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Online Magnetresonanztomographie-geführte und adaptive Strahlentherapie

Neue Möglichkeiten durch technologischen Fortschritt

Online MR-guided and adaptive radiotherapy

New possibilities through technological progress

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best practice onkologie Aims and scope

Zusammenfassung

Die Strahlentherapie ist einer der Eckpfeiler in der Behandlung von onkologischen Erkrankungen mit der stetigen Herausforderung, die erforderliche Dosis in möglichst kurzer Zeit mit maximaler Präzision auf die gewünschten Strukturen zu applizieren und die Normalgewebe hierbei bestmöglich zu schonen. Aufgrund der Lagevariabilität von Tumoren und häufiger Tumorschrumpfung im Verlauf der Strahlentherapie ist die adaptive Strahlentherapie, bei welcher während einer Bestrahlungsserie der Bestrahlungsplan kontinuierlich angepasst wird, eine vielversprechende Entwicklung. Mittels MR-Linac-Hybridgeräten, die einen Linearbeschleuniger und einen Magnetresonanztomographen in einem Gerät vereinen, ist nun auch eine online adaptive magnetresonanztomographiebasierte Strahlentherapie möglich. Die Magnetresonanztomographie (MRT) bietet aufgrund des höheren Weichteilkontrasts die Möglichkeit einer präziseren Definition der Zielstrukturen und Risikoorgane und erlaubt es häufig, höhere Dosen auch in der Nähe von kritischen Strukturen applizieren zu können. So kann Patienten eine effektive, gutverträgliche und nichtinvasive Therapie angeboten werden. Häufige Indikationen für die Bestrahlung an einem MR-Linac sind die Behandlung von Lymphknotenmetastasen, die Behandlung des Prostatakarzinoms, insbesondere mittels Ultrahypofraktionierung, sowie die hochdosierte Bestrahlung von Lebermetastasen und des hepatozellulären Karzinoms ohne Anlage von röntgendichten Markern („fiducials“). Bei Patienten mit frühen Rektumkarzinomen wird eine MRT-geführte adaptive Dosiseskalation untersucht. Die MRT-Komponente ermöglicht zudem die Visualisierung funktioneller MRT-Parameter, welche z. B. bei neuartigen innovativen Konzepten in der Behandlung von Kopf-Hals-Tumoren eingesetzt werden.

Abstract

Radiation therapy is one of the cornerstones in the treatment of oncological diseases. It is associated with the constant challenge of applying the dose to the desired structures in the shortest possible time with maximum precision, while sparing normal tissues as much as possible. Due to the variability in tumor location and tumor shrinkage during the course of radiation therapy, adaptive radiation therapy, in which adjustments are made to the original radiation plan during a radiation series, is a promising development. With MR-LINAC hybrid devices, which combine a linear accelerator and an MRI scanner within a single unit, adaptive MR-based online radiotherapy is now possible. MRI offers the possibility to more accurately define target structures and organs at risk due to higher soft tissue contrast, which often enables delivery of higher doses near critical structures. This allows patients to be offered an effective, well-tolerated, personalized, and noninvasive therapy. Common indications for irradiation at an MR-LINAC include treatment of lymph node metastases, treatment of prostate cancer (particularly using ultrahypofractionation), and high-dose irradiation of liver metastases and hepatocellular carcinoma without the need for placement of fiducial markers. MR-guided adaptive dose escalation is currently being investigated in patients with early rectal cancer. Magnetic resonance imaging also allows visualization of functional parameters, which are employed by novel innovative concepts for the treatment of, e.g., head and neck cancers.

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Authors and Affiliations

  1. Universitätsklinik für Radioonkologie, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland

    Laura Uder, Simon Böke, Daniel Wegener &  Cihan Gani

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  1. Laura Uder
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  2. Simon Böke
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  4. Cihan Gani
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Correspondence to Cihan Gani.

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Interessenkonflikt

Die Universitätsklinik für Radioonkologie Tübingen, und in diesem Rahmen auch C. Gani, L. Uder, S. Böke und D. Wegener, erhält im Rahmen von Forschungskooperationen finanzielle und technische Unterstützung von Elekta, Philips, Siemens, Dr. Sennewald Medizintechnik, Kaiku Health, TheraPanacea, PTW, ITV. Das MR-Linac- Programm wird durch die Deutsche Forschungsgemeinschaft gefördert (DFG ZI 736/2‑1; PAK 997/1: GA 2996/1‑1, ZI 736/4‑1).

Alle beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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David Krug, Kiel

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Uder, L., Böke, S., Wegener, D. et al. Online Magnetresonanztomographie-geführte und adaptive Strahlentherapie. best practice onkologie 17, 530–541 (2022). https://doi.org/10.1007/s11654-022-00440-1

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