{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T16:06:03Z","timestamp":1782489963003,"version":"3.54.5"},"reference-count":22,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T00:00:00Z","timestamp":1765411200000},"content-version":"vor","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Applied Clin Med Phys"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Stereotactic body radiotherapy (SBRT) for pancreatic cancer is limited by the proximity of tumors to gastrointestinal (GI) organs, increasing the risk of toxicity. Magnetic resonance\u2010guided radiotherapy (MRgRT) offers potential advantages through superior soft tissue visualization, real\u2010time tumor tracking, and online adaptive planning. This study aimed to quantitatively compare dosimetric outcomes of pancreatic cancer SBRT using online adaptive MRgRT versus conventional computed tomography\u2010based image\u2010guided radiotherapy (CT\u2010IGRT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A retrospective dosimetric analysis was conducted on 100 plans from 10 patients with primary (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a03) or recurrent (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a07) pancreatic adenocarcinoma treated between July 2021 and December 2022 at UZ Brussel. Treatment included 80 adaptive MRgRT fractions, 10 initial MR plans, and 10 CT\u2010based volumetric\u2010modulated arc therapy (VMAT) plans using an internal target volume (ITV) approach. All patients were treated on the MRIdian system with daily online adaptation and real\u2010time beam gating. Dosimetric endpoints included target coverage, plan quality metrics, and organ\u2010at\u2010risk (OAR) doses. Statistical comparisons were performed using Wilcoxon signed\u2010rank tests.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      MRgRT significantly reduced target volumes compared to CT\u2010IGRT (median gross tumor volume (GTV): 40.65 cc vs. 62.56 cc;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.005; median planning target volume (PTV): 64.4 cc vs. 94.4 cc;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.005) and improved dose coverage of both GTV and PTV. Intermediate dose spillage (R50%) was also lower with MRgRT (5.18\u00a0vs. 6.56,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.04). MRgRT plans provided superior sparing of critical GI OARs, with median D\n                      <jats:sub>5cc<\/jats:sub>\n                      relative dose reductions of 42% to the small bowel (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.02), 23% to the duodenum (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.02), and 13% to the stomach (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.01). No significant differences were observed for the liver, kidneys, or large bowel. Treatment was well tolerated, with only grade I\u2013II toxicities reported.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>MR\u2010guided adaptive SBRT demonstrated dosimetric superiority over CT\u2010IGRT in pancreatic cancer, with improved target coverage and enhanced GI OAR sparing. These findings support the use of MRgRT to expand the therapeutic window for safe dose escalation. Prospective studies are warranted to confirm clinical benefits.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70391","type":"journal-article","created":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T08:45:51Z","timestamp":1765442751000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Online adaptive MR\u2010guided SBRT versus CT\u2010based planning in pancreatic cancer: A single\u2010center dosimetric comparative study"],"prefix":"10.1002","volume":"26","author":[{"given":"Randa","family":"Kamel","sequence":"first","affiliation":[{"name":"Faculteit Geneeskunde en Farmacie Vrije Universiteit Brussel, Jette Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4556-5681","authenticated-orcid":false,"given":"Thierry","family":"Gevaert","sequence":"additional","affiliation":[{"name":"Radiation Oncology Department Universitair Ziekenhuis Brussel Vrije Universiteit Brussel, Jette  Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Van den Berge","sequence":"additional","affiliation":[{"name":"Radiation Oncology Department Universitair Ziekenhuis Brussel Vrije Universiteit Brussel, Jette  Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"De Ridder","sequence":"additional","affiliation":[{"name":"Radiation Oncology Department Universitair Ziekenhuis Brussel Vrije Universiteit Brussel, Jette  Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,12,11]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"National Comprehensive Cancer Network.NCCN clinical practice guidelines in oncology: pancreatic adenocarcinoma. Version 3.2024 [Internet].NCCN;2024[Cited 2024 December 31]. Available from:https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/pancreatic.pdf"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2024.42.16_suppl.4005"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.4324"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.21037\/apc.2018.07.03"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prro.2020.01.012"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000005080"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2017.11.032"},{"key":"e_1_2_10_9_1","doi-asserted-by":"crossref","unstructured":"ChuongMD BryantJ MittauerKE et\u00a0al.Ablative 5\u2010fraction stereotactic magnetic resonance\u2010guided radiation therapy with on\u2010table adaptive replanning and elective nodal irradiation for inoperable pancreas cancer.Pract Radiat Oncol.2021;11(2):134\u2010147. doi:10.1016\/j.prro.2020.09.005","DOI":"10.1016\/j.prro.2020.09.005"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.adro.2021.100840"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.phro.2021.07.006"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2023.05.023"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clon.2017.09.007"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prro.2019.06.016"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13566\u2010020\u201000443\u2010x"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13014\u2010018\u20101138\u20103"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2020.11.017"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2021.0057"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2023.110064"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prro.2018.08.010"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.842402"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2017.07.028"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2021.11.024"}],"container-title":["Journal of Applied Clinical Medical Physics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acm2.70391","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T11:12:41Z","timestamp":1767179561000},"score":1,"resource":{"primary":{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/10.1002\/acm2.70391"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12]]},"references-count":22,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1002\/acm2.70391"],"URL":"https:\/\/doi.org\/10.1002\/acm2.70391","archive":["Portico"],"relation":{},"ISSN":["1526-9914","1526-9914"],"issn-type":[{"value":"1526-9914","type":"print"},{"value":"1526-9914","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12]]},"assertion":[{"value":"2025-06-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-06","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70391"}}