MRIdian Stereotactic MRI-Guided Adaptive Radiation Therapy (SMART) is making novel strides in metastatic and primary ultra-central and central lung lesion treatment. This technology, manufactured by ViewRay, Inc. demonstrates real-time image-guidance, small treatment margins and adaptation, with the objective to administer ablative radiation with minimal toxicity in ultra-central/central lung lesions.
Previously, studies surrounding stereotactic body radiation therapy (SBRT) for ultra-central and central lung lesions have reported high rates of toxicity, including reports of fatal Grade 5 toxicities. The HILUS- trial, conducted last year, used non-MRI-guided radiation therapy systems, detecting unacceptable high-grade toxicity when delivering SBRT to ultra-central lung tumors. The trial noted Grade 3-5 toxicity in 22 of the 65 patients, including 10 cases of treatment-related death.
Moffitt researchers conducted a retrospective review of results from 29 patients with MRI-guided SBRT/ hypofractionated radiation therapy with image-guided real-time tracking and automatic beam gating and/or adaptation for ultra-central or central lesions. These findings, which were presented at ESTRO 2022, exhibited the use of MRI-guided SBRT/ hypofractionated RT with high biologically effective doses (BEDs) resulted in excellent oncologic outcomes and only a single Grade 3 toxicity with no Grade 4 or Grade 5.
"From our experience with MRIdian SMART over the past three years, we believed it could be used to safely treat metastatic and primary ultra-central and central lung lesions, providing excellent local control with minimal toxicity. These high-risk lung lesions are challenging to treat with high-dose radiation because of the proximity to critical structures such as the esophagus, major airways and vessels while dealing with significant anatomical motion in the thorax, said Dr. Rosenberg. "However, our findings demonstrate that MRIdian's real-time tumor tracking and automatic beam gating make it possible to accurately deliver an ablative dose with tight margins that may allow us to reduce toxicity to surrounding healthy tissue and spare organs at risk."
Currently, Moffitt is one out of 50 hospitals where MRIdian systems are installed to treat a wide variety of solid tumors and are the focus of numerous ongoing research efforts.
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