{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T04:25:40Z","timestamp":1791951940544,"version":"4.3.4"},"reference-count":27,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T00:00:00Z","timestamp":1750118400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Purpose\/Objective: The clinical implementation of MR-guided radiotherapy on MR-linacs (MRL) hasrapidly increased in recent years. The advantages represented by the MR-based daily online plan adaptation and real-time monitoring have been exploited for different tumor sites. Nevertheless, some concerns remain, mainly related to the longer treatment time and limited patient eligibility. We report here the experience of our center, where a 1.5T MRL was clinically implemented in 2019 and, since then, more than 1200 patients have been treated. Material and Methods: The first 1000 patients treated at the MRL in our department were selected. Technical information such as treatment time and adaptive technic have been prospectively recorded, while toxicity data were retrospectively collected. Results: Between October 2019 and June 2024, 1000 patients for a total of 1061 treatment courses were included. Prostate and prostate bed were irradiated in 57.1% and 10.2% of the cases, respectively, including regional pelvic lymphnodes in 4.7%. Other frequent treated sites were lymph node metastases, pancreas and liver. The most frequent prescribed doses were 36.25 Gy (31%), 35 Gy (28.3%) and 30 Gy (9.4%) in five fractions. On a total of 9076 administered fractions, 80.8% were performed with adapt-to-shape and 19.2% with adapt-to-position method. The mean in-room time was 38 min (range, 18\u2013103), with 74.4% of patients completing the session within 40 min. Acute grade (G) 3 toxicity was recorded in 1.6% of the cases, while, on a total of 858 patients available for late toxicity, G3 was recorded in 0.3% of the cases, with no &gt;G3. Conclusions: Our real-world experience of an early-adopter center confirms that MRL treatments are feasible for different tumor entities in several anatomical sites. We showed that most of the patients could be treated within 40 min and showed low toxicity rates. Protocols for dose escalation and margin reduction, by adopting new comprehensive motion monitoring strategies, are under development.<\/jats:p>","DOI":"10.3390\/cancers17122012","type":"journal-article","created":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T03:37:07Z","timestamp":1750131427000},"page":"2012","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The Clinical Feasibility and Safety of 1.5 T MR-Guided Daily Adapted Radiotherapy in 1000 Patients: A Real-World Large Experience of an Early-Adopter Center"],"prefix":"10.3390","volume":"17","author":[{"given":"Chiara","family":"De-Colle","sequence":"first","affiliation":[{"name":"Department of Advanced Radiation Oncology, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar di Valpolicella, VR, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0645-0251","authenticated-orcid":false,"given":"Michele","family":"Rigo","sequence":"additional","affiliation":[{"name":"Department of Advanced Radiation Oncology, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar di Valpolicella, VR, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6109-4563","authenticated-orcid":false,"given":"Andrea Gaetano","family":"Allegra","sequence":"additional","affiliation":[{"name":"Department of Advanced Radiation Oncology, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar di Valpolicella, VR, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0731-8041","authenticated-orcid":false,"given":"Luca","family":"Nicosia","sequence":"additional","affiliation":[{"name":"Department of Advanced Radiation Oncology, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar di Valpolicella, VR, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4328-0319","authenticated-orcid":false,"given":"Niccol\u00f2","family":"Giaj-Levra","sequence":"additional","affiliation":[{"name":"Department of Advanced Radiation Oncology, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar di Valpolicella, VR, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edoardo","family":"Pastorello","sequence":"additional","affiliation":[{"name":"Department of Advanced Radiation Oncology, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar di Valpolicella, VR, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4307-3440","authenticated-orcid":false,"given":"Francesco","family":"Ricchetti","sequence":"additional","affiliation":[{"name":"Department of Advanced Radiation Oncology, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar di Valpolicella, VR, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina","family":"Orsatti","sequence":"additional","affiliation":[{"name":"Department of Advanced Radiation Oncology, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar di Valpolicella, VR, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Romei","sequence":"additional","affiliation":[{"name":"Department of Advanced Radiation Oncology, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar di Valpolicella, VR, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Bianchi","sequence":"additional","affiliation":[{"name":"Department of Advanced Radiation Oncology, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar di Valpolicella, VR, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5773-6913","authenticated-orcid":false,"given":"Riccardo Filippo","family":"Borgese","sequence":"additional","affiliation":[{"name":"Department of Advanced Radiation Oncology, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar di Valpolicella, VR, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2003-6097","authenticated-orcid":false,"given":"Antonio","family":"De Simone","sequence":"additional","affiliation":[{"name":"Department of Advanced Radiation Oncology, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar di Valpolicella, VR, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6138-3621","authenticated-orcid":false,"given":"Davide","family":"Gurrera","sequence":"additional","affiliation":[{"name":"Department of Advanced Radiation Oncology, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar di Valpolicella, VR, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania","family":"Naccarato","sequence":"additional","affiliation":[{"name":"Department of Advanced Radiation Oncology, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar di Valpolicella, VR, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluisa","family":"Sicignano","sequence":"additional","affiliation":[{"name":"Department of Advanced Radiation Oncology, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar di Valpolicella, VR, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2044-8035","authenticated-orcid":false,"given":"Ruggero","family":"Ruggieri","sequence":"additional","affiliation":[{"name":"Department of Advanced Radiation Oncology, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar di Valpolicella, VR, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6569-8628","authenticated-orcid":false,"given":"Filippo","family":"Alongi","sequence":"additional","affiliation":[{"name":"Department of Advanced Radiation Oncology, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar di Valpolicella, VR, Italy"},{"name":"University of Brescia, 25121 Brescia, BR, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,17]]},"reference":[{"key":"ref_1","first-page":"54","article-title":"Adaptive radiotherapy: The Elekta Unity MR-linac concept","volume":"18","author":"Winkel","year":"2019","journal-title":"Clin. Transl. Radiat. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1038\/s41571-022-00631-3","article-title":"Integrated MRI-guided radiotherapy\u2014Opportunities and challenges","volume":"19","author":"Keall","year":"2022","journal-title":"Nat. Rev. Clin. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Ng, J., Gregucci, F., Pennell, R.T., Nagar, H., Golden, E.B., Knisely, J.P.S., Sanfilippo, N.J., and Formenti, S.C. (2023). MRI-LINAC: A transformative technology in radiation oncology. Front. Oncol., 13.","DOI":"10.3389\/fonc.2023.1117874"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1186\/s13014-020-01510-w","article-title":"1.5 T MR-guided and daily adapted SBRT for prostate cancer: Feasibility, preliminary clinical tolerability, quality of life and patient-reported outcomes during treatment","volume":"15","author":"Alongi","year":"2020","journal-title":"Radiat. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1016\/j.ijrobp.2022.05.016","article-title":"Stereotactic Magnetic Resonance-Guided Adaptive Radiation Therapy (SMART) for Abdominopelvic Oligometastases","volume":"114","author":"Yang","year":"2022","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_6","first-page":"153","article-title":"Online MR guided dose escalated radiotherapy for organ preservation in distal rectal cancer","volume":"37","author":"Boeke","year":"2022","journal-title":"Clin. Transl. Radiat. Oncol."},{"key":"ref_7","first-page":"55","article-title":"Marker-less online MR-guided stereotactic body radiotherapy of liver metastases at a 1.5 T MR-Linac\u2014Feasibility, workflow data and patient acceptance","volume":"26","author":"Gani","year":"2021","journal-title":"Clin. Transl. Radiat. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e296","DOI":"10.1016\/j.prro.2022.03.002","article-title":"Clinical Implementation and Initial Experience with a 1.5 Tesla MR-Linac for MR-Guided Radiation Therapy for Gynecologic Cancer: An R-IDEAL Stage 1 and 2a First in Humans Feasibility Study of New Technology Implementation","volume":"12","author":"Lakomy","year":"2022","journal-title":"Pract. Radiat. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1606","DOI":"10.1016\/j.ijrobp.2020.12.015","article-title":"Initial Feasibility and Clinical Implementation of Daily MR-Guided Adaptive Head and Neck Cancer Radiation Therapy on a 1.5T MR-Linac System: Prospective R-IDEAL 2a\/2b Systematic Clinical Evaluation of Technical Innovation","volume":"109","author":"McDonald","year":"2021","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_10","first-page":"100693","article-title":"CT-based online adaptive radiotherapy improves target coverage and organ at risk (OAR) avoidance in stereotactic body radiation therapy (SBRT) for prostate cancer","volume":"44","author":"Waters","year":"2023","journal-title":"Clin. Transl. Radiat. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"100662","DOI":"10.1016\/j.phro.2024.100662","article-title":"Comparison of online adaptive and non-adaptive magnetic resonance image-guided radiation therapy in prostate cancer using dose accumulation","volume":"32","author":"Murr","year":"2024","journal-title":"Phys. Imaging Radiat. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.phro.2022.06.011","article-title":"Impact of magnetic resonance-guided versus conventional radiotherapy workflows on organ at risk doses in stereotactic body radiotherapy for lymph node oligometastases","volume":"23","author":"Kroon","year":"2022","journal-title":"Phys. Imaging Radiat. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.radonc.2021.12.013","article-title":"Online adaptive radiotherapy potentially reduces toxicity for high-risk prostate cancer treatment","volume":"167","author":"Christiansen","year":"2022","journal-title":"Radiother. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"S124","DOI":"10.1016\/j.ijrobp.2024.07.224","article-title":"Magnetic Resonance Imaging-Guided vs. Computed Tomography-Guided Stereotactic Body Radiotherapy for Prostate Cancer: 2-Year Outcomes from the MIRAGE Randomized Clinical Trial","volume":"120","author":"Kishan","year":"2024","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1001\/jamaoncol.2024.2488","article-title":"MRI-Linac-Based Radiotherapy-Promising or Hype?","volume":"10","author":"Roach","year":"2024","journal-title":"JAMA Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Nicosia, L., Trapani, G., Rigo, M., Giaj-Levra, N., Mazzola, R., Pastorello, E., Ricchetti, F., Cuccia, F., Figlia, V., and Fiorini, M. (2022). 1.5 T MR-Guided Daily Adapted SBRT on Lymph Node Oligometastases from Prostate Cancer. J. Clin. Med., 11.","DOI":"10.20944\/preprints202210.0205.v1"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Press, O.U. (2010). ICRU Report 83. Prescribing, Recording and Reporting Photon-beam Intensity-modulated Radiation Therapy (IMRT). J. ICRU, 10.","DOI":"10.1093\/jicru\/10.1.Report83"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.ejmp.2020.09.026","article-title":"Adaptive SBRT by 1.5 T MR-linac for prostate cancer: On the accuracy of dose delivery in view of the prolonged session time","volume":"80","author":"Ruggieri","year":"2020","journal-title":"Phys. Medica"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.ijrobp.2021.09.027","article-title":"A Story of Hypofractionation and the Table on the Wall","volume":"112","author":"Timmerman","year":"2022","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"109932","DOI":"10.1016\/j.radonc.2023.109932","article-title":"Gating and intrafraction drift correction on a 1.5 T MR-Linac: Clinical dosimetric benefits for upper abdominal tumors","volume":"189","author":"Grimbergen","year":"2023","journal-title":"Radiother. Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3044","DOI":"10.1002\/cncr.34836","article-title":"Acute toxicity comparison of magnetic resonance-guided adaptive versus fiducial or computed tomography-guided non-adaptive prostate stereotactic body radiotherapy: A systematic review and meta-analysis","volume":"129","author":"Leeman","year":"2023","journal-title":"Cancer"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"110043","DOI":"10.1016\/j.radonc.2023.110043","article-title":"Prostate volume variation during 1.5T MR-guided adaptive stereotactic body radiotherapy (SBRT) and correlation with treatment toxicity","volume":"190","author":"Nicosia","year":"2023","journal-title":"Radiother. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3269","DOI":"10.1007\/s00432-021-03739-8","article-title":"Mitigation on bowel loops daily variations by 1.5-T MR-guided daily-adaptive SBRT for abdomino-pelvic lymph-nodal oligometastases","volume":"147","author":"Cuccia","year":"2021","journal-title":"J. Cancer Res. Clin. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Alongi, F., Rigo, M., Figlia, V., Nicosia, L., Mazzola, R., Levra, N.G., Ricchetti, F., Trapani, G., Attin\u00e0, G., and Vitale, C. (2022). 1.5T MR-Guided Daily-Adaptive SBRT for Prostate Cancer: Preliminary Report of Toxicity and Quality of Life of the First 100 Patients. J. Pers. Med., 12.","DOI":"10.3390\/jpm12121982"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e2410819","DOI":"10.1001\/jamanetworkopen.2024.10819","article-title":"Safety and Tolerability of Online Adaptive High-Field Magnetic Resonance\u2013Guided Radiotherapy","volume":"7","author":"Westerhoff","year":"2024","journal-title":"JAMA Netw. Open"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e261","DOI":"10.1016\/j.prro.2022.09.007","article-title":"Magnetic Resonance-Guided Adaptive Radiation Therapy for Prostate Cancer: The First Results from the MOMENTUM study\u2014An International Registry for the Evidence-Based Introduction of Magnetic Resonance-Guided Adaptive Radiation Therapy","volume":"13","author":"Teunissen","year":"2022","journal-title":"Pract. Radiat. Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/S2666-1683(24)01184-4","article-title":"P056 First clinical application of comprehensive motion management with 1.5T MR-linac on prostate cancer patients treated with radiotherapy: Technical issues and suggested workflow","volume":"69","author":"Nicosia","year":"2024","journal-title":"Eur. Urol. Open Sci."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/12\/2012\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:53:14Z","timestamp":1760032394000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/12\/2012"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,17]]},"references-count":27,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["cancers17122012"],"URL":"https:\/\/doi.org\/10.3390\/cancers17122012","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,17]]}}}