International journal of radiation oncology, biology, physics · 2026
MRI-Guided Reduced-Volume Radiation Therapy for Early-Stage Glottic Cancer:A Prospective Phase 1 Trial With Quantification of Laryngeal Motion.
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Leeman Jonathan E, Droznin Alexander D, Dwyer Christopher D, Shin Kee-Young, Roth Douglas F, Chirmade Sejal, Han Zhaohui, Boyle Sara, Margalit Danielle N, Tishler Roy B, Sethi Rosh K, Annino Donald J, Goguen Laura A, Rettig Eleni M, Haddad Robert I, Uppaluri Ravindra, Mak Raymond H, Carroll Thomas L, Singhrao Kamal, Schoenfeld Jonathan D
Аннотация
PURPOSE: Five to 7 weeks of whole-larynx radiation therapy (RT) is standard for treatment of early-stage glottic cancer. Previous studies evaluated computed tomography-guided hypofractionated or stereotactic treatment to a smaller volume. Magnetic resonance-guided RT (MRgRT) allows real-time motion tracking and gating by continuously imaging the larynx. We performed the first prospective study of MRgRT in patients with early-stage glottic cancer with quantification of laryngeal motion.
METHODS AND MATERIALS: This phase 1 trial evaluated MRgRT in patients with stage I/II squamous cell glottic cancer undergoing definitive RT. The RT prescription was either 42.5 Gy/5 fractions (treatment volume <10 cm3, not actively smoking) or 58.08 Gy/16 fractions (treatment volume >10 cm3/smokers). Treatment was delivered using gated 0.35-T MRgRT with continuous tracking. Coprimary endpoints were feasibility and safety (grade 3+ toxicity rate). Patient-reported outcome measures, voice quality, MRgRT treatment parameters, and local control were assessed. Intrafraction cine-MRI quantified laryngeal motion.
RESULTS: MRgRT was feasible in all patients. Median time on study was 10.9 months. Treatment was well tolerated with no acute or late grade 3+ toxicities. There was no change in patient-reported outcome measures over the course of the study. Two patients who received 42.5 Gy experienced locoregional failure: 1 in-field only and 1 in-field and nodal. MR tracking resulted in 20/94 (21%) of treatment fractions requiring ≥1 shift necessitating intrafraction reimaging. In 19/94 (20%) of treatment fractions, the beam was off for >20% of the treatment time due to stochastic beam-interruption events. During beam-interruption events, larynx displacement exceeded 3 mm in 53% of cine-MRI frames.
CONCLUSIONS: MRgRT targeting gross disease instead of the whole larynx is feasible and safe for patients with early-stage glottic cancer with minimal treatment-associated toxicity and no detriment in patient-reported outcome measures. MRI guidance provides real-time verification of larynx position. Data regarding real-time intrafraction motion has important implications for patients receiving standard laryngeal RT.
METHODS AND MATERIALS: This phase 1 trial evaluated MRgRT in patients with stage I/II squamous cell glottic cancer undergoing definitive RT. The RT prescription was either 42.5 Gy/5 fractions (treatment volume <10 cm3, not actively smoking) or 58.08 Gy/16 fractions (treatment volume >10 cm3/smokers). Treatment was delivered using gated 0.35-T MRgRT with continuous tracking. Coprimary endpoints were feasibility and safety (grade 3+ toxicity rate). Patient-reported outcome measures, voice quality, MRgRT treatment parameters, and local control were assessed. Intrafraction cine-MRI quantified laryngeal motion.
RESULTS: MRgRT was feasible in all patients. Median time on study was 10.9 months. Treatment was well tolerated with no acute or late grade 3+ toxicities. There was no change in patient-reported outcome measures over the course of the study. Two patients who received 42.5 Gy experienced locoregional failure: 1 in-field only and 1 in-field and nodal. MR tracking resulted in 20/94 (21%) of treatment fractions requiring ≥1 shift necessitating intrafraction reimaging. In 19/94 (20%) of treatment fractions, the beam was off for >20% of the treatment time due to stochastic beam-interruption events. During beam-interruption events, larynx displacement exceeded 3 mm in 53% of cine-MRI frames.
CONCLUSIONS: MRgRT targeting gross disease instead of the whole larynx is feasible and safe for patients with early-stage glottic cancer with minimal treatment-associated toxicity and no detriment in patient-reported outcome measures. MRI guidance provides real-time verification of larynx position. Data regarding real-time intrafraction motion has important implications for patients receiving standard laryngeal RT.