The goal of this clinical trial is to compare a new way of using magnetic resonance-guided adaptive radiation therapy (MRgART) to the standard of care linear accelerator (LINAC) radiation treatment in people with cancer in the thoracic region near the heart.
The main question it aims to answer is whether MRgART affects the heart differently than LINAC.
Participants will:
* Receive radiation therapy * Undergo MRIs and bloodwork * Complete quality of life questionnaires
Age > 18 years at the time of consent.
Dosimetric eligibility criteria met using endpoints from QUANTEC (>10% of heart receives > 25 Gy) as determined through rapid auto-planning
Stage IIB, IIIA, IIIB, IIIC, or IV non-operable non-small cell lung cancer
Limited stage small cell lung cancer, once daily treatment (excluding twice per day fractionation schemes). Stage I-III N0-2 disease esophageal/esophagogastric cancer
Definitive clinical or radiologic evidence of metastatic disease with life expectancy <12 months
Prior thoracic radiotherapy significantly overlapping the heart region
Contraindications to MRI
Severe, active co-morbidity defined as follows: New York Heart Association Functional Classification III/IV are not eligible.
Parallel
MRgART
RadiationMagnetic Resonance-guided Adaptive Radiation Therapy (MRgART) is a form of MRgRT that incorporates daily adaptive planning, or making a new treatment plan each treatment, and real-time imaging during treatment delivery.
LINAC
RadiationDaily 3D x-ray scans will be obtained for radiation delivery to confirm tumor and organ at risk placement.
Change in left ventricular ejection fraction (LVEF)
Changes are measured between timepoints as determined by cardiac MRI. LVEF is calculated by dividing the left ventricular (LV) stroke volume (the amount of blood pumped out) by the end-diastolic volume (the amount of blood in the left ventricle before contraction) and multiplying by 100.
Change in right ventricular function (RVEF)
Changes are measured between timepoints as determined by cardiac MRI. RVEF is calculated by dividing the right ventricular (RV) stroke volume (the amount of blood pumped out) by the end-diastolic volume (the amount of blood in the right ventricle before contraction) and multiplying by 100.
Change in left and right ventricular (LV/RV) volumes
Volumes of LV and RV chamber - each derived from tracing the endocardial borders at end-diastole and end-systole in a cardiac MRI scan.
Change in myocardial strain
Myocardial strain measures how much the heart muscle stretches or contracts during a heartbeat. Strain is measured on cardiac MRI images by tracking myocardial deformation using feature tracking techniques, which analyze changes in myocardial length or orientation between end-diastole and end-systole to calculate strain values.
Change in T1 Mapping
By acquiring a series of images at different inversion times (Modified Look-Locker Inversion recovery sequence), the longitudinal relaxation time of myocardial tissue on a pixel-by-pixel basis to derive the T1 map.
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University of Wisconsin, Madison
Lead sponsor
National Heart, Lung, and Blood Institute (NHLBI)
Collaborator
