PMID- 38250959
OWN - NLM
STAT- MEDLINE
DCOM- 20240123
LR  - 20240221
IS  - 2379-139X (Electronic)
IS  - 2379-1381 (Print)
IS  - 2379-1381 (Linking)
VI  - 10
IP  - 1
DP  - 2024 Jan 17
TI  - Accelerated Hypofractionated Magnetic Resonance Guided Adaptive Radiation Therapy 
      for Ultracentral Lung Tumors.
PG  - 169-180
LID - 10.3390/tomography10010013 [doi]
AB  - Radiotherapy for ultracentral lung tumors represents a treatment challenge, 
      considering the high rates of high-grade treatment-related toxicities with 
      stereotactic body radiation therapy (SBRT) or hypofractionated schedules. 
      Accelerated hypofractionated magnetic resonance-guided adaptive radiation therapy 
      (MRgART) emerged as a potential game-changer for tumors in these challenging 
      locations, in close proximity to central organs at risk, such as the trachea, 
      proximal bronchial tree, and esophagus. In this series, 13 consecutive patients, 
      predominantly male (n = 9), with a median age of 71 (range (R): 46-85), underwent 
      195 MRgART fractions (all 60 Gy in 15 fractions) to metastatic (n = 12) or 
      primary ultra-central lung tumors (n = 1). The median gross tumor volumes (GTVs) 
      and planning target volumes (PTVs) were 20.72 cc (R: 0.54-121.65 cc) and 61.53 cc 
      (R: 3.87-211.81 cc), respectively. The median beam-on time per fraction was 14 
      min. Adapted treatment plans were generated for all fractions, and indications 
      included GTV/PTV undercoverage, OARs exceeding tolerance doses, or both 
      indications in 46%, 18%, and 36% of fractions, respectively. Eight patients 
      received concurrent systemic therapies, including immunotherapy (four), 
      chemotherapy (two), and targeted therapy (two). The crude in-field loco-regional 
      control rate was 92.3%. No CTCAE grade 3+ toxicities were observed. Our results 
      offer promising insights, suggesting that MRgART has the potential to mitigate 
      toxicities, enhance treatment precision, and improve overall patient care in the 
      context of ultracentral lung tumors.
FAU - La Rosa, Alonso
AU  - La Rosa A
AUID- ORCID: 0000-0002-9814-2642
AD  - Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South 
      Florida, Miami, FL 33176, USA.
FAU - Mittauer, Kathryn E
AU  - Mittauer KE
AD  - Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South 
      Florida, Miami, FL 33176, USA.
AD  - Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida 
      International University, Miami, FL 33199, USA.
FAU - Bassiri, Nema
AU  - Bassiri N
AD  - Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South 
      Florida, Miami, FL 33176, USA.
AD  - Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida 
      International University, Miami, FL 33199, USA.
FAU - Rzepczynski, Amy E
AU  - Rzepczynski AE
AD  - Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South 
      Florida, Miami, FL 33176, USA.
FAU - Chuong, Michael D
AU  - Chuong MD
AD  - Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South 
      Florida, Miami, FL 33176, USA.
AD  - Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida 
      International University, Miami, FL 33199, USA.
FAU - Yarlagadda, Sreenija
AU  - Yarlagadda S
AUID- ORCID: 0000-0001-5203-7989
AD  - Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South 
      Florida, Miami, FL 33176, USA.
FAU - Kutuk, Tugce
AU  - Kutuk T
AUID- ORCID: 0000-0003-0416-8612
AD  - Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South 
      Florida, Miami, FL 33176, USA.
FAU - McAllister, Nicole C
AU  - McAllister NC
AD  - Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South 
      Florida, Miami, FL 33176, USA.
FAU - Hall, Matthew D
AU  - Hall MD
AUID- ORCID: 0000-0001-8768-3577
AD  - Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South 
      Florida, Miami, FL 33176, USA.
AD  - Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida 
      International University, Miami, FL 33199, USA.
FAU - Gutierrez, Alonso N
AU  - Gutierrez AN
AD  - Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South 
      Florida, Miami, FL 33176, USA.
AD  - Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida 
      International University, Miami, FL 33199, USA.
FAU - Tolakanahalli, Ranjini
AU  - Tolakanahalli R
AD  - Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South 
      Florida, Miami, FL 33176, USA.
AD  - Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida 
      International University, Miami, FL 33199, USA.
FAU - Mehta, Minesh P
AU  - Mehta MP
AUID- ORCID: 0000-0002-4812-5713
AD  - Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South 
      Florida, Miami, FL 33176, USA.
AD  - Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida 
      International University, Miami, FL 33199, USA.
FAU - Kotecha, Rupesh
AU  - Kotecha R
AUID- ORCID: 0000-0001-6927-0402
AD  - Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South 
      Florida, Miami, FL 33176, USA.
AD  - Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida 
      International University, Miami, FL 33199, USA.
AD  - Department of Translational Medicine, Herbert Wertheim College of Medicine, 
      Florida International University, Miami, FL 33199, USA.
LA  - eng
PT  - Journal Article
DEP - 20240117
PL  - Switzerland
TA  - Tomography
JT  - Tomography (Ann Arbor, Mich.)
JID - 101671170
SB  - IM
MH  - Humans
MH  - *Radiotherapy Planning, Computer-Assisted
MH  - Magnetic Resonance Imaging
MH  - *Lung Neoplasms/diagnostic imaging/radiotherapy
MH  - Magnetic Resonance Spectroscopy
PMC - PMC10820032
OTO - NOTNLM
OT  - MRgART
OT  - adaptive
OT  - lung tumor
OT  - radiation therapy
OT  - ultracentral
COIS- ALR: Received travel/reimbursement from GT Medical Technologies. KM: Reports 
      ownership interest in a company that provides consulting services on image guided 
      radiation therapy technology (MR Guidance, LLC. Gainesville, FL, USA). She 
      received travel reimbursement/consulting fees/speaking fees/grants from ViewRay 
      Inc. NB: grants from ViewRay Inc. MDC: Honoraria from ViewRay, Sirtex, IBA and 
      institutional research funding from ViewRay, Novocure, StratPharma TK: Received 
      travel/reimbursement from GT Medical Technologies. MDH: Proton Collaborative 
      Group Executive Committee institutional representative and voting member, Miami 
      Cancer Institute (unpaid); grant funding from Live Like Bella Pediatric Cancer 
      Research Initiative, Florida Department of Health grants 8LA04 and 22L01. ANG: 
      Honoraria from ViewRay, Inc., Elekta AB, IBA AB. Ownership interest of Atlantic 
      Health Solutions (uPlan) MPM: Consulting Fees from Karyopharm, Kazia 
      Therapeutics, Sapience, Zap, Mevion, Xoft; BOD Oncoceutics; Stock in Chimerix RK: 
      Honoraria from Accuray Inc., Elekta AB, ViewRay Inc., Novocure Inc., Elsevier 
      Inc., Brainlab, Kazia Therapeutics, Castle Biosciences, and institutional 
      research funding from Medtronic Inc., Blue Earth Diagnostics Ltd., Novocure Inc., 
      GT Medical Technologies, AstraZeneca, Exelixis, ViewRay Inc., Brainlab, Cantex 
      Pharmaceuticals, and Kazia Therapeutics. All remaining authors declare no 
      conflicts of interest.
EDAT- 2024/01/22 06:42
MHDA- 2024/01/23 06:43
PMCR- 2024/01/17
CRDT- 2024/01/22 05:37
PHST- 2023/10/05 00:00 [received]
PHST- 2024/01/04 00:00 [revised]
PHST- 2024/01/10 00:00 [accepted]
PHST- 2024/01/23 06:43 [medline]
PHST- 2024/01/22 06:42 [pubmed]
PHST- 2024/01/22 05:37 [entrez]
PHST- 2024/01/17 00:00 [pmc-release]
AID - tomography10010013 [pii]
AID - tomography-10-00013 [pii]
AID - 10.3390/tomography10010013 [doi]
PST - epublish
SO  - Tomography. 2024 Jan 17;10(1):169-180. doi: 10.3390/tomography10010013.