Pulmonary magnetic resonance-guided online adaptive radiotherapy of locally advanced: the PUMA trial

被引：13

作者：

Regnery, Sebastian ^{[1
,2
,3
,4
,5
]}

de Colle, Chiara ^{[6
]}

Eze, Chukwuka ^{[7
]}

Corradini, Stefanie ^{[7
]}

Thieke, Christian ^{[7
]}

Sedlaczek, Oliver ^{[8
]}

Schlemmer, Heinz-Peter ^{[8
]}

Dinkel, Julien ^{[9
]}

Seith, Ferdinand ^{[10
]}

Kopp-Schneider, Annette ^{[11
]}

Gillmann, Clarissa ^{[12
]}

Renkamp, C. Katharina ^{[1
,2
]}

Landry, Guillaume ^{[7
]}

Thorwarth, Daniela ^{[13
]}

Zips, Daniel ^{[6
]}

Belka, Claus ^{[7
]}

Jaekel, Oliver ^{[2
,3
,4
,12
]}

Debus, Juergen ^{[1
,2
,3
,4
,5
]}

Hoerner-Rieber, Juliane ^{[1
,2
,3
,4
,5
]}

机构：

[1] Heidelberg Univ Hosp, Dept Radiat Oncol, Neuenheimer Feld 400, D-69120 Heidelberg, Germany

[2] Heidelberg Inst Radiat Oncol HIRO, Natl Ctr Radiat Oncol NCRO, Neuenheimer Feld 400, D-69120 Heidelberg, Germany

[3] Heidelberg Univ Hosp, Heidelberg Ion Beam Therapy Ctr HIT, Dept Radiat Oncol, Heidelberg, Germany

[4] Natl Ctr Tumor Dis NCT, Heidelberg, Germany

[5] German Canc Res Ctr, Clin Cooperat Unit Radiat Oncol, Heidelberg, Germany

[6] Univ Hosp Tubingen, Dept Radiat Oncol, Tubingen, Germany

[7] Ludwig Maximilians Univ Munchen, Univ Hosp, Dept Radiat Oncol, Munich, Germany

[8] German Canc Res Ctr, Div Radiol, Heidelberg, Germany

[9] Ludwig Maximilians Univ Munchen, Dept Radiol, Munich, Germany

[10] Univ Hosp Tubingen, Dept Radiol, Tubingen, Germany

[11] German Canc Res Ctr, Div Biostat, Heidelberg, Germany

[12] German Canc Res Ctr, Div Med Phys Radiat Oncol, Heidelberg, Germany

[13] Univ Hosp Tubingen, Dept Radiat Oncol, Sect Biomed Phys, Tubingen, Germany

来源：

RADIATION ONCOLOGY | 2023年 / 18卷 / 01期

关键词：

Non-small-cell lung carcinoma; Lung Cancer; Image-guided Radiotherapy; MRI; MR-guided Radiotherapy; Adaptation; Gating; Feasibility study; CELL LUNG-CANCER; INTENSITY-MODULATED RADIOTHERAPY; RADIATION-THERAPY SMART; DOSE-ESCALATION; CONCURRENT; SURVIVAL; CHEMORADIOTHERAPY; CHEMORADIATION; CHEMOTHERAPY; TOXICITY;

D O I：

10.1186/s13014-023-02258-9

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Background Patients with locally-advanced non-small-cell lung cancer (LA-NSCLC) are often ineligible for surgery, so that definitive chemoradiotherapy (CRT) represents the treatment of choice. Nevertheless, long-term tumor control is often not achieved. Intensification of radiotherapy (RT) to improve locoregional tumor control is limited by the detrimental effect of higher radiation exposure of thoracic organs-at-risk (OAR). This narrow therapeutic ratio may be expanded by exploiting the advantages of magnetic resonance (MR) linear accelerators, mainly the online adaptation of the treatment plan to the current anatomy based on daily acquired MR images. However, MR-guidance is both labor-intensive and increases treatment times, which raises the question of its clinical feasibility to treat LA-NSCLC. Therefore, the PUMA trial was designed as a prospective, multicenter phase I trial to demonstrate the clinical feasibility of MR-guided online adaptive RT in LA-NSCLC. Methods Thirty patients with LA-NSCLC in stage III A- C will be accrued at three German university hospitals to receive MR-guided online adaptive RT at two different MR-linac systems (MRIdian Linac (R), View Ray Inc. and Elekta Unity (R), Elekta AB) with concurrent chemotherapy. Conventionally fractioned RT with isotoxic dose escalation up to 70 Gy is applied. Online plan adaptation is performed once weekly or in case of major anatomical changes. Patients are followed-up by thoracic CT- and MR-imaging for 24 months after treatment. The primary endpoint is twofold: (1) successfully completed online adapted fractions, (2) on-table time. Main secondary endpoints include adaptation frequency, toxicity, local tumor control, progression-free and overall survival. Discussion PUMA aims to demonstrate the clinical feasibility of MR-guided online adaptive RT of LA-NSCLC. If successful, PUMA will be followed by a clinical phase II trial that further investigates the clinical benefits of this approach. Moreover, PUMA is part of a large multidisciplinary project to develop MR-guidance techniques.

引用

页数：8