Michael Chuong, MD, FACRO, Vice Chair and Medical Director of Radiation Oncology at Baptist Health and Professor of Radiation Oncology at Florida International University, shared on LinkedIn:
“It is hard to believe that our Baptist Health MR guided radiation therapy program using the ViewRay Systems, Inc. MRIdian Linac has been treating patients for nearly a decade.
What we treat, and how we treat, has evolved substantially over that time. Our program now focuses predominantly on complex mobile tumors, particularly in the upper abdomen especially pancreatic cancer, using highly ablative radiation doses typically delivered in just 1 or 5 fractions.
These treatments leverage real time soft tissue tracking, automatic beam gating, and online adaptation to safely deliver doses that would be difficult to replicate with conventional treatment approaches.
One of the longstanding perceptions of MR-guided radiation therapy is that it is extremely slow, perhaps even impractically so. Longer treatment times have been a legitimate concern and have likely contributed to the limited adoption of this technology.
We retrospectively evaluated our first 8 years of clinical experience, which included 1,026 patients, 1,203 treatment courses, and 7,665 fractions. That publication is now in press at Cancers MDPI:
Over time, our treatments became progressively more complex, with substantially greater use of SBRT, online adaptation, respiratory gating, and treatment of pancreatic tumors with large elective volumes.
Despite this increasing complexity, median in room time for online adaptive treatments decreased from 67 to 48 minutes, while the time required for the adaptive process itself decreased from 20 to just 7 minutes. Nearly 80% of adaptive treatments in the later era were completed in fewer than 60 minutes.
The improvement likely reflects a combination of technology upgrades, standardization of our adaptive workflows, parallelization of tasks, and the accumulated experience of a high volume multidisciplinary team.
I expect MRgRT treatment efficiency to improve considerably further over the next 3-5 years, particularly as AI becomes increasingly integrated into contouring, treatment planning, quality assurance, and other components of the adaptive workflow.
The question will increasingly shift from whether online adaptation can be performed efficiently to how much of the process can be safely automated.”
Title: Longitudinal Improvements in Treatment Delivery Efficiency for MR-Guided Radiation Therapy: An 8-Year Single-Institution Experience
Authors: Robert A. Herrera, Sirikorn Unsri, Kathryn E. Mittauer, Rupesh Kotecha, Adeel Kaiser, Matthew D. Hall, Yongsook C. Lee, Yonatan Weiss, Tatiana Bejarano, Eyub Y. Akdemir, Mattison J. Flakus, Nikolai Strusberg-Fernandez, Ranjini Tolakanahalli, Nema Bassiri, Maria Ayala, Noah S. Kalman, Diane Alvarez, Tino Romaguera, Minesh P. Mehta, Alonso N. Gutierrez, Michael D. Chuong
You can also read: Check out the new review just published in Cancers MDPI on Tumor Mutational Burden in Breast Cancer – Dana-Farber’s Breast Oncology Center
