Linkowski Lauren C, Sim Austin J, Redler Gage, Brohl Andrew S, Rosenberg Stephen A, Wuthrick Evan J
Radiation Oncology, University of South Florida Morsani College of Medicine, Tampa, USA.
Department of Radiation Oncology, James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, USA.
Cureus. 2022 Aug 1;14(8):e27558. doi: 10.7759/cureus.27558. eCollection 2022 Aug.
MRI-guided radiation therapy (MRgRT) enables real-time imaging during treatment and daily online adaptive planning. It is particularly useful for areas of treatment that have been previously excluded or restricted from ablative doses due to potential damage to adjacent normal tissue. In certain cases, ablative doses to metastatic lesions may be justified and treated with MRgRT using video-assisted gated breath-hold adjustments throughout delivery. The workflow relies on patient biofeedback and auditory cues. A 74-year-old deaf male with a history of prostate cancer status post prostatectomy was found to have an enlarged cervical lymph node, which was excised with histopathology demonstrating Merkel cell carcinoma. Approximately one year after treatment with two cycles of pembrolizumab, which was subsequently discontinued due to toxicity, surveillance imaging demonstrated an enlarging left adrenal nodule. It was initially stable for an additional seven months with pembrolizumab rechallenge but was again found enlarged on subsequent imaging. The patient underwent MRg stereotactic body radiation therapy (MRgSBRT) to a total dose of 60 Gy in five fractions to this isolated site of progression. The patient was equipped with mirrored glasses to view the tracking structure with respect to gating the boundary structure, and the traditional reliance on verbal cues for coaching was reimagined to rely on visual cues instead. Follow-up positron emission tomography/CT (PET/CT) two weeks after treatment demonstrated interval resolution of the left adrenal metastatic nodule and a return to symmetric bilateral adrenal gland metabolic activity. The necessary MRgSBRT treatment for single metastatic lesions near normal tissue structures relies on verbal cues and coaching. However, deaf patients are unable to receive this treatment according to the traditional workflow model. Unique opportunities exist for the implementation of culturally competent care for the Deaf community, relying more heavily on visual cues, in radiation oncology practice.
磁共振成像引导放射治疗（MRgRT）可在治疗期间进行实时成像，并进行每日在线自适应规划。对于因可能损害相邻正常组织而先前被排除或限制接受消融剂量的治疗区域，它特别有用。在某些情况下，对转移性病变进行消融剂量治疗可能是合理的，并可在整个治疗过程中使用视频辅助门控屏气调整的MRgRT进行治疗。该工作流程依赖于患者的生物反馈和听觉提示。一名74岁的失聪男性，有前列腺癌前列腺切除术后病史，发现颈部淋巴结肿大，切除后组织病理学显示为默克尔细胞癌。在用两个周期的帕博利珠单抗治疗后约一年，由于毒性反应随后停药，监测成像显示左肾上腺结节增大。最初在再次使用帕博利珠单抗治疗的另外七个月里病情稳定，但在随后的成像中再次发现增大。该患者接受了MRg立体定向体部放射治疗（MRgSBRT），对这个孤立的进展部位总共给予60 Gy分五次照射。为患者配备了反光眼镜，以便在门控边界结构时查看跟踪结构，并且重新设想了传统上依赖言语提示进行指导的方式，改为依赖视觉提示。治疗两周后的随访正电子发射断层扫描/计算机断层扫描（PET/CT）显示左肾上腺转移性结节间隔期消退，双侧肾上腺代谢活动恢复对称。对于靠近正常组织结构的单个转移性病变，必要的MRgSBRT治疗依赖于言语提示和指导。然而，失聪患者无法按照传统工作流程模式接受这种治疗。在放射肿瘤学实践中，存在着为聋人社区实施更具文化能力护理的独特机会，更多地依赖视觉提示。
