Preliminary application of MR-Linac in breast cancer radiotherapy in a single academic center
Jing Hao, Tang Yu, Tian Yuan, Zhang Ke, Qin Shirui, Cao Ying, Fang Hui, Zhao Xuran, Chen Bo, Song Yongwen, Jin Jing, Liu Yueping, Qi Shunan, Tang Yuan, Lu Ningning, Li Ning, Wang Shulian, Li Yexiong
Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Abstract：Objective To describe a prospective study of pre-operative tumor-bed boost performed at the 1.5 T MR-Linac in combination with adjuvant whole breast irradiation, and a first case, with an accentuation on clinical feasibility and safety. Methods A phase II, single arm study recruiting early stage patients follows a paradigm that first boosts the tumor bed and then undergoes breast conservative surgery in 2 weeks, and last irradiates the whole breast in 6 weeks. The primary endpoint is ≥ grade 2 acute breast toxicity. A 43 years old patient affected by a breast carcinoma, not special type of the right-sided lateral quadrant, staged cT2N0M0, was planned and treated. The dose, 8Gy for one time, was calculated by Monaco on CT simulation images. Both the air electron stream effect (ESE) and the electron return effect (ERE) at the presence of 1.5 T magnetic field were evaluated. During the pre-treatment evaluation, we carried out adaptation-to-position adjustment. Results The normal organ dosimetry is within toleration. The Dmax to the skin, the chin and the right upper arm was 8.44Gy, 28.5cGy and 17.8cGy, respectively. There was no increased toxicity from ERE and ESE, and the treatment was well tolerated without > grade 1 acute toxicity. The patient received breast conservative surgery on day 7 without delayed wound healing. Conclusions This is the first case successfully treated within a clinical trial by pre-operative tumor-bed boost under 1.5 T MR-Linac in our institution. More participants are needed to validate and optimize the paradigm.
Jing Hao,Tang Yu,Tian Yuan et al. Preliminary application of MR-Linac in breast cancer radiotherapy in a single academic center[J]. Chinese Journal of Radiation Oncology, 2022, 31(1): 8-14.
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