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      The utility of 1.5 tesla MR-guided adaptive stereotactic body radiotherapy for recurrent ovarian tumor – Case reports and review of the literature

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          Abstract

          Introduction

          Although epithelioid ovarian cancer (EOC) is a radiosensitive tumor and radiotherapy (RT) played a significant role in adjuvant treatment management in the past, the role of RT has evolved with the advent of platinum-based chemotherapy regimens. Nonetheless, modern RT techniques may be useful in certain patients particularly those with recurrent disease.

          Presentation of case

          After surgery and chemotherapy, two patients, aged 57 and 70, presented with recurrent lesions in the parailiac region. The recurrent lesions were treated with high field 1.5-Tesla MR-Linac treatment in 5 fractions at a dose of 30 Gy. The patients tolerated the treatment well and were disease free after 12 and 20 months of magnetic resonance guided radiotherapy (MRgRT), respectively.

          Discussion

          MRgRT is a novel and rapidly evolving technology that allows for the highly precise treatment of even mobile targets through direct visualization of the tumor. The majority of patients with EOC frequently present with abdominal-pelvic recurrences. It has been demonstrated that EOC requires high radiation doses for curative treatment. MR-Linac enables monitoring of organ motion during treatment, which is necessary for delivering higher doses to target volumes while sparing surrounding organs.

          Conclusion

          To reduce radiation doses to nearby normal tissues, MRgRT allows for the delivery of hypofractionated RT with tight safety margins. Regardless of initial resistance or gradual development of intolerance to standard chemotherapy regimens, the role of RT in patients with persistent or recurrent EOC should be reconsidered.

          Highlights

          • •

            Abdominal-pelvic region or other distant recurrence is common in ovarian cancer patients.

          • •

            The role of radiotherapy is debatable in ovarian cancer patients due to toxicity.

          • •

            Magnetic resonance guided RT allows direct target visualization during treatment delivery.

          • •

            We present two cases of recurrent ovarian cancer treated with adaptive MRgRT using 1.5 T-MR linac.

          • •

            MRgRT may be an alternative treatment option in patients with persistent or recurrent ovarian cancer.

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          Most cited references12

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          Cancer Statistics, 2021

          Rebecca Siegel, Kimberly D Miller, Hannah Fuchs … (2021)
          Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths in the United States and compiles the most recent data on population-based cancer occurrence. Incidence data (through 2017) were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data (through 2018) were collected by the National Center for Health Statistics. In 2021, 1,898,160 new cancer cases and 608,570 cancer deaths are projected to occur in the United States. After increasing for most of the 20th century, the cancer death rate has fallen continuously from its peak in 1991 through 2018, for a total decline of 31%, because of reductions in smoking and improvements in early detection and treatment. This translates to 3.2 million fewer cancer deaths than would have occurred if peak rates had persisted. Long-term declines in mortality for the 4 leading cancers have halted for prostate cancer and slowed for breast and colorectal cancers, but accelerated for lung cancer, which accounted for almost one-half of the total mortality decline from 2014 to 2018. The pace of the annual decline in lung cancer mortality doubled from 3.1% during 2009 through 2013 to 5.5% during 2014 through 2018 in men, from 1.8% to 4.4% in women, and from 2.4% to 5% overall. This trend coincides with steady declines in incidence (2.2%-2.3%) but rapid gains in survival specifically for nonsmall cell lung cancer (NSCLC). For example, NSCLC 2-year relative survival increased from 34% for persons diagnosed during 2009 through 2010 to 42% during 2015 through 2016, including absolute increases of 5% to 6% for every stage of diagnosis; survival for small cell lung cancer remained at 14% to 15%. Improved treatment accelerated progress against lung cancer and drove a record drop in overall cancer mortality, despite slowing momentum for other common cancers.
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            The SCARE 2020 Guideline: Updating Consensus Surgical CAse REport (SCARE) Guidelines

            Riaz Agha, Thomas Franchi, Catrin Sohrabi … (2020)
            The SCARE Guidelines were first published in 2016 and were last updated in 2018. They provide a structure for reporting surgical case reports and are used and endorsed by authors, journal editors and reviewers, in order to increase robustness and transparency in reporting surgical cases. They must be kept up to date in order to drive forwards reporting quality. As such, we have updated these guidelines via a DELPHI consensus exercise.
            Article 0 comments Cited 4660 times – based on 0 reviews     Review now
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              MR-guidance in clinical reality: current treatment challenges and future perspectives

              S. Corradini, F Alongi, N. Andratschke … (2019)
              Magnetic Resonance-guided radiotherapy (MRgRT) marks the beginning of a new era. MR is a versatile and suitable imaging modality for radiotherapy, as it enables direct visualization of the tumor and the surrounding organs at risk. Moreover, MRgRT provides real-time imaging to characterize and eventually track anatomical motion. Nevertheless, the successful translation of new technologies into clinical practice remains challenging. To date, the initial availability of next-generation hybrid MR-linac (MRL) systems is still limited and therefore, the focus of the present preview was on the initial applicability in current clinical practice and on future perspectives of this new technology for different treatment sites. MRgRT can be considered a groundbreaking new technology that is capable of creating new perspectives towards an individualized, patient-oriented planning and treatment approach, especially due to the ability to use daily online adaptation strategies. Furthermore, MRL systems overcome the limitations of conventional image-guided radiotherapy, especially in soft tissue, where target and organs at risk need accurate definition. Nevertheless, some concerns remain regarding the additional time needed to re-optimize dose distributions online, the reliability of the gating and tracking procedures and the interpretation of functional MR imaging markers and their potential changes during the course of treatment. Due to its continuous technological improvement and rapid clinical large-scale application in several anatomical settings, further studies may confirm the potential disruptive role of MRgRT in the evolving oncological environment.
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                Author and article information

                Contributors
                Cem Onal
                Journal
                Journal ID (nlm-ta): Int J Surg Case Rep
                Journal ID (iso-abbrev): Int J Surg Case Rep
                Title: International Journal of Surgery Case Reports
                Publisher: Elsevier
                ISSN (Electronic): 2210-2612
                Publication date PMC-release: 22 September 2022
                Publication date Collection: October 2022
                Publication date (Electronic): 22 September 2022
                Volume: 99
                Electronic Location Identifier: 107696
                Affiliations
                [a ]Baskent University, School of Medicine, Department of Radiation Oncology, Turkey
                [b ]Baskent University, School of Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Turkey
                [c ]Baskent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Treatment Center, Department of Radiation Oncology, Adana, Turkey
                Author notes
                [* ]Corresponding author at: Department of Radiation Oncology, Adana Dr. Turgut Noyan Research and Treatment Center, Baskent University Faculty of Medicine, 01120 Adana, Turkey. hcemonal@ 123456hotmail.com
                Article
                Publisher Item ID: S2210-2612(22)00942-7 Publisher ID: 107696
                DOI: 10.1016/j.ijscr.2022.107696
                PMC ID: 9568843
                SO-VID: b23d1d7c-d3cc-428e-8ebc-d1ab2eb32930
                Copyright © © 2022 The Authors
                License:

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 6 August 2022
                Date revision received : 19 September 2022
                Date accepted : 19 September 2022
                Categories
                Subject: Case Report

                Keywords: ovarian cancer,oligometastasis,radiotherapy,mr-guided radiotherapy,stereotactic body radiotherapy
                Data availability:
                Keywords: ovarian cancer, oligometastasis, radiotherapy, mr-guided radiotherapy, stereotactic body radiotherapy

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