Clinically Delivered Treatment for Glioma Patients on a Hybrid Magnetic Resonance Imaging (MRI)-Linear Accelerator (MR-Linac) and a Cone Beam CT (CBCT)-Guided Linac: Dosimetric Comparisons with In Vivo Skin Dose Correlation

Abstract Background Magnetic Resonance Imaging (MRI)-Linear Accelerator (MR-Linac) radiotherapy requires special consideration for secondary electron interactions within the magnetic field, which can alter dose deposition at air-tissue interfaces. Methods Thirty-seven consecutive glioma patients treated during their radiotherapy course with at least one fraction delivered on MR-Linac or Cone Beam CT (CBCT)-guided Linac, were analyzed. Treatment planning for both systems were completed prior to radiotherapy initiation and approved for clinical delivery using commercial treatment planning systems (TPS): a Monte Carlo calculation-based or convolution calculation-based TPS for MR-Linac or CBCT-Linac, respectively. Dosimetric parameters for planning target volume (PTV), organs-at-risk (OARs), and air-tissue interface were compared. In vivo skin dose during a single fraction of MR-Linac and CBCT-Linac treatment was measured using an Optically Stimulated Luminescent Dosimeter (OSLD) and correlated with TPS skin dose. Results Monte Carlo-based MR-Linac plans and convolution-based CBCT-Linac plans exhibited minimal differences in PTV and OAR parameters. However, MR-Linac plans had greater doses within tissues surrounding air cavities (1.52 Gy higher mean Dmean, p < 0.0001) and skin (1.10 Gy higher mean Dmean, p < 0.0001). In vivo OSLD skin readings were 14.5% greater for MR-Linac treatments (p = 0.0027), and were more accurately predicted by Monte Carlo-based calculation (ρ = 0.95, p < 0.0001) vs. convolution-based (ρ = 0.80, p = 0.0096). Conclusions The magnetic field’s dosimetric impact was minimal for PTV and OARs in glioma as compared to standard CBCT-Linac treatment plans. However, skin doses were significantly greater with the MR-Linac and correlated with in vivo measurements. Future MR-Linac planning processes are being designed to account for skin dosimetry and treatment delivery.