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A framework for systematic clinical evaluation of technical innovations in lung cancer patients treated on the MR-linac (MRL)
Cobben, David Bainbridge, H. Belderbos, J. Cheung, P. Dubec, Michael Gomez, D. Gore, E. Knowles, E. Lalezari, F. Oelfke, U.
Cobben, David
Bainbridge, H.
Belderbos, J.
Cheung, P.
Dubec, Michael
Gomez, D.
Gore, E.
Knowles, E.
Lalezari, F.
Oelfke, U.
Citations
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Abstract
Introduction: A recent innovation in radiotherapy is the MRL
developed by Elekta and Philips. The MRL combines a 1.5-T MRI with
a 7-MV linac. It allows the acquisition of high-resolution MR images
for on treatment verification, adaption and response monitoring.
Methods: Seven cancer institutions from Europe and North America,
are working within the Elekta MR-Linac Consortium to evaluate
the MRL within a framework called 'R-IDEAL' (Radiotherapy Idea
Development Exploration Assessment Longterm Evaluation) [1].
Results: Stage 0: We defined in 80 patients the optimal MRI
sequences suitable for GTV and organ at risk (OAR) contouring: T2
Turbo Spin Echo (TSE), T2 TSE with fat sat, T1 radial gradient echo,
and DIXON TSE. Two radiology-led workshops were organized and
inter-observer agreement was assessed for OARs. These led to a
consensus-based OAR atlas. A study is being prepared to compare
the image quality of the current standard CBCT and MR images at baseline and mid-treatment for treatment verification and set-up
correction.
Stage 1: we will investigate the clinical feasibility of the MRL for
standard of care radiotherapy and the scope for adaptive radiotherapy
(margin reductions) and detecting changes in oxygenation during
treatment on the MRL in patients with locally advanced (LA) NSCLC.
Stage 2a/b: based on the results from stage 1 we will design a study
aiming to reduce margins around the tumour and dose escalate in
patients with LA NSCLC. Table 1 summarizes the ongoing and
planned work within the Elekta MR-Linac Consortium.
Conclusion: The aim of this programme of work is to generate
robust evidence to support the introduction of the MRL and to
improve outcomes of patients with LA NSCLC.
Reference:
[1] Verkooijen et al. Frontiers in Oncology 2017.
Description
Date
2019
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Cobben D, Bainbridge H, Belderbos J, Cheung P, Dubec M, Gomez D, et al. A framework for systematic clinical evaluation of technical innovations in lung cancer patients treated on the MR-linac (MRL). Lung Cancer. 2019;127:S58-S9.