Price Alex T, Schiff Joshua P, Laugeman Eric, Maraghechi Borna, Schmidt Matthew, Zhu Tong, Reynoso Francisco, Hao Yao, Kim Taeho, Morris Eric, Zhao Xiaodong, Hugo Geoffrey D, Vlacich Gregory, DeSelm Carl J, Samson Pamela P, Baumann Brian C, Badiyan Shahed N, Robinson Clifford G, Kim Hyun, Henke Lauren E
University Hospitals/Case Western Reserve University, Department of Radiation Oncology, Cleveland, OH, USA.
Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA.
Clin Transl Radiat Oncol. 2023 Jul 22;42:100661. doi: 10.1016/j.ctro.2023.100661. eCollection 2023 Sep.
Our institution was the first in the world to clinically implement MR-guided adaptive radiotherapy (MRgART) in 2014. In 2021, we installed a CT-guided adaptive radiotherapy (CTgART) unit, becoming one of the first clinics in the world to build a dual-modality ART clinic. Herein we review factors that lead to the development of a high-volume dual-modality ART program and treatment census over an initial, one-year period.
The clinical adaptive service at our institution is enabled with both MRgART (MRIdian, ViewRay, Inc, Mountain View, CA) and CTgART (ETHOS, Varian Medical Systems, Palo Alto, CA) platforms. We analyzed patient and treatment information including disease sites treated, radiation dose and fractionation, and treatment times for patients on these two platforms. Additionally, we reviewed our institutional workflow for creating, verifying, and implementing a new adaptive workflow on either platform.
From October 2021 to September 2022, 256 patients were treated with adaptive intent at our institution, 186 with MRgART and 70 with CTgART. The majority (106/186) of patients treated with MRgART had pancreatic cancer, and the most common sites treated with CTgART were pelvis (23/70) and abdomen (20/70). 93.0% of treatments on the MRgART platform were stereotactic body radiotherapy (SBRT), whereas only 72.9% of treatments on the CTgART platform were SBRT. Abdominal gated cases were allotted a longer time on the CTgART platform compared to the MRgART platform, whereas pelvic cases were allotted a shorter time on the CTgART platform when compared to the MRgART platform. Our adaptive implementation technique has led to six open clinical trials using MRgART and seven using CTgART.
We demonstrate the successful development of a dual platform ART program in our clinic. Ongoing efforts are needed to continue the development and integration of ART across platforms and disease sites to maximize access and evidence for this technique worldwide.
我们机构于2014年在世界上率先临床实施磁共振引导的自适应放疗（MRgART）。2021年，我们安装了计算机断层扫描引导的自适应放疗（CTgART）设备，成为世界上首批建立双模式自适应放疗诊所的机构之一。在此，我们回顾了在最初的一年时间里，促成高容量双模式自适应放疗项目发展的因素以及治疗情况。
我们机构的临床自适应放疗服务采用了MRgART（MRIdian，ViewRay公司，加利福尼亚州山景城）和CTgART（ETHOS，瓦里安医疗系统公司，加利福尼亚州帕洛阿尔托）平台。我们分析了患者和治疗信息，包括治疗的疾病部位、放射剂量和分割方式以及这两个平台上患者的治疗时间。此外，我们还回顾了我们机构在这两个平台上创建、验证和实施新的自适应放疗流程的工作流程。
从2021年10月到2022年9月，我们机构有256例患者接受了自适应放疗，其中186例采用MRgART，70例采用CTgART。接受MRgART治疗的患者大多数（106/186）患有胰腺癌，接受CTgART治疗的最常见部位是骨盆（23/70）和腹部（20/70）。MRgART平台上93.0%的治疗是立体定向体部放疗（SBRT），而CTgART平台上只有72.9%的治疗是SBRT。与MRgART平台相比，腹部门控病例在CTgART平台上分配的时间更长，而骨盆病例在CTgART平台上分配的时间比MRgART平台短。我们的自适应放疗实施技术促成了六项使用MRgART的开放临床试验和七项使用CTgART的开放临床试验。
我们展示了我们诊所双平台自适应放疗项目的成功发展。需要持续努力，以继续跨平台和疾病部位开展自适应放疗的研发与整合，从而在全球范围内最大限度地推广这项技术并积累相关证据。
