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Magnetic Resonance Imaging-Guided Radiotherapy for Cervix Cancer Response Monitoring and Treatment Adaptation

Michael Velec

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Canadian Institutes of Health Research (CIHR)
Radiotherapy is a primary treatment modality for cervix cancers. Serious radiation toxicity occurs in up to 20% of patients however. Standard radiotherapy dose plans typically encompass the whole pelvis and are based on a single pre-treatment image. Over the month long treatment course, substantial unpredictable pelvic organ motion and tumour regression has been observed with magnetic resonance imaging (MRI). Standard non-MRI images acquired at each treatment session are insufficient to visualize this motion and soft tissue anatomy in detail, preventing the use of dose-shaping techniques that could reduce normal tissue doses and toxicity. A state of the art facility has been developed which integrates a standard treatment unit with a diagnostic MRI scanner allowing for detailed anatomic assessment at each radiotherapy session. The current research program will use individual patient organ motion and tumour responses seen on MRI to adapt radiation dose plans as the treatment course progresses. To make this feasible in the clinical setting, automated processes will be developed and evaluated to minimize the prohibitive workload required. These processes include developing reliable tools to automatically identify treatment targets and normal tissues on MRI and to incorporate organ motion into calculations of the actual doses delivered to the patient. This strategy is expected to result in more precise tumour targeting and significantly reduced doses to healthy normal tissues. This research will facilitate the implementation of trials for adaptive radiotherapy that may reduce toxicity and improve local control in patients. Future investigations with this platform will integrate MRI-based biological response monitoring to personalize radiotherapy and improve the prediction of patient outcomes.

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