Zhao Yao, Cozma Adrian, Ding Yao, Perles Luis Augusto, Reiazi Reza, Chen Xinru, Kang Anthony, Prajapati Surendra, Yu Henry, Subashi Ergys David, Brock Kristy, Wang Jihong, Beddar Sam, Lee Belinda, Mohammedsaid Mustefa, Cooper Sian, Westley Rosalyne, Tree Alison, Mohamad Osama, Hassanzadeh Comron, Mok Henry, Choi Seungtaek, Tang Chad, Yang Jinzhong
Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Cancers (Basel). 2024 Nov 27;16(23):3987. doi: 10.3390/cancers16233987.
Advancements in radiotherapy technology now enable the delivery of ablative doses to targets in the upper urinary tract, including primary renal cell carcinoma (RCC) or upper tract urothelial carcinomas (UTUC), and secondary involvement by other histologies. Magnetic resonance imaging-guided linear accelerators (MR-Linacs) have shown promise to further improve the precision and adaptability of stereotactic body radiotherapy (SBRT). This single-institution retrospective study analyzed 34 patients (31 with upper urinary tract non-metastatic primaries [RCC or UTUC] and 3 with metastases of non-genitourinary histology) who received SBRT from August 2020 through September 2024 using a 1.5 Tesla MR-Linac system. Treatment plans were adjusted by using [online settings] for "adapt-to-position" (ATP) and "adapt-to-shape" (ATS) strategies for anatomic changes that developed during treatment; compression belts were used for motion management. The median duration of treatment was 56 min overall and was significantly shorter using the adapt-to-position (ATP) (median 54 min, range 38-97 min) in comparison with adapt-to-shape (ATS) option (median 80, range 53-235 min). Most patients (77%) experienced self-resolving grade 1-2 acute radiation-induced toxicity; none had grade ≥ 3. Three participants (9%) experienced late grade 1-2 toxicity, potentially attributable to SBRT, with one (3%) experiencing grade 3. We conclude that MR-Linac-based SBRT, supported by online plan adaptation, is a feasible, safe, and highly precise treatment modality for the definitive management of select upper urinary tract lesions.
放射治疗技术的进步使得现在能够对上尿路的靶区给予消融剂量，包括原发性肾细胞癌（RCC）或上尿路尿路上皮癌（UTUC），以及其他组织学类型的继发性累及。磁共振成像引导直线加速器（MR-Linacs）已显示出有望进一步提高立体定向体部放射治疗（SBRT）的精度和适应性。这项单机构回顾性研究分析了34例患者（31例上尿路非转移性原发性肿瘤[RCC或UTUC]和3例非泌尿生殖系统组织学类型的转移瘤患者），这些患者在2020年8月至2024年9月期间使用1.5特斯拉MR-Linac系统接受了SBRT治疗。通过使用[在线设置]对治疗期间出现的解剖学变化采用“适应位置”（ATP）和“适应形状”（ATS）策略来调整治疗计划；使用压迫带进行运动管理。总体治疗中位持续时间为56分钟，与“适应形状”（ATS）选项（中位80分钟，范围53 - 235分钟）相比，采用“适应位置”（ATP）时明显更短（中位54分钟，范围38 - 97分钟）。大多数患者（77%）经历了可自行缓解的1 - 2级急性放射诱导毒性；无≥3级毒性。三名参与者（9%）经历了可能归因于SBRT的晚期1 - 2级毒性，其中一名（3%）经历了3级毒性。我们得出结论，基于MR-Linac的SBRT在在线计划调整的支持下，是一种用于特定上尿路病变确定性治疗的可行、安全且高精度的治疗方式。
