Abstract
PurposeMagnetic resonance-guided radiotherapy (MRgRT) has recently been introduced in our institution. As MRgRT requires high patient compliance compared to conventional techniques and can be associated with prolonged treatment times, feasibility and patient tolerance were prospectively assessed using patient-reported outcome questionnaires (PRO-Q).Materials and methodsForty-three patients were enrolled in a prospective observational study and treated with MRgRT on a low-field hybrid Magnetic Resonance Linear Accelerator system (MR-Linac) between April 2018 and April 2019. For assistance in gated breath-hold delivery using cine-MRI, a video feedback system was installed. PRO-Qs consisted of questions on MR-related complaints and also assessed aspects of active patient participation.ResultsThe most commonly treated anatomic sites were nodal metastases and liver lesions. The mean treatment time was 34 min with a mean beam-on time of 2:17 min. Gated stereotactic body radiotherapy (SBRT) was applied in 47% of all patients. Overall, patients scored MRgRT as positive or at least tolerable in the PRO‑Q. Almost two thirds of patients (65%) complained about at least one item of the PRO‑Q (score ≥4), mainly concerning coldness, paresthesia, and uncomfortable positioning. All patients reported high levels of satisfaction with their active role using the video feedback system in breath-hold delivery.ConclusionMRgRT was successfully implemented in our clinic and well tolerated by all patients, despite MR-related complaints and complaints about uncomfortable immobilization. Prospective clinical studies are in development for further evaluation of MRgRT and for quantification of the benefit of MR-guided on-table adaptive radiotherapy.
Highlights
Image-guided radiotherapy (IGRT) allows for daily monitoring of patient and tumor positioning and, to some extent, immediate detection of alterations in tumor volume and patient anatomy [1,2,3]
We describe our institutional experience with the implementation of Magnetic resonance-guided radiotherapy (MRgRT) within a highvolume clinical center after 1 year of patient treatments, and review patient-reported outcomes
MRgRT was selected for these patients due to a variety of reasons, including superior soft tissue contrast or gated dose delivery and mostly for a combination of these factors
Summary
Image-guided radiotherapy (IGRT) allows for daily monitoring of patient and tumor positioning and, to some extent, immediate detection of alterations in tumor volume and patient anatomy [1,2,3]. Devices integrating an MRI scanner with a treatment delivery system have become clinically available [11,12,13,14,15] These new hybrid systems for MRgRT do offer three-dimensional MRI for soft tissue target and organ at risk visualization, and allow for continuous cine-MRI before as well as during treatment [12, 13]. CineMRI during treatment enables advanced motion management based on real-time soft tissue anatomic feedback such as treatment beam gating [11, 16, 17] This eliminates the need for invasive implantation of fiducial markers as well as the application of internal target volumes (ITV) in order to account for intrafractional motion, and thereby offers the potential for margin reduction and a lower risk of ensuing toxicity [18]
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