2724 - Prospective Multi-Institutional Outcomes Using a 1.5 Tesla MR Linac in the Treatment of Adrenal Metastatic Lesions with Stereotactic Ablative Body Radiation (SABR), A Report from the MOMENTUM Study
Presenter(s)
D. C. Demircioglu1, L. A. Daamen2, T. Schytte3, U. Bernchou4, H. Tan5, M. Velec6, C. Gani7, F. Alongi8, M. E. Nowee9, P. Jeene10, P. B. Renz11, M. Luzzara12, J. P. Christodouleas13, K. Orrling14, E. S. Paulson15, H. Verkooijen16, and W. A. Hall15; 1Medical College of Wisconsin, Milwaukee, WI, 2Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands, 3Department of Oncology, Odense University Hospital, Odense, Denmark, 4Department of Clinical Research, University of Southern Denmark, Odense, Denmark, 5Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada, 6Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada, 7Department of Radiation Oncology, University Hospital and Medical Faculty Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany, 8Varian, Milpitas, CA, Uganda, 9Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, Netherlands, 10Radiotherapiegroep, Deventer, Netherlands, 11Allegheny Health Network Cancer Institute, Department of Radiation Oncology, Pittsburgh, PA, 12Elekta S.p.A., Agrate Brianza (MB), Italy, 13Elekta, Stockholm, Sweden, 14Lygature, Utrecht, Netherlands, 15Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, 16University Medical Center Utrecht, Utrecht, Netherlands
Purpose/Objective(s): SABR is a well-established procedure for the treatment of metastatic lesions to the adrenal gland. However, intra-treatment localization of these lesions is often difficult on cone beam CT. In this regard, MRI guided SABR presents a compelling and novel treatment strategy. However, the safety and tolerance of treating adrenal metastatic lesions using a 1.5 Tesla MR Linac remains poorly understood. To address this question, we prospectively collected clinical outcomes and patient reported quality of life (QOL) in patients with adrenal metastatic lesions treated on a 1.5T MR Linac.
Materials/Methods: Patients who met inclusion criteria for the Multiple OutcoMe EvaluatioN of radiation Therapy Using the MR-linac Study (MOMENTUM, NCT04075305) were prospectively enrolled across a total of ten institutions globally. All patients were treated using one of two techniques: Adapt to shape (ATS) or adapt to position (ATP). Toxicities were measured using CTCAE with severe adverse events being defined as greater than or equal to grade 3. Overall survival was calculated using a Kaplan-Meier analysis. Patient reported QOL was measured using the EORTC QLQ-C-30 instrument.
Results: 139 patients had adrenal metastatic lesions. The primary tumor originated from the lungs (89), kidney (16), skin (7), colon (6), and other (21). Mean patient age was 67.5 years and 43.9% of patients were female. Fractionation schedules ranged from 3-10 and prescription doses ranged from 25-50 Gy. The majority of patients (79.1 %) were treated with daily adaptation using ATS. The majority of patients (97.8%) completed their treatment course. There were only two cases of grade 3 fatigue at 1 year. Otherwise, no severe adverse events were recorded. Median overall survival (OS) was 18.7 months (95% CI, 12.2–23.6). 1-year %OS was 63.2% (95% CI 53.5–74.6) and 2-year %OS was 34.8% (95% CI 24.9–48.7). Approximately 42% of patients completed pre-treatment QOL questionnaires, and at 24 months this had declined to 35%. Across the various domains assessed by the EORTC QLC-C-30 such as global health score, global functioning, role functioning, cognitive functioning, fatigue, and nausea/vomiting, the one QOL indicator that demonstrated consistent, but modest decline, was fatigue.
Conclusion: 1.5T MR guided SABR is a well-tolerated modality with very minimal patient reported toxicity. Amongst the patients in our series that completed QOL questionnaires, QOL was well preserved.