MR-guided stereotactic radiotherapy for lung cancer: the Utrecht experience and future developments
Dr. Sara Hackett, Clinical physicist, UMCU
Lung cancer is the leading cause of cancer mortality in both the Netherlands and Japan. Radiotherapy (RT) for early-stage lung cancer achieves high rates of tumour control, but RT for central lung tumours is challenging because of radio-sensitive critical structures in the mediastinum situated near the target. The Elekta Unity MR-linac can potentially improve sparing of these mediastinal structures by adapting RT delivery to the anatomy at the time of treatment. MR-guided RT for central lung tumours was introduced at the University Medical Center Utrecht (UMCU) in 2019, and we have since treated over 20 patients.
This presentation reviews the current workflow used at UMCU for stereotactic MR-guided lung RT. We will look at some of the challenges associated with these treatments, and introduce some of the planned improvements over the next five years, such as (I) gating and (II) tracking of the tumour with the MLCs. In conclusion, MR-guided lung RT has excellent potential to achieve high rates of tumour control with few RT-related complications. Technical developments in the near future could further reduce the risk of injury to radio-sensitive mediastinal structures.