SMART ablation of lymphatic oligometastases in the pelvis and abdomen

• Verfasst von: Regnery, Sebastian [VerfasserIn]
• Verfasst von: Buchele, Carolin [VerfasserIn]
• Verfasst von: Piskorski, Lars [VerfasserIn]
• Verfasst von: Weykamp, Fabian [VerfasserIn]
• Verfasst von: Held, Thomas [VerfasserIn]
• Verfasst von: Eichkorn, Tanja [VerfasserIn]
• Verfasst von: Rippke, Carolin [VerfasserIn]
• Verfasst von: Renkamp, Claudia Katharina [VerfasserIn]
• Verfasst von: Klüter, Sebastian [VerfasserIn]
• Verfasst von: Ristau, Jonas [VerfasserIn]
• Verfasst von: König, Laila [VerfasserIn]
• Verfasst von: Körber, Stefan A. [VerfasserIn]
• Verfasst von: Adeberg, Sebastian [VerfasserIn]
• Verfasst von: Debus, Jürgen [VerfasserIn]
• Verfasst von: Hörner-Rieber, Juliane [VerfasserIn]
• Titel: SMART ablation of lymphatic oligometastases in the pelvis and abdomen
• Titelzusatz: clinical and dosimetry outcomes
• Verf.angabe: Sebastian Regnery, Carolin Buchele, Lars Piskorski, Fabian Weykamp, Thomas Held, Tanja Eichkorn, Carolin Rippke, C. Katharina Renkamp, Sebastian Klüter, Jonas Ristau, Laila König, Stefan A. Koerber, Sebastian Adeberg, Jürgen Debus, Juliane Hörner-Rieber
• E-Jahr: 2022
• Jahr: 2 February 2022
• Umfang: 7 S.
• Fussnoten: Gesehen am 24.10.2022
• Titel Quelle: Enthalten in: Radiotherapy and oncology
• Ort Quelle: Amsterdam [u.a.] : Elsevier Science, 1983
• Jahr Quelle: 2022
• Band/Heft Quelle: 168(2022), Seite 106-112
• ISSN Quelle: 1879-0887
• DOI: doi:10.1016/j.radonc.2022.01.038
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Image-guided radiotherapy (IGRT)
• Sach-SW: Lymphatic metastasis
• Sach-SW: Magnetic resonance imaging (MRI)
• Sach-SW: Pelvic neoplasms
• Sach-SW: Prostate cancer
• Sach-SW: Stereotactic body radiotherapy (SBRT)
• K10plus-PPN: 1819801594

Abstract

Purpose - To demonstrate dosimetry benefits and report clinical outcomes of stereotactic magnetic resonance (MR)-guided online adaptive radiotherapy (SMART) of abdominopelvic lymphatic oligometastases. - Patients & Methods - Prospective registry data of 26 patients with 31 oligoprogressive lymphatic metastases (1-2 lesions) who received SMART between April 2020 and April 2021 was analyzed. Prostate cancer was the most common histology (69%). Most patients (63%) had received previous abdominopelvic radiotherapy (RT). SMART was delivered in 3-7 fractions based on planning target volume (PTV) location and previous dose exposures. For SMART, the baseline plan was recalculated on daily 3D MR-imaging (predicted plan), and plan adaptation was mandatory in case of planning objective violations. - Results - Plan adaptation was mostly performed due to violation of planning objectives in the predicted plan (134/140 fractions, 96%) and significantly improved plan dosimetry: (1) PTV coverage was increased (predicted: median 89%, adapted: median 95%, p < 0.001), (2) organs-at-risk (OAR) overdoses were reduced (predicted: 27/140 (19%), adapted: 1/140 (1%), p < 0.001) and (3) PTV overdoses were reduced (predicted: 21/140 (15%), adapted: 1/140 (1%), p < 0.001). After a median follow-up of 9.8 months, one patient had in-field tumor progression and twelve patients had out-field tumor progression (at 6 months: progression-free survival: 63% [46-88%], local control rate: 97% [90-100%]). Treatment was tolerated well and no grade ≥3 toxicity was reported. - Conclusion - SMART improves target volume coverage and yields superior OAR protection compared to non-adaptive radiotherapy, thus representing an innovative approach to challenging cases, such as repeated radiotherapy.