Magnetic Resonance Guided Radiation Therapy for Pancreatic Adenocarcinoma, Advantages, Challenges, Current Approaches, and Future Directions
IntroductionPancreatic adenocarcinoma (PAC) has some of the worst treatment outcomes for any solid tumor. PAC creates substantial difficulty for effective treatment with traditional RT delivery strategies primarily secondary to its location and limited visualization using CT. Several of these challe...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-05-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2021.628155/full |
| _version_ | 1818717879626891264 |
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| author | William A. Hall Christina Small Eric Paulson Eugene J. Koay Christopher Crane Martijn Intven Lois A. Daamen Gert J. Meijer Hanne D. Heerkens Michael Bassetti Stephen A. Rosenberg Katharine Aitken Sten Myrehaug Laura A. Dawson Percy Lee Cihan Gani Michael David Chuong Parag J. Parikh Beth A. Erickson |
| author_facet | William A. Hall Christina Small Eric Paulson Eugene J. Koay Christopher Crane Martijn Intven Lois A. Daamen Gert J. Meijer Hanne D. Heerkens Michael Bassetti Stephen A. Rosenberg Katharine Aitken Sten Myrehaug Laura A. Dawson Percy Lee Cihan Gani Michael David Chuong Parag J. Parikh Beth A. Erickson |
| author_sort | William A. Hall |
| collection | DOAJ |
| description | IntroductionPancreatic adenocarcinoma (PAC) has some of the worst treatment outcomes for any solid tumor. PAC creates substantial difficulty for effective treatment with traditional RT delivery strategies primarily secondary to its location and limited visualization using CT. Several of these challenges are uniquely addressed with MR-guided RT. We sought to summarize and place into context the currently available literature on MR-guided RT specifically for PAC.MethodsA literature search was conducted to identify manuscript publications since September 2014 that specifically used MR-guided RT for the treatment of PAC. Clinical outcomes of these series are summarized, discussed, and placed into the context of the existing pancreatic literature. Multiple international experts were involved to optimally contextualize these publications.ResultsOver 300 manuscripts were reviewed. A total of 6 clinical outcomes publications were identified that have treated patients with PAC using MR guidance. Successes, challenges, and future directions for this technology are evident in these publications. MR-guided RT holds theoretical promise for the treatment of patients with PAC. As with any new technology, immediate or dramatic clinical improvements associated with its use will take time and experience. There remain no prospective trials, currently publications are limited to small retrospective experiences. The current level of evidence for MR guidance in PAC is low and requires significant expansion. Future directions and ongoing studies that are currently open and accruing are identified and reviewed.ConclusionsThe potential promise of MR-guided RT for PAC is highlighted, the challenges associated with this novel therapeutic intervention are also reviewed. Outcomes are very early, and will require continued and long term follow up. MR-guided RT should not be viewed in the same fashion as a novel chemotherapeutic agent for which dosing, administration, and toxicity has been established in earlier phase studies. Instead, it should be viewed as a novel procedural intervention which must be robustly tested, refined and practiced before definitive conclusions on the potential benefits or detriments can be determined. The future of MR-guided RT for PAC is highly promising and the potential implications on PAC are substantial. |
| first_indexed | 2024-12-17T19:42:10Z |
| format | Article |
| id | doaj.art-2a374b6a3b8b46eb97b901ba932bb69c |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-17T19:42:10Z |
| publishDate | 2021-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-2a374b6a3b8b46eb97b901ba932bb69c2022-12-21T21:34:58ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2021-05-011110.3389/fonc.2021.628155628155Magnetic Resonance Guided Radiation Therapy for Pancreatic Adenocarcinoma, Advantages, Challenges, Current Approaches, and Future DirectionsWilliam A. Hall0Christina Small1Eric Paulson2Eugene J. Koay3Christopher Crane4Martijn Intven5Lois A. Daamen6Gert J. Meijer7Hanne D. Heerkens8Michael Bassetti9Stephen A. Rosenberg10Katharine Aitken11Sten Myrehaug12Laura A. Dawson13Percy Lee14Cihan Gani15Michael David Chuong16Parag J. Parikh17Beth A. Erickson18Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United StatesDepartment of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United StatesDepartment of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United StatesDivision of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United StatesDepartment of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United StatesDepartment of Radiation Oncology, University Medical Center Utrecht, Utrecht, NetherlandsDepartment of Radiation Oncology, University Medical Center Utrecht, Utrecht, NetherlandsDepartment of Radiation Oncology, University Medical Center Utrecht, Utrecht, NetherlandsDepartment of Radiation Oncology, University Medical Center Utrecht, Utrecht, NetherlandsDepartment of Radiation Oncology, University of Wisconsin-Madison, Madison, WI, United StatesDepartment of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, United StatesDepartment of Radiation Oncology, Royal Marsden NHS Foundation Trust, London, United KingdomOdette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, CanadaPrincess Margaret Cancer Centre, University Health Network, Toronto, ON, CanadaDivision of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States0Department of Radiation Oncology, Faculty of Medicine, University of Tübingen, Tübingen, Germany1Miami Cancer Institute, Baptist Hospital of Miami, Miami, FL, United States2Henry Ford Medical Center, Henry Ford Health System, Detroit, MI, United StatesDepartment of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United StatesIntroductionPancreatic adenocarcinoma (PAC) has some of the worst treatment outcomes for any solid tumor. PAC creates substantial difficulty for effective treatment with traditional RT delivery strategies primarily secondary to its location and limited visualization using CT. Several of these challenges are uniquely addressed with MR-guided RT. We sought to summarize and place into context the currently available literature on MR-guided RT specifically for PAC.MethodsA literature search was conducted to identify manuscript publications since September 2014 that specifically used MR-guided RT for the treatment of PAC. Clinical outcomes of these series are summarized, discussed, and placed into the context of the existing pancreatic literature. Multiple international experts were involved to optimally contextualize these publications.ResultsOver 300 manuscripts were reviewed. A total of 6 clinical outcomes publications were identified that have treated patients with PAC using MR guidance. Successes, challenges, and future directions for this technology are evident in these publications. MR-guided RT holds theoretical promise for the treatment of patients with PAC. As with any new technology, immediate or dramatic clinical improvements associated with its use will take time and experience. There remain no prospective trials, currently publications are limited to small retrospective experiences. The current level of evidence for MR guidance in PAC is low and requires significant expansion. Future directions and ongoing studies that are currently open and accruing are identified and reviewed.ConclusionsThe potential promise of MR-guided RT for PAC is highlighted, the challenges associated with this novel therapeutic intervention are also reviewed. Outcomes are very early, and will require continued and long term follow up. MR-guided RT should not be viewed in the same fashion as a novel chemotherapeutic agent for which dosing, administration, and toxicity has been established in earlier phase studies. Instead, it should be viewed as a novel procedural intervention which must be robustly tested, refined and practiced before definitive conclusions on the potential benefits or detriments can be determined. The future of MR-guided RT for PAC is highly promising and the potential implications on PAC are substantial.https://www.frontiersin.org/articles/10.3389/fonc.2021.628155/fullMRI guidancepancreatic image–guided RTpancreatic cancer and radiation therapypancreatic cancerMR-guided RTMR-guided radiation therapy |
| spellingShingle | William A. Hall Christina Small Eric Paulson Eugene J. Koay Christopher Crane Martijn Intven Lois A. Daamen Gert J. Meijer Hanne D. Heerkens Michael Bassetti Stephen A. Rosenberg Katharine Aitken Sten Myrehaug Laura A. Dawson Percy Lee Cihan Gani Michael David Chuong Parag J. Parikh Beth A. Erickson Magnetic Resonance Guided Radiation Therapy for Pancreatic Adenocarcinoma, Advantages, Challenges, Current Approaches, and Future Directions Frontiers in Oncology MRI guidance pancreatic image–guided RT pancreatic cancer and radiation therapy pancreatic cancer MR-guided RT MR-guided radiation therapy |
| title | Magnetic Resonance Guided Radiation Therapy for Pancreatic Adenocarcinoma, Advantages, Challenges, Current Approaches, and Future Directions |
| title_full | Magnetic Resonance Guided Radiation Therapy for Pancreatic Adenocarcinoma, Advantages, Challenges, Current Approaches, and Future Directions |
| title_fullStr | Magnetic Resonance Guided Radiation Therapy for Pancreatic Adenocarcinoma, Advantages, Challenges, Current Approaches, and Future Directions |
| title_full_unstemmed | Magnetic Resonance Guided Radiation Therapy for Pancreatic Adenocarcinoma, Advantages, Challenges, Current Approaches, and Future Directions |
| title_short | Magnetic Resonance Guided Radiation Therapy for Pancreatic Adenocarcinoma, Advantages, Challenges, Current Approaches, and Future Directions |
| title_sort | magnetic resonance guided radiation therapy for pancreatic adenocarcinoma advantages challenges current approaches and future directions |
| topic | MRI guidance pancreatic image–guided RT pancreatic cancer and radiation therapy pancreatic cancer MR-guided RT MR-guided radiation therapy |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2021.628155/full |
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