Ma Chi, Wang Xiao, Nie Ke, Xiong Zhenyu, Xu Keying, Yue Ning, Zhang Yin
Department of Radiation Oncology, Rutgers Cancer Institute, New Brunswick, NJ, United States.
Front Oncol. 2025 Jul 1;15:1622060. doi: 10.3389/fonc.2025.1622060. eCollection 2025.
Magnetic resonance-guided radiotherapy (MRgRT) represents a significant advancement in lung cancer treatment, integrating non-ionizing high-resolution magnetic resonance imaging (MRI) with linear accelerators to enable real-time tumor visualization and adaptive treatment planning. This review highlights recent advancements in MRgRT technology and explores its clinical applications, particularly in managing lung cancer patients. MRgRT has proven particularly advantageous in stereotactic body radiotherapy (SBRT) treatment for lung cancer, where motion management is critical due to respiratory-induced tumor motion. Real-time tumor monitoring and online adaptive plan modifications ensure target accuracy, reduce margins, and mitigate radiation-induced toxicity. Additionally, MRgRT could potentially allow multileaf collimator (MLC) tracking to further improve the treatment efficiency. Recent technological innovations, including AI-powered auto-contouring algorithms, deep-learning (DL) based prediction models, and adaptive treatment strategies, further optimize MRgRT by improving workflow efficiency and reducing treatment time. Despite these benefits, the widespread adoption of MRgRT is challenged by high infrastructure costs, prolonged treatment time, and the need for specialized expertise. Ongoing research is addressing these challenges through workflow optimization, remote treatment models, and AI-driven decision support systems. As MRgRT technology continues to evolve, its integration with functional imaging, radiomics, and adaptive protocols is expected to expand its applications beyond lung cancer treatment. MRgRT represents a paradigm shift in precision oncology, delivering personalized care. Future research and prospective clinical trials should be warranted to generate high-quality clinical evidence supporting MRgRT's clinical adoption for lung cancer patient management. As these advancements progress, MRgRT is poised to transform the future of lung cancer treatment.
磁共振引导放疗（MRgRT）是肺癌治疗领域的一项重大进展，它将非电离高分辨率磁共振成像（MRI）与直线加速器相结合，实现肿瘤的实时可视化和适应性治疗计划。本综述重点介绍了MRgRT技术的最新进展，并探讨了其临床应用，特别是在肺癌患者管理中的应用。事实证明，MRgRT在肺癌的立体定向体部放疗（SBRT）中具有特别的优势，在这种治疗中，由于呼吸引起的肿瘤运动，运动管理至关重要。实时肿瘤监测和在线适应性计划调整可确保靶区准确性、减少边界并减轻放射毒性。此外，MRgRT可能允许多叶准直器（MLC）跟踪，以进一步提高治疗效率。包括人工智能驱动的自动轮廓算法、基于深度学习（DL）的预测模型和适应性治疗策略在内的最新技术创新，通过提高工作流程效率和减少治疗时间，进一步优化了MRgRT。尽管有这些好处，但MRgRT的广泛应用受到高基础设施成本、延长的治疗时间以及对专业知识的需求的挑战。正在进行的研究通过工作流程优化、远程治疗模式和人工智能驱动的决策支持系统来应对这些挑战。随着MRgRT技术的不断发展，其与功能成像、放射组学和适应性方案的整合有望将其应用扩展到肺癌治疗之外。MRgRT代表了精准肿瘤学的范式转变，提供个性化医疗。未来的研究和前瞻性临床试验应确保产生高质量的临床证据，支持MRgRT在肺癌患者管理中的临床应用。随着这些进展的推进，MRgRT有望改变肺癌治疗的未来。
