary malignancies of the abdomen.
Ablative 5-fraction stereotactic magnetic resonance-guided radiation therapy with on-table adaptive replanning and elective nodal irradiation for inoperable pancreas cancer.
Stereotactic MR-guided online adaptive radiation therapy (SMART) for the treatment of liver metastases in oligometastatic patients: Initial clinical experience.
An analysis of a large multi-institutional database reveals important associations between treatment parameters and clinical outcomes for stereotactic body radiotherapy (SBRT) of oligometastatic colorectal cancer.
van Dams R, Wu TC, Kishan AU, et al. Ablative radiotherapy for liver tumors using stereotactic mri-guidance: A prospective phase I trial [e-pub ahead of print]. Radiother Oncol. doi:10.1016/j.radonc.2021.06.005, accessed January 31, 2022.
Assessing the role of stereotactic body radiation therapy in a large cohort of patients with lymph node oligometastases: Does it affect systemic treatment's intensification?.
Phase 3 multi-center, prospective, randomized trial comparing single-dose 24 Gy radiation therapy to a 3-fraction SBRT regimen in the treatment of oligometastatic cancer.
Patterns of care, tolerability, and safety of the first cohort of patients treated on a novel high-field MR-linac within the momentum study: Initial results from a prospective multi-institutional registry.
Sources of support: This work had no specific funding.
Disclosures: Dr Kotecha reports honoraria from Accuray Inc, Elekta AB, ViewRay Inc, Novocure Inc, Elsevier Inc, and Brainlab and institutional research funding from Medtronic Inc, Blue Earth Diagnostics Ltd., Novocure Inc, GT Medical Technologies, AstraZeneca, Exelixis, ViewRay Inc, and Brainlab. Dr Hall reports honorarium from Accuray, Inc.; is a Proton Collaborative Group Executive Committee Institutional Representative and a voting member, Miami Cancer Institute (unpaid); receives grant funding from Live Like Bella Pediatric Cancer Research Initiative, and a Florida Department of Health grant (8LA04). Dr Mittauer reports honoraria, consulting, and research funding from ViewRay Inc and is a cofounder of MR Guidance LLC. Dr Contreras reports consulting fees from Boston Scientific. Kalman reports being an advisory board participant for Naveris. Dr Gutierrez reports honoraria from ViewRay Inc, Elekta AB, IBA S.A, and ownership of uPlan Oncology. Dr Mehta reports consulting fees from Mevion, Zap, Sapience, Blue Earth Diagnostics, IBA, and Xoft, NRG Oncology leadership role, stock or stock options for Chimerix, and is on the Board of Directors of Oncoceutics. Dr Chuong reports honoraria from ViewRay, Sirtex, is on the advisory board for ViewRay, and receives research funding from ViewRay, Novocure, StratPharma. All other authors have no disclosures to declare.
Presented at the American Society for Radiation Oncology 2021 meeting. Chicago, IL. October 26, 2021.
Research data are stored in an institutional repository and will be shared upon request to the corresponding author.
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