MR-guided radiotherapy in rectal cancer: First clinical experience of an innovative technology

Giuditta Chiloiro, Luca Boldrini, Elisa Meldolesi, Alessia Re, Francesco Cellini, Davide Cusumano, Barbara Corvari, Giovanna Mantini, Mario Balducci, Vincenzo Valentini, Maria Antonietta Gambacorta, Giuditta Chiloiro, Luca Boldrini, Elisa Meldolesi, Alessia Re, Francesco Cellini, Davide Cusumano, Barbara Corvari, Giovanna Mantini, Mario Balducci, Vincenzo Valentini, Maria Antonietta Gambacorta

Abstract

•This study represents one of the first reports of online MRgRT.•Integrated Low-field MR provides better anatomical visualization than CBCT or MVCT.•Better visualization of the target can help to reduce the margins from CTV to PTV.•MRgRT appears a feasible option in rectal cancer treatment offering potential benefits.•MRgRT represents a promising technology for rectal cancer management.

Figures

Fig. 1
Fig. 1
Low T alignment image.
Fig. 2
Fig. 2
Volume gating: CTV1 (red) inside the 5 mm boundary gating ROI (blue). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

References

    1. Valentini V., Glimelius B., Haustermans K., Marijnen C.A.M., Rödel C., Gambacorta M.A. EURECCA consensus conference highlights about rectal cancer clinical management: the radiation oncologist’s expert review. Radiother Oncol. 2014;110:195–198.
    1. Sauer R., Becker H., Hohenberger W., Rödel C., Wittekind C., Fietkau R. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351:1731–1740.
    1. Vecchio F.M., Valentini V., Minsky B.D., Padula G.D.A., Venkatraman E.S., Balducci M. The relationship of pathologic tumor regression grade (TRG) and outcomes after preoperative therapy in rectal cancer. Int J Radiat Oncol Biol Phys. 2005;62:752–760.
    1. Capirci C., Valentini V., Cionini L., De Paoli A., Rodel C., Glynne-Jones R. Prognostic value of pathologic complete response after neoadjuvant therapy in locally advanced rectal cancer: long-term analysis of 566 ypCR patients. Int J Radiat Oncol Biol Phys. 2008;72:99–107.
    1. Zorcolo L., Rosman A.S., Restivo A., Pisano M., Nigri G.R., Fancellu A. Complete pathologic response after combined modality treatment for rectal cancer and long-term survival: a meta-analysis. Ann Surg Oncol. 2012;19:2822–2832.
    1. Burbach J.P.M., Den Harder A.M., Intven M., Van Vulpen M., Verkooijen H.M., Reerink O. Impact of radiotherapy boost on pathological complete response in patients with locally advanced rectal cancer: a systematic review and meta-analysis. Radiother Oncol. 2014;113:1–9.
    1. Appelt A.L., Ploen J., Vogelius I.R., Bentzen S.M., Jakobsen A. Radiation dose-response model for locally advanced rectal cancer after preoperative chemoradiation therapy. Int J Radiat Oncol Biol Phys. 2013;85:74–80.
    1. Jakobsen A., Ploen J., Vuong T., Appelt A., Lindebjerg J., Rafaelsen S.R. Dose-effect relationship in chemoradiotherapy for locally advanced rectal cancer: a randomized trial comparing two radiation doses. Int J Radiat Oncol Biol Phys. 2012;84:949–954.
    1. Mohiuddin M., Regine W.F., John W.J., Hagihara P.F., McGrath P.C., Kenady D.E. Preoperative chemoradiation in fixed distal rectal cancer: dose time factors for pathological complete response. Int J Radiat Oncol Biol Phys. 2000;46:883–888.
    1. Myerson R.J., Valentini V., Birnbaum E.H., Cellini N., Coco C., Fleshman J.W. A phase I/II trial of three-dimensionally planned concurrent boost radiotherapy and protracted venous infusion of 5-FU chemotherapy for locally advanced rectal carcinoma. Int J Radiat Oncol Biol Phys. 2001;50:1299–1308.
    1. Wiltshire K.L., Ward I.G., Swallow C., Oza A.M., Cummings B., Pond G.R. Preoperative radiation with concurrent chemotherapy for resectable rectal cancer: effect of dose escalation on pathologic complete response, local recurrence-free survival, disease-free survival, and overall survival. Int J Radiat Oncol Biol Phys. 2006;64:709–716.
    1. Valentini V., De Paoli A., Barba M.C., Friso M.L., Lupattelli M., Rossi R. Capecitabine based preoperative chemo-RT in rectal cancer intensified by RT or oxaliplatin: the INTERACT trial. Radiother Oncol. 2014;111:S193.
    1. Samuelian J.M., Callister M.D., Ashman J.B., Young-Fadok T.M., Borad M.J., Gunderson L.L. Reduced acute bowel toxicity in patients treated with intensity-modulated radiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys. 2012;82:1981–1987.
    1. Urbano M.T.G., Henrys A.J., Adams E.J., Norman A.R., Bedford J.L., Harrington K.J. Intensity-modulated radiotherapy in patients with locally advanced rectal cancer reduces volume of bowel treated to high dose levels. Int J Radiat Oncol Biol Phys. 2006;65:907–916.
    1. Arbea L., Ramos L., Martínez-Monge R., Moreno M., Aristu J. Intensity-modulated radiation therapy (IMRT) vs. 3D conformal radiotherapy (3DCRT) in locally advanced rectal cancer (LARC): dosimetric comparison and clinical implications. Radiat Oncol. 2010;5:17.
    1. Mok H., Crane C.H., Palmer M.B., Briere T.M., Beddar S., Delclos M.E. Intensity modulated radiation therapy (IMRT): differences in target volumes and improvement in clinically relevant doses to small bowel in rectal carcinoma. Radiat Oncol. 2011;6:1–9.
    1. Mutic S., Dempsey J.F. The ViewRay system: magnetic resonance-guided and controlled radiotherapy. Semin Radiat Oncol. 2014;24:196–199.
    1. Raaymakers B.W., Lagendijk J.J.W., Overweg J., Kok J.G.M., Raaijmakers A.J.E., Kerkhof E.M. Integrating a 1.5 T MRI scanner with a 6 MV accelerator: proof of concept. Phys Med Biol. 2009;54:N229–N237.
    1. Noel C.E., Parikh P.J., Spencer C.R., Green O.L., Hu Y., Mutic S. Comparison of onboard low-field magnetic resonance imaging versus onboard computed tomography for anatomy visualization in radiotherapy. Acta Oncol (Madr) 2015;54:1474–1482.
    1. Boldrini L., Placidi E., Dinapoli N., Azario L., Cellini F., Massaccesi M. Technical innovations & patient support in radiation oncology hybrid tri-co-60 MRI radiotherapy for locally advanced rectal cancer: an in silico evaluation. Tech Innov Patient Support Radiat Oncol. 2018;6:5–10.
    1. Valentini V., Gambacorta M.A., Barbaro B., Chiloiro G., Coco C., Das P. International consensus guidelines on Clinical Target Volume delineation in rectal cancer. Radiother Oncol. 2016;120:195–201.
    1. Uh J., Merchant T.E., Li Y., Li X., Hua C. MRI-based treatment planning with pseudo CT generated through atlas registration. Med Phys. 2014;41
    1. Rödel C., Graeven U., Fietkau R., Hohenberger W., Hothorn T., Arnold D. Oxaliplatin added to fluorouracil-based preoperative chemoradiotherapy and postoperative chemotherapy of locally advanced rectal cancer (the German CAO/ARO/AIO-04 study): Final results of the multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2015;16:979–989.
    1. Valentini V., Van Stiphout R.G.P.M., Lammering G., Gambacorta M.A., Barba M.C., Bebenek M. Nomograms for predicting local recurrence, distant metastases, and overall survival for patients with locally advanced rectal cancer on the basis of european randomized clinical trials. J Clin Oncol. 2011;29:3163–3172.
    1. Lahaye M.J., Beets G.L., Engelen S.M., Kessels A.G., de Bruïne A.P., Kwee H.W. Locally advanced rectal cancer: MR imaging for restaging after neoadjuvant radiation therapy with concomitant chemotherapy. Part II. What are the criteria to predict involved lymph nodes? Radiology. 2009;252(1):81–91.
    1. Verellen D., De Ridder M., Tournel K., Duchateau M., Reynders T., Gevaert T. An overview of volumetric imaging technologies and their quality assurance for IGRT. Acta Oncol (Madr) 2008;47:1271–1278.
    1. Verellen D., De Ridder M., Linthout N., Tournel K., Soete G., Storme G. Innovations in image-guided radiotherapy. Nat Rev Cancer. 2007;7:949–960.
    1. Brown G., Davies S., Williams G.T., Bourne M.W., Newcombe R.G., Radcliffe A.G. Effectiveness of preoperative staging in rectal cancer: digital rectal examination, endoluminal ultrasound or magnetic resonance imaging? Br J Cancer. 2004;91:23–29.
    1. LeBlanc J.K. Imaging and management of rectal cancer. Nat Clin Pract Gastroenterol Hepatol. 2007;4:665–676.
    1. Matsuoka H., Nakamura A., Masaki T., Sugiyama M., Takahara T., Hachiya J. A prospective comparison between multidetector-row computed tomography and magnetic resonance imaging in the preoperative evaluation of rectal carcinoma. Am J Surg. 2003;185:556–559.
    1. Boldrini L., Cellini F., Manfrida S., Chiloiro G., Teodoli S., Cusumano D. Use of indirect target gating in magnetic resonance-guided liver stereotactic body radiotherapy: case report of an oligometastatic patient. Cureus. 2018;10(3) e2292.
    1. Boldrini L., Cusumano D., Chiloiro G., Casà C., Masciocchi C., Lenkowicz J. Radiomics for rectal cancer response prediction with hybrid 0.35 T Magnetic Resonance guided Radiotherapy (MRgRT): a hypothesis generating study for an innovative personalized medicine approach. Radiol Med. 2018
    1. Sun Y.-S., Zhang X.-P., Tang L., Ji J.-F., Gu J., Cai Y. Locally advanced rectal carcinoma treated with preoperative chemotherapy and radiation therapy: preliminary analysis of diffusion-weighted mr imaging for early detection of tumor histopathologic downstaging. Radiology. 2010;254:170–178.
    1. Shaverdian N., Yang Y., Hu P., Hart S., Sheng K., Lamb J. Feasibility evaluation of diffusion-weighted imaging using an integrated MRIradiotherapysystem for response assessment to neoadjuvant therapy in rectal cancer. Br J Radiol. 2017;90:20160739.
    1. Hauri P., Hälg R.A., Schneider U. Technical Note: comparison of peripheral patient dose from MR-guided 60 Co therapy and 6 MV linear accelerator IGRT. Med Phys. 2017;44:3788–3793.
    1. Lupattelli M., Matrone F., Gambacorta M.A., Osti M., Macchia G., Palazzari E. Preoperative intensity-modulated radiotherapy with a simultaneous integrated boost combined with Capecitabine in locally advanced rectal cancer: short-term results of a multicentric study. Radiat Oncol. 2017;12(1):139.
    1. Hernando-Requejo O., López M., Cubillo A., Rodriguez A., Ciervide R., Valero J. Complete pathological responses in locally advanced rectal cancer after preoperative IMRT and integrated-boost chemoradiation. Strahlentherapie Und Onkol. 2014;190:515–520.
    1. Arbea L., Martínez-Monge R., Díaz-González J.A., Moreno M., Rodríguez J., Hernández J.L. Four-week neoadjuvant intensity-modulated radiation therapy with concurrent capecitabine and oxaliplatin in locally advanced rectal cancer patients: a validation phase II trial. Int J Radiat Oncol Biol Phys. 2012;83:587–593.
    1. Chan A.K., Wong A.O., Langevin J., Jenken D., Heine J., Buie D. Preoperative chemotherapy and pelvic radiation for tethered or fixed rectal cancer: a phase II dose escalation study. Int J Radiat Oncol Biol Phys. 2000;48:843–856.
    1. Van Wickle J.D., Paulson E.S., Landry J.C., Erickson B.A., Hall W.A. Adaptive radiation dose escalation in rectal adenocarcinoma: a review. J Gastrointest Oncol. 2017;8:902–914.
    1. Park J.M., Park S.-Y., Kim J.-I., Kang H.-C., Choi C.H. A comparison of treatment plan quality between Tri-Co-60 intensity modulated radiation therapy and volumetric modulated arc therapy for cervical cancer. Phys Med. 2017;40:11–16.
    1. Bosset J.F., Magnin V., Maingon P., Mantion G., Pelissier E.P., Mercier M. Preoperative radiochemotherapy in rectal cancer: long-term results of a phase II trial. Int J Radiat Oncol Biol Phys. 2000;46:323–327.
    1. Bosset J.-F., Collette L., Calais G., Mineur L., Maingon P., Radosevic-Jelic L. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med. 2006;355:1114–1123.

Source: PubMed

3
Abonnieren