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Magnetresonanzgeführte Strahlentherapie

Beginn einer neuen Ära in der Radioonkologie?

Magnetic-resonance-guided radiotherapy

The beginning of a new era in radiation oncology?

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Zusammenfassung

Klinisches Problem

Die bildgeführte Radiotherapie („image-guided radiotherapy“, IGRT) mittels Röntgen oder Cone-beam-Computertomographie (CT) war ein wesentlicher Entwicklungsschritt auf dem Weg zu hochpräzisen Bestrahlungstechniken. Inter- und intrafraktionelle Lageveränderungen der Zielvolumina und radiosensibler Risikoorgane stellen weiterhin einen limitierenden Faktor dar und können das Erreichen einer hohen Dosis im Tumor bei geringer Risikoorganbelastung erschweren.

Neue Verfahren

An Hybridgeräten, welche einen Linearbeschleuniger direkt mit einem integrierten Magnetresonanztomographen kombinieren, ist nun die Bestrahlung von Patienten unter Live-Bildgebung mittels MRT möglich.

Leistungsfähigkeit

Diese Systeme bieten neben einem deutlich verbesserten Weichgewebekontrast erstmals die Möglichkeit der online-adaptiven Radiotherapie. Hierbei kann der Bestrahlungsplan täglich, während der Patient auf dem Tisch liegt, an Veränderungen des Tumors und der umliegenden Risikoorgane angepasst werden, um eine noch bessere Schonung der Risikoorgane bei gleichzeitiger Dosiseskalation zur Optimierung der Tumorkontrolle zu ermöglichen.

Bewertung

In dieser Übersichtsarbeit werden die zugrundeliegende Motivation für die Entwicklung der MR-geführten Radiotherapie, technische Herausforderungen und der aktuelle Stand der Systeme dargestellt. Zudem werden das klinische Potenzial und mögliche weitere Entwicklungen aufgezeigt.

Empfehlung für die Praxis

Die zunehmende Verfügbarkeit der MRT-Bildgebung an Linearbeschleunigern erfordert hohe diagnostische Kompetenz. Hierfür ist eine enge Zusammenarbeit und gegenseitiges Lernen von Radiologie und Radioonkologie unerlässlich.

Abstract

Clinical issue

Image-guided radiotherapy (IGRT) using X‑rays and cone-beam computed tomography (CT) has fostered precision radiotherapy. However, inter- and intrafractional variations of target volume position and organs at risk still limit target volume dose and sparing of radiosensitive organs at risk.

Methodological innovations

Hybrid machines directly combining linear accelerators and magnetic resonance (MR) imaging allow for live imaging during radiotherapy.

Performance

Besides highly improved soft tissue contrast, MR-linacs enable online, on-table adaptive radiotherapy. Thus, adaptation of the treatment plan to the anatomy of the day, dose escalation and superior sparing of organs at risk become possible.

Achievements

This article summarizes the underlying intention for the development of MR-guided radiotherapy, technical innovations and challenges as well as the current state-of-the-art. Potential clinical benefits and future developments are discussed.

Practical recommendations

Increasing availability of MR imaging at linear accelerators calls for the ability to review and interpret MR images. Therefore, close collaborations of diagnostic radiologists and radiation oncologists are mandatory to foster this fascinating technique.

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Authors and Affiliations

  1. Klinik für Radioonkologie und Strahlentherapie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland

    P. Hoegen, C. K. Spindeldreier, C. Buchele, C. Rippke, S. Regnery, F. Weykamp, S. Klüter, J. Debus &  J. Hörner-Rieber

  2. Heidelberger Institut für Radiooncology (HIRO), Heidelberg, Deutschland

    P. Hoegen, C. K. Spindeldreier, C. Buchele, C. Rippke, S. Regnery, F. Weykamp, S. Klüter, J. Debus &  J. Hörner-Rieber

  3. Nationales Centrum für Tumorerkrankungen (NCT), Heidelberg, Deutschland

    P. Hoegen, S. Regnery, F. Weykamp, J. Debus &  J. Hörner-Rieber

  4. Clinical Cooperation Unit Radiation Oncology, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland

    P. Hoegen, J. Debus &  J. Hörner-Rieber

  5. Heidelberger Ionenstrahl-Therapiezentrum (HIT), Klinik für Radioonkologie und Strahlentherapie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    J. Debus

  6. Standort Heidelberg, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Heidelberg, Deutschland

    J. Debus

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  1. P. Hoegen
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Corresponding author

Correspondence to J. Hörner-Rieber.

Ethics declarations

Interessenkonflikt

P. Hoegen erhielt Reisekostenerstattungen von AstraZeneca und hält Aktien an Novocure ohne Bezug zur eingereichten Arbeit. S. Regnery wird durch das Physician-Scientist Programm der Medizinischen Fakultät Heidelberg gefördert. S. Klüter erhielt Vortragshonorare und Reisekostenerstattungen von ViewRay Inc. J. Debus erhielt Drittmittel von CRI – The Clinical Research Institute GmbH, View Ray Inc., Accuray International, Accuray Incorporated, RaySearch Laboratories AB, Vision RT limited, Astellas Pharma GmbH, Merck Serono GmbH, Astra Zeneca GmbH, Solution Akademie GmbH, Ergomed PLC Surrey Research Park, Siemens Healthcare GmbH, Quintiles GmbH, Pharmaceutecal Research Associates GmbH, Boehringer Ingelheim Pharma GmbH Co, PTW-Freiburg Dr. Pychlau GmbH, Nanobiotix A.A. und IntraOP Medical ohne Bezug zum eingereichten Manuskript. J. Hörner-Rieber erhielt Vortragshonorare und Reiskeostenerstattungen von ViewRay Inc, wie auch Reisekostenerstattungen von IntraOP Medical und Elekta Instrument AB ohne Bezug zur eingereichten Arbeit. C. K. Spindeldreier, C. Buchele, C. Rippke und F. Weykamp geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Hoegen, P., Spindeldreier, C.K., Buchele, C. et al. Magnetresonanzgeführte Strahlentherapie. Radiologe 61, 13–20 (2021). https://doi.org/10.1007/s00117-020-00761-8

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