A framework for systematic clinical evaluation of technical innovations in lung cancer patients treated on the MR-linac (MRL)
Van Es, C.
van Herk, Marcel
AffiliationDepartment of Radiotherapy Related Research, The Christie, Manchester,
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AbstractIntroduction: 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) . 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:  Verkooijen et al. Frontiers in Oncology 2017.
CitationCobben 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.
TypeMeetings and Proceedings