Abstract
Adaptive MR-guided radiotherapy (MRgRT) is a new treatment paradigm and its role as a non-invasive treatment option for renal cell carcinoma is evolving. The early clinical experience to date shows that real-time plan adaptation based on the daily MRI anatomy can lead to improved target coverage and normal tissue sparing. Continued technological innovations will further mitigate the challenges of organ motion and enable more advanced treatment adaptation, and potentially lead to enhanced oncologic outcomes and preservation of renal function. Future applications look promising to make a positive clinical impact and further the personalization of radiotherapy in the management of renal cell carcinoma.
Highlights
Renal cell carcinoma (RCC) is the seventh most common malignancy in the world, where an estimated 400 000 people are diagnosed per year [1]
MRgRT can potentially facilitate dose escalation and smaller treatment margins by overcoming the challenge of complex kidney motion, and reduce treatment-related toxicities by carefully evaluating and sparing critical OARs in real time. This technology will help advance the use of Stereotactic body radiotherapy (SBRT) for small and large renal tumors with potentially less renal toxicity, and improve the therapeutic ratio which will facilitate future comparative effectiveness studies versus other ablative modalities
All authors contributed to the article and approved the submitted version
Summary
Renal cell carcinoma (RCC) is the seventh most common malignancy in the world, where an estimated 400 000 people are diagnosed per year [1]. For all three disease sites, the maximum NTCP improvements were for the normal kidney, the bowels and the duodenum, with reductions in associated toxicities of 79% (radiation nephropathy) [38, 39], 69% (stricture/fistula) [38, 40] and 25% (ulceration) [38, 41], respectively Even though this was a simulation study using a well-validated planning system, it indicates the potential benefits, in a best case scenario, that may be achieved in the reduction of side effects and/or an increase in tumor control probability if real-time tumor tracking is implemented (Figure 2). Prins et al [21] evaluated two motion management techniques, tumor trailing and respiratory tracking, in 15 RCC patients simulated for single-fraction, MRI-based SBRT within a 25minute treatment time with free breathing. With consensus guidelines for image acquisition and quantification [57], MRgRT offers a unique opportunity to assess novel imaging biomarkers of response and toxicity in conjunction with serological correlates during SBRT alone or in combination with immunotherapy
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