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Trimodal Therapy Using an MR–guided Radiation Therapy Partial Bladder Tumor Boost in Muscle Invasive Bladder Cancer

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العنوان: Trimodal Therapy Using an MR–guided Radiation Therapy Partial Bladder Tumor Boost in Muscle Invasive Bladder Cancer
المؤلفون: Casey Liveringhouse, MD, Alexander Netzley, BS, John M. Bryant, MD, Lauren C. Linkowski, MD, Joseph Weygand, PhD, Maria L. Sandoval, MD, Ammoren Dohm, MD, Marsha Dookhoo, RTT, Stacey Kelley, CMD, Stephen A. Rosenberg, MD, MS, Kujtim Latifi, PhD, Javier F. Torres-Roca, MD, Peter A.S. Johnstone, MD, Kosj Yamoah, MD, PhD, G. Daniel Grass, MD, PhD
المصدر: Advances in Radiation Oncology, Vol 8, Iss 6, Pp 101268- (2023)
بيانات النشر: Elsevier, 2023.
سنة النشر: 2023
المجموعة: LCC:Medical physics. Medical radiology. Nuclear medicine
LCC:Neoplasms. Tumors. Oncology. Including cancer and carcinogens
مصطلحات موضوعية: Medical physics. Medical radiology. Nuclear medicine, R895-920, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
الوصف: Purpose: Bladder preservation with trimodal therapy (TMT; maximal tumor resection followed by chemoradiation) is an effective paradigm for select patients with muscle invasive bladder cancer. We report our institutional experience of a TMT protocol using nonadaptive magnetic resonance imaging–guided radiation therapy (MRgRT) for partial bladder boost (PBB). Methods and Materials: A retrospective analysis was performed on consecutive patients with nonmetastatic muscle invasive bladder cancer who were treated with TMT using MRgRT between 2019 and 2022. Patients underwent intensity modulated RT-based nonadaptive MRgRT PBB contoured on True fast imaging with steady state precession (FISP) images (full bladder) followed sequentially by computed tomography–based RT to the whole empty bladder and pelvic lymph nodes with concurrent chemotherapy. MRgRT treatment time, table shifts, and dosimetric parameters of target coverage and normal tissue exposure were described. Prospectively assessed acute and late genitourinary and gastrointestinal (GI) toxicity were reported. Two-year local control was assessed with Kaplan-Meier methods. Results: Seventeen patients were identified for analysis. PBB planning target volume margins were ≤8 mm in 94% (n = 16) of cases. Dosimetric target coverage parameters were favorable and all normal tissue dose constraints were met. For MRgRT PBB fractions, median table shifts were 0.4 cm (range, 0-3.15), 0.45 cm (0-2.65), and 0.75 cm (0-4.8) in the X, Y, and Z planes, respectively. Median treatment time for MRgRT PBB fractions was 9 minutes (range, 6.9-17.4). We identified 32 out of 100 total MRgRT fractions that may have benefitted from online adaptation based on changes in organ position relative to planning target volume, predominantly because of small bowel (13/32, 41%) or rectum (8/32, 25%). Two patients discontinued RT prematurely. The incidence of highest-grade acute genitourinary toxicity was 1 to 2 (69%) and 3 (6%), whereas the incidence of acute GI toxicity was 1 to 2 (81%) and 3 (6%). There were no late grade 3 events; 17.6% had late grade 2 cystitis and none had late GI toxicity. With median follow-up of 18.2 months (95% CI, 12.4-22.5), the local control rate was 92%, and no patient has required salvage cystectomy. Conclusions: Nonadaptive MRgRT PBB is feasible with favorable dosimetry and low resource utilization. Larger studies are needed to evaluate for potential benefits in toxicity and local control associated with this approach in comparison to standard treatment techniques.
نوع الوثيقة: article
وصف الملف: electronic resource
اللغة: English
تدمد: 2452-1094
Relation: http://www.sciencedirect.com/science/article/pii/S2452109423000970; https://doaj.org/toc/2452-1094
DOI: 10.1016/j.adro.2023.101268
URL الوصول: https://doaj.org/article/739717f0514b4be0b78bbc799d30be49
رقم الانضمام: edsdoj.739717f0514b4be0b78bbc799d30be49
قاعدة البيانات: Directory of Open Access Journals
الوصف
تدمد:24521094
DOI:10.1016/j.adro.2023.101268