The integration of magnetic resonance imaging (MRI) with linear accelerators (LAAs) will revolutionize the treatment of central nervous system (CNS) tumors. This cutting-edge approach aims to improve the precision of radiotherapy and significantly reduce neurotoxicity by tailoring treatment plans based on daily anatomical changes. This innovation could be a game-changer for patients with CNS tumors, offering them more personalized and effective therapy.
Researchers at the H. Lee Moffitt Cancer Center and Research Institute, led by Dr. John Bryant and Dr. Daniel Oliver, have explored the potential of MRIs to improve the treatment of central nervous system tumors. Published in the journal Cancers, their review highlights how MRI’s superior soft tissue contrast helps accurately visualize tumors and nearby organs at risk. This allows for real-time adjustments to radiation therapy, ensuring precise dose delivery and minimizing damage to healthy tissue.
Dr. Bryant highlighted the transformative potential of this technology: “MRI provides excellent visualization of central nervous system tumors due to its superior soft tissue contrast, making it essential in the diagnosis and treatment planning of these malignancies.” This technology enables magnetic resonance-guided adaptive radiation therapy (MRgRT), allowing physicians to modify treatment plans on a daily basis based on the latest anatomical data.
An important application of MRLs discussed in the study is the treatment of glioblastoma (GBM), one of the most aggressive brain tumors. By adapting the treatment plan throughout therapy, physicians can account for changes in tumor size and position. A prospective study involving a large number of GBM patients revealed substantial anatomical changes during treatment, underscoring the need for adaptive planning to maintain treatment precision and efficacy.
Furthermore, the study explores the use of MRL in stereotactic radiotherapy (SRT) for both intracranial and spinal tumors. The improved precision offered by MRL-guided SRT reduces morbidity compared to conventional methods. Feasibility studies have shown promising results for hippocampal-sparing whole brain radiotherapy (HA-WBRT), which aims to minimize cognitive side effects while effectively targeting tumors.
The study also details the capabilities of the two commercially available MRL systems: ViewRay MRIdian and Elekta Unity. These systems have demonstrated significant improvements in dosimetry and treatment planning, demonstrating the potential to reduce radiation exposure to healthy tissue while maintaining effective tumor control.
The ongoing clinical trials highlighted in the study aim to further validate these benefits, with the hope of establishing LMRs as a standard tool in the treatment of central nervous system tumors. “Our goal is to provide evidence-based support for widespread adoption of LMRs in clinical practice,” said Dr. Oliver.
Looking ahead, the study suggests that integrating multiparametric magnetic resonance imaging (mpMRI) and genomically guided radiotherapy could further improve the precision and efficacy of treatments for central nervous system tumors. These advances hold the promise of tailoring treatments to the unique biological characteristics of each patient’s tumor, potentially leading to improved outcomes.
In summary, the integration of MRI with linear accelerators marks a significant advance in the treatment of central nervous system tumors. Dr. Bryant, Dr. Oliver, and their colleagues are optimistic that as research continues and clinical trials confirm these findings, linear accelerators are on the cusp of becoming a crucial tool in combating central nervous system malignancies.
Journal reference
Bryant, John Michael, et al. “Treatment of central nervous system tumors with a combination of linear accelerators and magnetic resonance imaging: a review of current practice and future directions.” Cancers 2023, 15, 5200. DOI: https://doi.org/10.3390/cancers15215200
About the authors
Dr. John Michael Bryant is the Chief Resident Physician at the H. Lee Moffitt Cancer Center and Research Institute. His research focuses on the development and translation of advanced technologies to improve cancer patient outcomes, particularly in MRI-guided radiation therapy, deep neural networks for clinical outcome prediction, and advanced nanomaterials for oncotherapeutic applications. In addition to his research, he is dedicated to improving the integration of research into clinical practice. As co-founder and chair of the Canopy Cancer Collective Resident and Fellow Committee, he has coordinated collaborative research efforts at 14 leading cancer centers. As he transitions to attending physician status, he aims to continue leveraging advanced technologies to improve clinical outcomes and advance the field of radiation oncology.
Dr. Daniel Oliver Dr. Oliver is an attending member of the Neuro-Oncology and Supportive Care Section of the Department of Radiation Oncology at Moffitt Cancer Center. Prior to medical school, Dr. Oliver served on the music (cello) faculties of the University of Alaska-Fairbanks and Emory University. He received his medical degree from Emory University School of Medicine and completed a residency in radiation oncology at Moffitt Cancer Center/University of South Florida. Dr. Oliver’s clinical interests focus on the use of stereotactic and conventional radiation therapy to treat patients with primary and metastatic tumors of the brain and spine. His research interests focus on improving outcomes in early metastatic disease through a multidisciplinary treatment approach and advanced radiation therapy techniques.
Ajay Doniparti Ajay is a fourth-year medical student at the University of South Florida. He grew up in Brookfield, Wisconsin and earned a Bachelor of Science in Biomedical Engineering from the University of Miami. He then completed a Master of Science with a concentration in Translational Biomedical Engineering at Northwestern University. He spent time as an engineering intern at Baxter completing R&D projects in the dialysis and disposable medical device divisions. Ajay is currently pursuing a career in vascular surgery. As he begins his clinical journey, he is excited to explore new frontiers in medicine and ultimately translate these discoveries into tangible advancements that positively impact patient outcomes.
Dr. Stephen Rosenberg Dr. Rosenberg is the Director of MRI-Guided Radiation Therapy and an Associate Member at Moffitt Cancer Center in the Department of Radiation Oncology. He grew up in Medford, New Jersey and graduated from Brown University with a Bachelor of Science in Biology. He earned a Master of Science in Clinical and Translational Research from Rutgers University in combination with his Medical Degree. During medical school, he was named a Howard Hughes Medical Institute Research Scholar. He then completed his medical internship at Memorial Sloan Kettering Cancer Center where he was named the Suzanne Munson Intern of the Year. He completed his residency in radiation oncology at the University of Wisconsin where he also served as Chief Resident. Dr. Rosenberg’s clinical focus is the treatment of patients with thoracic malignancies. He is interested in combining radiation with immunomodulatory drugs and targeted therapies to improve outcomes. Dr. Rosenberg also conducts research with a special focus on MRI-guided radiation. He is interested in using radiomics and genomics as part of his research efforts. His work is part of the departmental research program FORT (Future of Radiotherapy) which aims to personalize radiotherapy using novel approaches to improve local control of tumors and decrease side effects for patients.
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