Clinical Report: Enhanced MR-guided Pulsed Adaptive Therapy for NSCLC

Overview

This case study presents the use of MR-guided adaptive radiotherapy in a 65-year-old woman with large, inoperable non-small cell lung cancer (NSCLC). The treatment resulted in significant tumor regression and no observed toxicity, highlighting the potential of this innovative approach.

Background

Large, centrally located thoracic lesions often present significant treatment challenges, particularly when they are inoperable and have poor responses to existing therapies. Stereotactic body radiotherapy (SBRT) is limited by toxicity in tumors larger than 5 cm, necessitating the exploration of new treatment strategies. Adaptive radiotherapy (ART) guided by MR-Linac systems offers a promising solution by allowing real-time adjustments to treatment plans based on daily anatomical changes.

Data Highlights

Key Findings

• The patient had a 55 mm tumor in the left lung with 10 intracranial metastases.
• MR-guided adaptive radiotherapy was delivered in 3 fractions of 10 Gy each.
• Significant tumor regression was observed, with size reduction from 79 mm to 17 mm.
• No acute or late toxicity was reported during the treatment.
• Integration of immunotherapy with radiotherapy may enhance treatment response.

Clinical Implications

The use of MR-guided adaptive radiotherapy may improve treatment precision for large, inoperable NSCLC while minimizing toxicity. This approach could potentially enhance the efficacy of concurrent immunotherapy.

Conclusion

This case demonstrates the effectiveness of MR-guided adaptive radiotherapy in managing large NSCLC, warranting further clinical trials to validate these findings in broader patient populations.

Related Resources & Content

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2. The ASCO Post, 2024 -- Accelerated Hypofractionated Chemoradiation With Adaptive SABR Boost in Locally Advanced, Unresectable NSCLC
3. The ASCO Post, 2025 -- Primary Lung Tumor SBRT Followed by Mediastinal Chemoradiotherapy in Locally Advanced NSCLC
4. Non-Small Cell Lung Cancer Treatment (PDQ®) - NCI
5. The HILUS-Trial—a Prospective Nordic Multicenter Phase 2 Study of Ultracentral Lung Tumors Treated With Stereotactic Body Radiotherapy - ScienceDirect
6. The ASCO Post — Primary Lung Tumor SBRT Followed by Concurrent Mediastinal Chemoradiotherapy and Immunotherapy Consolidation in Locally Advanced NSCLC
7. Stereotactic body radiotherapy of central lung tumours using a 1.5 T MR-linac: First clinical experiences
8. Non-Small Cell Lung Cancer Treatment (PDQ®) - NCI
9. The HILUS-Trial—a Prospective Nordic Multicenter Phase 2 Study of Ultracentral Lung Tumors Treated With Stereotactic Body Radiotherapy - ScienceDirect