Neoplasms

Respiratory Tract (Lung and Bronchial) Diseases

All Conditions

Digestive System Diseases

Gland and Hormone Related Diseases

Rare Diseases

Carcinoma, Non-Small-Cell Lung

Carcinoma

Lung Neoplasms

Small Cell Lung Carcinoma

Carcinoma, Hepatocellular

Pancreatic Neoplasms

Liver Neoplasms

Respiratory Tract Neoplasms

Thoracic Neoplasms

Lung Diseases

Respiratory Tract Diseases

Carcinoma, Bronchogenic

Bronchial Neoplasms

Small Cell Lung Cancer

Pancreatic Cancer

Bile Duct Cancer

Gallbladder Cancer

MR Imaging

Amit Sawant

Paul J Keall

This study aims to investigate and optimize imaging sequences and parameters of rapid real-time MRI in order to obtain adequate guidance for accurately and precisely delivering radiation to moving abdominal and thoracic tumors.

Accurate dose delivery remains one of the weakest aspects of radiotherapy, especially in the case of thoracic and abdominal tumors, where significant patient motion occurs during dose delivery (intrafraction motion). Such motion results in geometric and dosimetric uncertainties that compromise treatment quality. Effective management of intrafraction motion is therefore key to realizing the full potential of modern image-guided radiation therapy (IGRT). While external markers have been found to be well-correlated with internal anatomy within an imaging session, there is no guarantee that these correlations will continue to exist and be constant throughout the course of the therapy. In general, implanted, radio-opaque seeds have been found to be more reliable than external markers. However, implantation of fiducials, whether radio-opaque or electromagnetic, is necessarily invasive and carries with it the risk of associated complications - an issue that becomes especially important for cancer patients with weakened immune systems. Currently, MR imaging is the only modality that is non-invasive and provides high quality volumetric information for the whole body.

The "ideal" intrafraction motion management requires complete spatio-temporal knowledge of the irradiated anatomy. However, to date, there is no clinical method of directly visualizing the tumor volume during dose delivery. Most techniques rely on external or internal surrogate markers which often provide (usually non-volumetric) information of limited accuracy and reliability. In addition, internal markers impose significant "costs" on the patient in terms of interventional complications and increased imaging dose. In this work, we investigate the feasibility of using in-room, fast cine MR imaging as a non-invasive means to provide real-time, soft-tissue-based, volumetric image guidance for continuous monitoring of the target and surrounding anatomy. To date, there has been no systematic investigation of the imaging requirements of an integrated MRI+linac for the specific task of real-time radiotherapy guidance.

Feasibility of Using Real-time Cine-MRI for Treating Moving & Deforming Tumors

Investigating the Feasibility of Using Real-time Cine-MRI for Treating Moving and Deforming Tumors

The American Association of Physicists in Medicine

Stanford University

Mesothelioma

Mesothelioma, Malignant

Adenoma

Neoplasms, Glandular and Epithelial

Neoplasms by Histologic Type

Neoplasms, Mesothelial

Malignant Mesothelioma

Pharmaceutical Solutions

All Drugs and Chemicals

Micronutrients

Anti-Infective Agents

Iodine

Cadexomer iodine

stereotactic body radiation therapy \& pulmonary interstitial lymphography

Standard of care diagnostic radiotherapy procedure

Stereotactic Body Radiation Therapy (SBRT)

For each participant, 3 chest CT scans will be obtained, 1 before and 2 after interstitial injection of the water-soluble contrast

Computed Tomography (CT)

Linear accelerator for producing high energy x-rays for radiation therapy.

Cyberknife

Trilogy

True Beam

Aqueous solution of a nonionic, water-soluble radiographic contrast medium in prefilled cartridges with a molecular weight of 821.14 (iodine content 46.36%), available at 140, 180, 240, 300, and 350 mgI/mL.

Iohexol

Aqueous solution of a nonionic, water-soluble, dimeric, isosmolar, radiographic contrast medium with a molecular weight of 1550.20 (iodine content 49.1%), available in 2 concentrations, (270 mgI/mL and 320 mgI/mL.

Iodixanol

Billy W Loo, Jr, MD, PhD

Jonathan Abelson, MD

The stereotactic body radiation therapy (SBRT) procedure is an emerging alternative to the standard treatment for early stage non-small cell lung cancer (NSCLC), typically lobectomy with lymphadenectomy. This procedure (lobectomy) does not fulfill the medical need as many patients are poor operative candidates or decline surgery.

This study assesses the feasibility of stereotactic body radiation therapy (SBRT) as a tool to produce therapeutically useful computed tomography (CT) scans, using standard water-soluble iodinated compounds as the contrast agents.

Non-small cell lung cancer (NSCLC) is the most deadly cancer in the world. NSCLC annually causes 150,000 deaths in the US and greater than 1 million worldwide. The standard treatment for early stage NSCLC is lobectomy with lymphadenectomy. However, many patients are poor operative candidates or decline surgery. An emerging alternative is Stereotactic Body Radiation Therapy (SBRT). Mounting evidence from phase 1-2 studies demonstrates that SBRT offers excellent local control. Most SBRT trials focused on small, peripheral tumors in inoperable patients. Increasingly, clinical trials study SBRT in operable patients, often with larger, central tumors.

Using clinical staging, a significant proportion of patients harbor occult nodal metastases when undergoing SBRT to the primary tumor alone. Subgroups of patients carry even higher risk of nodal metastases. These nodal metastases frequently would be removed by surgical intervention. However, SBRT, at present, is only directed at the primary tumor, potentially leading to regional failures in otherwise curable patients. To increase the effectiveness of SBRT for lung tumors, the next logical step is to explore whether the highest risk areas of disease spread can be identified and targeted. Regional failure could be reduced and outcome improved in a significant proportion of patients treated with SBRT if the primary nodal drainage (PND) were identified, targeted and treated in addition to the primary tumor.

We propose to conduct a study to determine the feasibility of visualizing, by computed tomography (CT) scans, water-soluble iodinated contrast materials after direct injection into the tumor. Integration into radiation therapy treatment planning may also be assessed.

Pulmonary Interstitial Lymphography in Early Stage Lung Cancer

Associate Professor of Radiation Oncology

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Feasibility of Using Real-time Cine-MRI for Treating Moving & Deforming Tumors	NCT01071434	Pancreatic Canc... Liver Cancer Lung Cancer Lung Cancer Non... Lung Cancer Sma... Hepatobiliary C... Hepatobiliary C... Hepatobiliary C... Hepatobiliary C... Hepatobiliary C...	MR Imaging	18 Years -	Stanford University
Pulmonary Interstitial Lymphography in Early Stage Lung Cancer	NCT01188486	Lung Cancer Lung Cancer Non... Lung Cancer Sma... Mesothelioma	Stereotactic Bo... Computed Tomogr... Cyberknife Trilogy True Beam Iohexol Iodixanol	18 Years -	Stanford University
Pulmonary Interstitial Lymphography in Early Stage Lung Cancer	NCT01188486	Lung Cancer Lung Cancer Non... Lung Cancer Sma... Mesothelioma	Stereotactic Bo... Computed Tomogr... Cyberknife Trilogy True Beam Iohexol Iodixanol	18 Years -	Stanford University

Spots Global Cancer Trial Database for lung cancer small cell lung cancer (sclc)