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

Autor: Regnery S; Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.; National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.; Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, Heidelberg, Germany.; National Center for Tumor diseases (NCT), Heidelberg, Germany.; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany., de Colle C; Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany., Eze C; Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany., Corradini S; Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany., Thieke C; Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany., Sedlaczek O; Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany., Schlemmer HP; Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany., Dinkel J; Department of Radiology, LMU Munich, Munich, Germany., Seith F; Department of Radiology, University Hospital Tübingen, Tübingen, Germany., Kopp-Schneider A; Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany., Gillmann C; Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany., Renkamp CK; Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.; National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany., Landry G; Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany., Thorwarth D; Section for Biomedical Physics, Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany., Zips D; Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany., Belka C; Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany., Jäkel O; National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.; Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, Heidelberg, Germany.; National Center for Tumor diseases (NCT), Heidelberg, Germany.; Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany., Debus J; Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.; National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.; Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, Heidelberg, Germany.; National Center for Tumor diseases (NCT), Heidelberg, Germany.; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany., Hörner-Rieber J; Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. Juliane.Hoerner-Rieber@med.uni-heidelberg.de.; National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. Juliane.Hoerner-Rieber@med.uni-heidelberg.de.; Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, Heidelberg, Germany. Juliane.Hoerner-Rieber@med.uni-heidelberg.de.; National Center for Tumor diseases (NCT), Heidelberg, Germany. Juliane.Hoerner-Rieber@med.uni-heidelberg.de.; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany. Juliane.Hoerner-Rieber@med.uni-heidelberg.de.
Jazyk: angličtina
Zdroj: Radiation oncology (London, England) [Radiat Oncol] 2023 May 04; Vol. 18 (1), pp. 74. Date of Electronic Publication: 2023 May 04.
DOI: 10.1186/s13014-023-02258-9
Abstrakt: 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®, View Ray Inc. and Elekta Unity®, 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.
Trial Registration: ClinicalTrials.gov: NCT05237453 .
(© 2023. The Author(s).)
Databáze: MEDLINE
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