Authors
Jonathan E Leeman, Alexander D Droznin, Christopher D Dwyer, Kee-Young Shin, Douglas F Roth, Sejal Chirmade, Zhaohui Han, Sara Boyle, Danielle N Margalit, Roy B Tishler, Rosh K Sethi, Donald J Annino, Laura A Goguen, Eleni M Rettig, Robert I Haddad, Ravindra Uppaluri, Raymond H Mak, Thomas L Carroll, Kamal Singhrao, Jonathan D Schoenfeld
Published in
International journal of radiation oncology, biology, physics. Aug 26, 2026. Epub Aug 26, 2026.
Abstract
Five to 7 weeks of whole-larynx radiation (RT) is standard for treatment of early-stage glottic cancer. Previous studies evaluated CT-guided hypofractionated/SBRT treatment to a smaller volume. Magnetic resonance-guided radiotherapy (MRgRT) allows real-time motion tracking and gating by continuously imaging the larynx. We performed the first prospective study of MRgRT in patients with early-stage glottic cancer with quantification of laryngeal motion.
This phase 1 trial evaluated MRgRT in patients with stage I/II squamous cell glottic cancer undergoing definitive RT. The RT prescription was either 42.5 Gy/5 fractions (treatment volume < 10cc, not actively smoking) or 58.08 Gy/16 fractions (treatment volume > 10cc / smokers). Treatment was delivered using gated 0.35 T MRgRT with continuous tracking. Coprimary endpoints were feasibility and safety (grade 3+ toxicity rate). Patient-reported outcome measures (PROMs), voice quality, MRgRT treatment parameters, and local control were assessed. Intrafraction cine-MRI quantified laryngeal motion.
MRgRT was feasible in all patients. Median time on study was 10.9 months. Treatment was well tolerated with no acute or late grade 3+ toxicities. There was no change in PROMs over the course of the study. Two patients who received 42.5 Gy experienced locoregional failure, one in-field only and one in-field and nodal. MR tracking resulted in 20/94 (21%) of treatment fractions requiring ≥ 1 shift necessitating intra-fraction re-imaging. In 19/94 (20%) of treatment fractions, the beam was off more than 20% of the treatment time due to stochastic beam interruption events (BIEs). During BIEs, larynx displacement exceeded 3 mm in 53% of cine-MRI frames.
MRgRT targeting gross disease instead of the whole larynx is feasible and safe for patients with early-stage glottic cancer with minimal treatment-associated toxicity and no detriment in PROMs. MRI guidance provides real-time verification of larynx position. Data regarding real-time intrafraction motion has important implications for patients receiving standard laryngeal RT.
PMID:
42648578
Bibliographic data and abstract were imported from PubMed on 27 Aug 2026.
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