Clinical application of MR-guided radiotherapy based on MR-linac in esophageal cancer patients

Abstract

Abstract:ObjectiveTo explore the application process， efficacy and safety of MR-guided radiotherapy based on MR-linac in esophageal cancer.MethodsThe clinical data of patients with esophageal cancer treated with MR-linac at Shandong Cancer Hospital and Institute from September 2021 to July 2022 were retrospectively analyzed， to investigate the treatment process of esophageal cancer with MR-linac， and to analyze the efficacy and safety of patients. All patients received MR-guided radiotherapy， underwent CT and MR localization， target area delineation， and design of the Monaco treatment planning system plan. Adaptation-to-position adjustment was conducted during the pre-treatment evaluation. The median number of fractions was 25， the median single dose of planning target volume was 1.8 Gy， and the median total dose was 50.2 Gy. Median follow-up was 16 months.ResultsAmong the 12 patients in the whole group， there were 1 case of cervical esophageal cancer， 3 cases of upper thoracic esophageal cancer， 4 cases of middle thoracic esophageal cancer and 4 cases of lower thoracic esophageal cancer， including 3 cases of neoadjuvant radiotherapy and 9 cases of radical radiotherapy. All patients had a smooth treatment process. The median treatment time was 33 min， and the patients had good compliance. For patients with radical radiotherapy， one month after radiotherapy， the number of objective remission cases was 3， and the number of disease-control cases was 9； six months after radiotherapy， the number of objective remission cases was 3， and the number of disease-control cases was 6. All patients treated with neoadjuvant radiotherapy underwent surgery within 2 months， and one patient achieved pathological complete remission. The most common acute adverse reactions were radiation esophagitis （7 cases） and leukopenia in bone marrow suppression （8 cases）， with late-stage adverse reactions being radiation pneumonia （1 case）. The adverse reactions to radiotherapy were slight， and no grade 4 or above adverse reactions were observed.ConclusionThe clinical treatment process for esophageal cancer under MR-guided radiotherapy based on MR-linac is feasible， with good curative effects and mild adverse reactions.

Key words:Esophageal neoplasms,Magnetic resonance imaging,Radiotherapy, image-guided,Treatment outcome

Gao Xinyu, Li Zhenjiang, Sun Hongfu, Han Dan, Zhao Qian, Liu Chengxin, Huang Wei. Clinical application of MR-guided radiotherapy based on MR-linac in esophageal cancer patients[J]. Journal of International Oncology, 2024, 51(1): 37-42.

Figures/Tables4

患者	年龄（岁）	性别	KPS评分（分）	肿瘤部位	肿瘤内镜长度（cm）	病理类型	TNM分期	处方剂量	GTV（cm³）	治疗模式
1	70.0	男	80	下段	4.0	鳞状细胞癌	T₃N₁M₀	1.8 Gy×23次	14.3	新辅助放疗
2	73.0	男	80	中段	5.0	鳞状细胞癌	T₃N₀M₀	2.0 Gy×30次	38.6	术后复发后放疗
3	71.0	女	90	颈段	8.0	鳞状细胞癌	T₄N₁M₁	2.0 Gy×30次	48.0	根治性放疗
4	54.0	男	90	下段	9.0	鳞状细胞癌	T₂N₂M₀	1.8 Gy×23次	85.9	根治性放疗
5	89.0	男	80	上段	8.0	鳞状细胞癌	T₃N₀M₀	1.8 Gy×28次	19.8	根治性放疗
6	49.0	男	90	下段	15.0	鳞状细胞癌	T₃N₀M₀	1.8 Gy×23次	67.2	新辅助放疗
7	46.0	男	90	下段	11.0	黑色素瘤	T₄N₃M₀	1.8 Gy×23次	81.7	新辅助放疗
8	73.0	男	90	中段	8.0	鳞状细胞癌	T₃N₁M₀	1.8 Gy×23次	39.1	根治性放疗
9	63.0	男	90	中段	15.0	鳞状细胞癌	T₃N₂M₁	2.0 Gy×28次	71.7	根治性放疗
10	82.0	男	80	中段	4.0	鳞状细胞癌	T₃N₀M₀	2.5 Gy×25次	6.0	根治性放疗
11	81.0	女	80	上段	8.0	鳞状细胞癌	T₃N₂M₀	1.8 Gy×30次	95.4	根治性放疗
12	70.0	男	90	上段	3.0	鳞状细胞癌	T₂N₂M₁	2.0 Gy×25次	6.5	根治性放疗

不良反应	级别	合计
放射性食管炎	7	0	0	7
放射性皮炎	2	0	0	2
白细胞计数减少	1	4	3	8
中性粒细胞计数减少	3	2	1	6
血小板计数减少	4	0	0	4
贫血	3	0	0	3

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