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Radiation Oncology and Pancreatic Cancer: A New Era with MR-Guided Therapy
6 min. read
Baptist Health Cancer Care
Pancreatic cancer is one of the most challenging cancers to treat due to its aggressive nature, late diagnosis, and its position near critical organs. For years, radiation therapy was limited in its ability to treat pancreatic tumors effectively without harming surrounding tissues.
However, MR (magnetic resonance)-guided therapy is transforming the treatment landscape for pancreatic cancer.
In a recent Doc-to-Doc Baptist HealthTalk Podcast, The Future of Radiation Oncology and Pancreatic Cancer, two Baptist Health experts in the field are featured: Kathryn Mittauer, Ph.D., DABR, senior medical physicist with Baptist Health Miami Cancer Institute & Associate Professor at Florida International University (FIU) Herbert Wertheim College of Medicine; and Adeel Kaiser, M.D., radiation oncologist at the Institute and clinical associate professor at FIU’s Herbert Wertheim College of Medicine.
Miami Cancer Institute is part of Baptist Health Cancer Care, which includes the Eugene M. & Christine E. Lynn Cancer Institute at Boca Raton Regional Hospital. Lynn Cancer Institute offers some of the most advanced radiation treatments available, including ViewRay MRIdian® MRI-guided radiation therapy. Only a select number of cancer centers in the U.S. have this sophisticated radiation therapy system.
MR-Guided Radiation Therapy Overcomes Previous Limitations
For many years, pancreatic cancer treatment faced a significant hurdle: the inability to safely deliver high doses of radiation to the tumor without damaging surrounding critical structures. “Prior to MR-guided treatment, we had severe limitations in the doses that we could give to our pancreatic patients. As a consequence of that, outcomes were very poor,” explains Dr. Kaiser.
Before the advent of MR-guided technology, studies showed two-year survival rates for pancreatic cancer patients were about 20 to 30 percent. However, a landmark study demonstrated that escalating the radiation dose could improve survival rates, with the two-year survival improving to about one-third of patients.
Dr. Kaiser notes that the key challenge was, and still is, the tumor’s close proximity to organs like the duodenum and small bowel. “Most patients cannot get that higher dose of radiation safely because the pancreatic tumor is stuck adjacent to critical organs,” Dr. Kaiser says.
But the introduction of MR-guided radiation therapy became a game-changer. It uses magnetic resonance imaging to track the tumor's position in real time, allowing oncologists to deliver high doses of radiation with unprecedented precision. This capability has led to significant improvements in survival.
“With MR-guided radiation therapy, now we have the capability to actually safely deliver high doses of radiation to those tumors,” says Dr. Kaiser. This approach has dramatically improved survival rates for patients, with the SMART trial showing a more than 50 percent improvement in two-year survival rates for patients treated with MR-guided therapy.
A Precision Approach: Adaptive Radiation Therapy
One of the major advantages of MR-guided radiation therapy is its ability to adapt treatment plans on a daily basis. Traditional radiation treatment used fixed plans that were created based on initial imaging, but these plans often failed to account for daily changes in the tumor's position or the anatomy surrounding it. MR-guided therapy, on the other hand, allows for “adaptive radiotherapy,” where the radiation plan is adjusted each day based on the patient’s anatomy at the time of treatment.
Dr. Mittauer explains: “At Miami Cancer Institute, we evaluate plan quality and an important part is the robustness of the adaptive plan. We found that we have equivalent plan quality for the on-table adaptive plan done in 20 minutes, compared to an initial plan that took eight days to create." This adaptability allows for better precision in delivering radiation, which is particularly critical for pancreatic cancer patients, where even small shifts in tumor location can impact treatment effectiveness.
MR-guided therapy also minimizes the risk of delivering radiation to healthy tissues. “We can track the radiation target and leverage the patient’s feedback to ensure the tumor is in the right position at the right time,” Dr. Kaiser adds. This ability to monitor and adjust during treatment means that radiation is delivered more safely and efficiently than ever before.
Improved Patient Selection and Safety
The potential of MR-guided radiation therapy is also realized in better patient selection. Traditionally, radiation oncologists had to rely on specific anatomical criteria to select patients who could safely receive high-dose radiation.
MR-guided radiation therapy removes many of these limitations. As Dr. Kaiser explains, “With MR guidance, we can adjust for the positioning of these critical radio-sensitive structures and safely deliver high-dose radiation. Now, we can treat a much wider group of patients.” Even in cases where the tumor is in close proximity to these sensitive areas, MR-guided therapy can track the tumor's position in real time, minimizing the risk of damage to adjacent organs.
Additionally, MR-guided radiation does not require the use of fiducial markers, which were previously implanted in patients to help guide radiation delivery.
“We’re able to track the tumor directly,” says Dr. Mittauer. “We no longer need to implant fiducials, which were invasive and often led to additional patient discomfort. This direct tracking with MRI makes the whole process more efficient and less invasive.”
Tracking and Real-Time Adjustments
Another groundbreaking feature of MR-guided radiation therapy is its ability to track tumor motion in real time, particularly during respiration. In pancreatic cancer, the tumor can shift with the patient’s breathing, which can complicate treatment planning. However, with MR-guided therapy, the tumor is continuously tracked as the patient breathes, and radiation is delivered when the tumor is in the right position. “We want the patient to inhale at just the right spot so that the tumor overlaps with the target structure,” Dr. Kaiser explains. “This visual cue helps the patient hold their breath at the correct moment, ensuring precise radiation delivery.”
Dr. Mittauer further elaborates: “We’re using soft tissue imaging to visualize the tumor and surrounding structures without extra radiation doses. This allows us to track the tumor, watch for any deformations, and adjust the radiation plan if necessary during treatment.” The ability to make real-time adjustments based on patient feedback ensures that the radiation dose is delivered accurately and safely.
Real-World Results: Outcomes and Toxicity
MR-guided radiation therapy has not only improved survival rates -- but also reduced the incidence of side effects. One of the most common concerns with pancreatic cancer treatment is the potential for gastrointestinal (GI) toxicity, as radiation can damage sensitive organs like the stomach and small bowel.
“The new MR-guided approach has resulted in fewer GI toxicities. By delivering radiation more precisely, we are sparing normal organs and improving the patient’s quality of life,” Dr. Kaiser notes.
Dr. Mittauer agrees: “We have seen a reduction in GI toxicities, and patients are experiencing better overall outcomes.” The precision of MR-guided therapy minimizes damage to healthy tissues, which means that patients experience fewer side effects and recover more quickly.
Looking ahead, Dr. Kaiser sees a future where MR-guided radiation therapy becomes the standard for treating pancreatic cancer. “Ultimately, if you’re given the choice and you have the capability of doing both [MR-guided and traditional radiation], you’re going to choose MR-guided therapy, both because it’s faster, with fewer sessions, and because the results are better,” he says. As the technology becomes more widespread, more centers will be able to offer MR-guided radiation therapy, extending its benefits to more patients.
Dr. Mittauer shares a similar vision: “The technology’s impact goes beyond patient outcomes. It’s more efficient, and it reduces the time patients spend undergoing treatment. This results in better quality of life and faster recovery.”
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