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
Purpose: 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 adj...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-11-01
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| Series: | Advances in Radiation Oncology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2452109422000859 |
| _version_ | 1818547985751998464 |
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| author | Tugce Kutuk, MD Robert Herrera, BS Teuta Z. Mustafayev, MD Gorkem Gungor, PhD Gamze Ugurluer, MD Banu Atalar, MD Rupesh Kotecha, MD Matthew D. Hall, MD, MBA Muni Rubens, MBBS, MPH, PhD Kathryn E. Mittauer, PhD Jessika A. Contreras, MD James McCulloch, DMP Noah S. Kalman, MD, MBA Diane Alvarez, MSc Tino Romaguera, PhD Alonso N. Gutierrez, PhD, MBA Jacklyn Garcia, BS Adeel Kaiser, MD Minesh P. Mehta, MD Enis Ozyar, MD Michael D. Chuong, MD |
| author_facet | Tugce Kutuk, MD Robert Herrera, BS Teuta Z. Mustafayev, MD Gorkem Gungor, PhD Gamze Ugurluer, MD Banu Atalar, MD Rupesh Kotecha, MD Matthew D. Hall, MD, MBA Muni Rubens, MBBS, MPH, PhD Kathryn E. Mittauer, PhD Jessika A. Contreras, MD James McCulloch, DMP Noah S. Kalman, MD, MBA Diane Alvarez, MSc Tino Romaguera, PhD Alonso N. Gutierrez, PhD, MBA Jacklyn Garcia, BS Adeel Kaiser, MD Minesh P. Mehta, MD Enis Ozyar, MD Michael D. Chuong, MD |
| author_sort | Tugce Kutuk, MD |
| collection | DOAJ |
| description | Purpose: 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. |
| first_indexed | 2024-12-12T08:13:57Z |
| format | Article |
| id | doaj.art-d9553589e1394b15ac72b86b7212cbd6 |
| institution | Directory Open Access Journal |
| issn | 2452-1094 |
| language | English |
| last_indexed | 2024-12-12T08:13:57Z |
| publishDate | 2022-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Advances in Radiation Oncology |
| spelling | doaj.art-d9553589e1394b15ac72b86b7212cbd62022-12-22T00:31:40ZengElsevierAdvances in Radiation Oncology2452-10942022-11-0176100978Multi-Institutional Outcomes of Stereotactic Magnetic Resonance Image Guided Adaptive Radiation Therapy With a Median Biologically Effective Dose of 100 Gy10 for Non-bone OligometastasesTugce Kutuk, MD0Robert Herrera, BS1Teuta Z. Mustafayev, MD2Gorkem Gungor, PhD3Gamze Ugurluer, MD4Banu Atalar, MD5Rupesh Kotecha, MD6Matthew D. Hall, MD, MBA7Muni Rubens, MBBS, MPH, PhD8Kathryn E. Mittauer, PhD9Jessika A. Contreras, MD10James McCulloch, DMP11Noah S. Kalman, MD, MBA12Diane Alvarez, MSc13Tino Romaguera, PhD14Alonso N. Gutierrez, PhD, MBA15Jacklyn Garcia, BS16Adeel Kaiser, MD17Minesh P. Mehta, MD18Enis Ozyar, MD19Michael D. Chuong, MD20Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FloridaDepartment of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FloridaDepartment of Radiation Oncology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, TurkeyDepartment of Radiation Oncology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, TurkeyDepartment of Radiation Oncology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, TurkeyDepartment of Radiation Oncology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, TurkeyDepartment of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida; Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FloridaDepartment of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida; Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FloridaDepartment of Clinical Informatics, Miami Cancer Institute, Baptist Health South Florida, Miami, FloridaDepartment of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida; Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FloridaDepartment of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida; Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FloridaDepartment of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida; Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FloridaDepartment of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida; Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FloridaDepartment of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida; Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FloridaDepartment of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida; Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FloridaDepartment of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida; Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FloridaHerbert Wertheim College of Medicine, Florida International University, Miami, FloridaDepartment of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida; Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FloridaDepartment of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida; Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FloridaDepartment of Radiation Oncology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, TurkeyDepartment of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida; Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida; Corresponding author: Michael D. Chuong, MD, FACROPurpose: 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.http://www.sciencedirect.com/science/article/pii/S2452109422000859 |
| spellingShingle | Tugce Kutuk, MD Robert Herrera, BS Teuta Z. Mustafayev, MD Gorkem Gungor, PhD Gamze Ugurluer, MD Banu Atalar, MD Rupesh Kotecha, MD Matthew D. Hall, MD, MBA Muni Rubens, MBBS, MPH, PhD Kathryn E. Mittauer, PhD Jessika A. Contreras, MD James McCulloch, DMP Noah S. Kalman, MD, MBA Diane Alvarez, MSc Tino Romaguera, PhD Alonso N. Gutierrez, PhD, MBA Jacklyn Garcia, BS Adeel Kaiser, MD Minesh P. Mehta, MD Enis Ozyar, MD Michael D. Chuong, MD 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 Advances in Radiation Oncology |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| url | http://www.sciencedirect.com/science/article/pii/S2452109422000859 |
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