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Page 12 of 23 Thonglert et al. Hepatoma Res 2023;9:40 https://dx.doi.org/10.20517/2394-5079.2023.47

Table 2. Summary of magnetic resonance-guided radiotherapy (MRgRT) studies for patients with intrahepatic cholangiocarcinoma (iCCA)

Pt and tumor Median Local
Author yr Study type Country No.of Pts RT details OS Toxicity
characteristic follow-up control
[60]
Rogowski et al. 2021 Retrospective Germany Primary liver 0.35 T MR Linac system Age: median 66 (range 47-86) 5 mo no local N/A G1: nausea 1 (9%); vomiting 2
study tumor or liver Treatment volume Sex: male 54.5% failure at the (18%);
metastasis 11 - GTV = gross tumor Type of tumor: liver metastasis time of diarrhea 1 (9%)
(iCCA 2) - PTV = GTV + (3-5) mm 8; intrahepatic recurrence of analysis G2+: 0
Dose: BED10 CCA 2; recurrence of GI
- median PTV 84.4 Gy stroma tumor at hepatic hilum
(range 59.5-112.5 Gy) 1
3
- median GTV 147.9 Gy PTV volume: median 39.1 cm
(range 71.7-200.5 Gy) (range 8.3-411.3)
Motion management
- breath-hold respiratory
gating
ART for all patients
Treatment duration: median
53 min (range 46-78)
[67]
Feldman et al. 2019 Retrospective USA Primary liver 0.35 T MR Linac system Sex: male: 65.5% N/A N/A N/A Nausea/vomiting 1 (3%);
study tumor or liver Treatment volume Location: HCC 26; CCA 2; abdominal pain with bloody
metastasis 29 - GTV = gross tumor metastatic colon cancer 1 diarrhea 1 (3%) (brief treatment
(CCA 2) - CTV = GTV + region of Mean liver dose 5.56 Gy (1.39- break and resolved without any
potential microscopic 10.43) intervention)
disease
- PTV = CTV + 5 mm
Dose: 45-50 Gy in 5 F
(except 3 patients treated
with 27-42 Gy in 3 F)
Motion management
-End-exhale: 21
-End-inhale: 6
-Free-breathing: 2
ART: 1
Average treatment times:
34 mins
[68]
Luterstein et al. 2020 Retrospective USA CCA 17 (iCCA 5) 0.35 T tri-60Co MRgRT Age: median 57 yr 15.8 mo 1-yr LC median Acute toxicity
study Treatment volume Sex: male 65% (range 4.5- 85.6% OS 18.5 - G1: nausea 8 (47%); fatigue 4
- GTV = gross tumor Location: hilar 12; intrahepatic 29.9) 2-yr LC mo (24%); abdominal pain 2 (12%);
- CTV = GTV 5 73.3% 1-yr OS shoulder pain 1 (6%)
- PTV = CTV + 3 mm Median size: 25.5 mm (range 76% - G2: 0 (0%)
Dose: median 40 Gy in 5 F 14-37 mm) 2-yr OS - G3: duodenal ulcer with
Motion management: 46.1% perforation 1 (6%)
breath-hold respiratory Late toxicity
gating - G2: gastritis/colitis 1 (6%)
ART was routinely
implemented.
[69]
Rosenberg et al. 2019 Multi- USA Primary liver 0.35 T tri-60Co MRgRT Age: median 70 yr (range 30- 21.2 mo LC 80.4% 1-yr OS GI toxicity