Dosimetric analysis of stereotactic body radiation therapy for pancreatic cancer using MR-guided Tri-60Co unit, MR-guided LINAC, and conventional LINAC-based plans

Stephen James Ramey, Kyle R. Padgett, Narottam Lamichhane, Hanmath J. Neboori, Deukwoo Kwon, Eric A. Mellon, Karen Brown, Melissa Duffy, James Victoria, Nesrin Dogan, Lorraine Portelance

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Purpose: This study aims to perform a dosimetric comparison of 2 magnetic resonance (MR)-guided radiation therapy systems capable of performing online adaptive radiation therapy versus a conventional radiation therapy system for pancreas stereotactic body radiation therapy. Methods and materials: Ten cases of patients with pancreatic adenocarcinoma previously treated in our institution were used for this analysis. MR-guided tri-cobalt 60 therapy (MR-cobalt) and MR-LINAC plans were generated and compared with conventional LINAC (volumetric modulated arc therapy) plans. The prescription dose was 40 Gy in 5 fractions covering 95% of the planning tumor volume for the 30 plans. The same organs at risk (OARs) dose constraints were used in all plans. Dose-volume–based indices were used to compare PTV coverage and OAR sparing. Results: The conformity index of 40 Gy in 5 fractions covering 95% of the planning tumor volume demonstrated higher conformity in both LINAC-based plans compared with MR-cobalt plans. Although there was no difference in mean conformity index between LINAC and MR-LINAC plans (1.08 in both), there was a large difference between LINAC and MR-cobalt plans (1.08 vs 1.52). Overall, 79%, 72%, and 78% of critical structure dosimetric constraints were met with LINAC, MR-cobalt, and MR-LINAC plans, respectively. The MR-cobalt plans delivered more doses to all OARs compared with the LINAC plans. In contrast, the doses to the OARs of the MR-LINAC plans were similar to LINAC plans except in 2 cases: liver mean dose (MR-LINAC, 2.8 Gy vs LINAC, 2.1 Gy) and volume of duodenum receiving at least 15 Gy (MR-LINAC, 13.2 mL vs LINAC, 15.4 mL). Both differences are likely not clinically significant. Conclusion: This study demonstrates that dosimetrically similar plans were achieved with conventional LINAC and MR-LINAC, whereas doses to OARs were statistically higher for MR-cobalt compared with conventional LINAC plans because of low-dose spillage. Given the improved tumor-tracking capabilities of MR-LINAC, further studies should evaluate potential benefits of adaptive radiation therapy–capable MR-guided LINAC treatment.

Original languageEnglish (US)
Pages (from-to)e312-e321
JournalPractical Radiation Oncology
Issue number5
StatePublished - Sep 1 2018

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging


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