磁共振引导与基于内靶体积的肝转移性立体定向放射治疗的前瞻性计划比较-哪些患者真正受益于MR-linac？

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology Pub Date : 2025-02-28 DOI:10.1016/j.ctro.2025.100941

Philipp Hoegen-Saßmannshausen , C. Katharina Renkamp , Hoi Hin Lau , David Neugebauer , Nina Niebuhr , Carolin Buchele , Fabian Schlüter , Elisabetta Sandrini , Line Hoeltgen , Fabian Weykamp , Sebastian Regnery , Jakob Liermann , Eva Meixner , Kevin Zhang , Oliver Sedlaczek , Heinz-Peter Schlemmer , Laila König , Jürgen Debus , Sebastian Klüter , Juliane Hörner-Rieber

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引用次数: 0

摘要

目的/目的比较在线mr引导下的肝转移SBRT （MRgRT）与最新的基于itv的SBRT (ITV-SBRT)，并评估哪些患者从MRgRT中获益最多。材料和方法在一项前瞻性随机试验（MAESTRO研究，NCT05027711）中，如果100 Gy的生物有效剂量（BED10）适用于ITV-SBRT，则将患者随机分为门控和在线适应性MRgRT或ITV-SBRT。否则，患者接受MRgRT治疗。在20例患者的亚组分析中，进行了MRgRT和ITV-SBRT计划的剂量学比较。计算肿瘤控制和正常组织并发症的概率。结果在40%的患者中，MRgRT使SBRT的分数更低和/或处方BED10更高。MRgRT几乎改善了所有目标体积指标。MRgRT PTV D95%在整个队列（91.0±22.9 Gy比79.5±27.2 Gy, p = 0.001）、非危重病例（111.3±6.2 Gy比104.7±4.1 Gy, p = 0.022）和健康肝容量有限或附近胃肠器官有危险的危重病例（74.1±16.9 Gy比58.5±18.5 Gy, p = 0.041）中均显著升高。靶体积V100%也优于MRgRT。MRgRT计算的2年肿瘤控制概率总体上显著优于MRgRT(73.0±6.2%比69.7±7.9%,p = 0.002)，非危重病例（78.3±1.4%比76.8±1.0%,p = 0.022）和危重病例（68.5±4.8%比63.8±5.8%,p = 0.041），正常组织并发症发生率未升高。从剂量学角度来看，门控MRgRT对本研究中分析的几乎所有肝转移瘤都是有益的。转移灶严重靠近胃肠道OAR或健康肝脏容量有限的患者应分配到提供MRgRT的中心。

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Prospective planning comparison of magnetic resonance-guided vs. internal target volume-based stereotactic body radiotherapy of hepatic metastases – Which patients do really benefit from an MR-linac?

Purpose/objective

To compare online MR-guided SBRT (MRgRT) of liver metastases with state-of-the-art ITV-based SBRT (ITV-SBRT) and assess which patients benefit most from MRgRT.

Materials and methods

In a prospective randomized trial (MAESTRO study, NCT05027711), patients were randomized to either gated and online adaptive MRgRT or ITV-SBRT if a biologically effective dose (BED₁₀) of 100 Gy was feasible with ITV-SBRT. Otherwise, patients were treated with MRgRT. In this subgroup analysis of 20 patients, a dosimetric comparison of MRgRT and ITV-SBRT plans was performed. Tumor control and normal tissue complication probabilities were calculated.

Results

In 40 % of all patients, MRgRT enabled SBRT with less fractions and/or higher prescription BED₁₀. Almost all target volume metrics were improved with MRgRT. MRgRT PTV D95% was significantly higher in the overall cohort (91.0 ± 22.9 Gy vs. 79.5 ± 27.2 Gy, p = 0.001), in uncritical (111.3 ± 6.2 Gy vs. 104.7 ± 4.1 Gy, p = 0.022) and in critical cases with limited healthy liver volume or nearby gastrointestinal organs at risk (74.1 ± 16.9 Gy vs. 58.5 ± 18.5 Gy, p = 0.041). Target volume V100% was also superior with MRgRT. Calculated 2-year tumor control probability was significantly superior with MRgRT overall (73.0 ± 6.2 % vs. 69.7 ± 7.9 %, p = 0.002), in uncritical cases (78.3 ± 1.4 % vs. 76.8 ± 1.0 %, p = 0.022) and in critical cases (68.5 ± 4.8 % vs. 63.8 ± 5.8 %, p = 0.041), without elevated normal tissue complication probability.

Conclusion

Dosimetrically, gated MRgRT was beneficial for virtually all the hepatic metastases analyzed in this study. Patients with metastases located critically near gastrointestinal OAR or with limited healthy liver volume should be allocated to centers providing MRgRT.

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