MRI-guided Radiotherapy (MRgRT) for Treatment of Oligometastases: Review of Clinical Applications and Challenges

Purpose: Early clinical results on the application of magnetic resonance imaging (MRI) coupled with a linear accelerator to deliver Magnetic Resonance-guided Radiation Therapy (MRgRT) have demonstrated feasibility for safe delivery of stereotactic body radiation therapy in treatment of oligometastatic disease. Here, we set out to review the clinical evidence and challenges associated with MRgRT in this setting. Methods and Materials: We performed a systematic review of the literature pertaining to clinical experiences and trials on the use of MRgRT primarily for the treatment of oligometastatic cancers. We reviewed the opportunities and challenges associated with the use of MRgRT. Results: Benefits of MRgRT pertaining to superior soft-tissue contrast, real-time imaging and gating, and online adaptive radiation therapy facilitate safe and effective dose escalation to oligometastatic tumors while simultaneously sparing surrounding healthy tissues. Challenges concerning further need for clinical evidence and technical considerations related to planning, delivery, quality assurance of hypofractionated doses, and safety in the MRI environment must be considered. Conclusions: The promising early indications of safety and effectiveness of MRgRT for stereotactic body radiation therapybased treatment of oligometastatic disease in multiple treatment locations should lead to further clinical evidence to demonstrate the benefit of this technology. (c) 2022 Elsevier Inc. All rights reserved.

Automated summary

The combination of MRI and linear accelerator in MRgRT for the treatment of oligometastatic diseases has shown promising early results in terms of safety and effectiveness. The benefits include superior soft-tissue contrast, real-time imaging, and online adaptive radiation therapy. However, there are challenges regarding the need for further clinical evidence and technical considerations.