Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 102, Amsterdam, 1066CX, the Netherlands.
Department of Radiation Oncology, Medical College of Wisconsin, 9200 W Wisconsin Av, Milwaukee, WI, 53226, USA.
Eur J Cancer. 2021 Aug;153:64-71. doi: 10.1016/j.ejca.2021.04.041. Epub 2021 Jun 15.
Quantitative imaging biomarkers (QIBs) derived from MRI techniques have the potential to be used for the personalised treatment of cancer patients. However, large-scale data are missing to validate their added value in clinical practice. Integrated MRI-guided radiotherapy (MRIgRT) systems, such as hybrid MRI-linear accelerators, have the unique advantage that MR images can be acquired during every treatment session. This means that high-frequency imaging of QIBs becomes feasible with reduced patient burden, logistical challenges, and costs compared to extra scan sessions. A wealth of valuable data will be collected before and during treatment, creating new opportunities to advance QIB research at large. The aim of this paper is to present a roadmap towards the clinical use of QIBs on MRIgRT systems. The most important need is to gather and understand how the QIBs collected during MRIgRT correlate with clinical outcomes. As the integrated MRI scanner differs from traditional MRI scanners, technical validation is an important aspect of this roadmap. We propose to integrate technical validation with clinical trials by the addition of a quality assurance procedure at the start of a trial, the acquisition of in vivo test-retest data to assess the repeatability, as well as a comparison between QIBs from MRIgRT systems and diagnostic MRI systems to assess the reproducibility. These data can be collected with limited extra time for the patient. With integration of technical validation in clinical trials, the results of these trials derived on MRIgRT systems will also be applicable for measurements on other MRI systems.
定量成像生物标志物(QIBs)源自 MRI 技术,有望用于癌症患者的个体化治疗。然而,目前缺乏大规模数据来验证它们在临床实践中的附加价值。集成 MRI 引导放疗(MRIgRT)系统,如混合 MRI-线性加速器,具有独特的优势,即可以在每次治疗过程中采集 MR 图像。这意味着与额外的扫描会话相比,QIB 的高频成像在减少患者负担、物流挑战和成本方面变得可行。在治疗前和治疗期间将收集大量有价值的数据,为推进 QIB 研究提供新的机会。本文的目的是提出在 MRIgRT 系统上使用 QIB 的临床应用路线图。最重要的是需要收集并了解 MRIgRT 过程中采集的 QIB 如何与临床结果相关联。由于集成 MRI 扫描仪与传统 MRI 扫描仪不同,因此技术验证是该路线图的重要方面。我们建议通过在试验开始时添加质量保证程序、获取用于评估重复性的体内测试-再测试数据以及比较 MRIgRT 系统和诊断 MRI 系统的 QIB 来将技术验证与临床试验相结合,以评估可重复性。这些数据可以在患者的额外时间有限的情况下收集。通过将技术验证集成到临床试验中,从 MRIgRT 系统得出的这些试验结果也将适用于其他 MRI 系统的测量。